An interview with Richard Thomas

Richard Thomas is managing director of Oraldent Ltd., specialists in the field of preventive dentistry, and manufacturer of Gengigel.  It was Richard who made the kind offer of samples of Gengigel on the message board last year.  In the course of our dialogue I asked him a few questions:

What would you put at the top of the list of causes of mouth ulcers?

We believe there are a number of causes for mouth ulcers and for many people the cause can
be multi-causal. However we believe the following to be the main causes:-

  1) 45% of people with mouth ulcers have them due to family history

  2) Stress, anxiety and severe emotional disturbance

  3) Mechanical – biting of tongue, lips and cheeks

  4) Chemical – SLS, Aspirin and some antiseptic mouthwashes are known to cause ulceration
        in certain people

  5) Radio/chemo-therapy

  6) Bacterial, viral and fungal infections

Sodium Lauryl Sulphate (SLS) is accused of being a major contributor in causing and exacerbating mouth ulcers. What is your opinion of this agent?

Some clinicians estimate that 20% of patients have recurrent aphthous ulcers (RAS) due to SLS in toothpaste. There is growing clinical support for this with 2 recent clinical studies from Scandinavia.

It has been observed that smokers are less likely to suffer so badly from mouth ulcers as non-smokers, to the extent that there have been clinical trials. Do you have any information or theories regarding this connection?

Cigarette smoking has been reported to protect against Recurrent Aphthous Ulcers (RAS) and the onset of RAS in some patients has been associated with the cessation of tobacco smoking. Whether this protective effect of smoking is related to increased keratinisation of the mucosa or to a systemic mechanism is unknown at present.

How significant do you consider the role of allergic reactions to be in causing and exacerbating mouth ulcers?

Some patients with RAS associate the onset of ulceration with certain foods and this together with the raised level of IgE in some patients has led to the claim that food allergies play a role in the development of RAS. However controlled studies in which patients were challenged with specific foods have proved inconclusive in this matter.

Topical steroids certainly help to get troublesome ulcers to start healing. Are there any contraindications to be aware of in the repeated use of such products in the mouth?

Steroids have anti-inflammatory and anti-allergic properties. Undoubtedly steroids do give relief to an estimated 60% of patients with RAS however they should be used sparingly and for a short period due to their potential side effects.

Steroids when applied to the oral mucosa are rapidly absorbed into the systemic circulatory system. Applied topically the benefits are palliative and not curative and following withdrawal the symptoms reappear. Steroids do not heal to the contrary they slow down the wound healing process.
Steroids do however have numerous side effects including muscle wasting due to protein depletion; raised blood sugar levels so care must be exercised in diabetic patients, produce water and sodium retention. Steroids also suppress the action of the pituitary gland and can cause gastric or duodenal ulcers.

Some preparations make use of chemical cauterising agents. Is it really a good idea to use these on the top surface of the tongue where all your taste buds are?

There is no rationale for using cauterising agents on an ulcer, unless the cause is removed it will appear elsewhere in the mucosa. Also dead tissue due to cauterising agents can certainly result in loss of taste.

The active ingredient in Gengigel is Hyaluronic acid, what exactly is this, and how does it help mouth ulcers?

Hyaluronic Acid or more precisely Hyaluronan (High molecular weight Hyaluronic acid) is now accepted as the vital substance produced by the body which initiates the production of new cells as part of the wear and tear process and is responsible for iniating the healing process after trauma. It has been used for at least 20 years in the medical field for the treatment of burns, in ophthalmology and osteoarthritis. There are over 1000 published clinical papers on the role of Hyaluronic acid in wound and tissue repair.

When tissue in the mouth is damaged through whatever cause i.e. ulcers, the normal process of tissue repair is impeded by bacteria as bacteria destroy the Hyaluronic acid as it is produced in the mouth. It is therefore necessary to provide Hyaluronic acid in the form of Gengigel at the site of the wound i.e. ulcer so that it is sufficient in concentration to start the healing process.

Hyaluronic acid (Gengigel) rapidly controls inflammation and most people with recurrent mouth ulcers report rapid reduction in pain levels and the disappearance of soreness. More importantly Gengigel will initiate the healing process and reduce the time taken for the ulcer to heal. The success of Gengigel in healing ulcers is related to how many times it can be applied to the ulcer.

What advice would you give to someone in order to reduce the frequency and severity of their mouth ulcers?

To help reduce the frequency of ulcers you should avoid toothpastes containing sodium Lauryl sulphate as well as trying to avoid foods known to cause hypersensitivity. Also with stress being a major causative factor it is important to try avoiding stressful situations and to reduce stress levels in general. Using Gengigel gel at least 2 to 3 times a day by rubbing gently onto the ulcers will help reduce pain and start the healing process.

Some preparations have been around for years, but, Gengigel is new on the scene, how did it come about?

Hyaluronic acid as I mentioned earlier has been recognised as the body’s healing agent and has been used in other medical disciplines for years. Gengigel is unique as we developed a method of manufacturer of Hyaluronic acid via natural fermentation of vegetable matter. This was a major breakthrough as most Hyaluronic acid used in medicine came from an animal source – chicken combs.
Secondly we also had to develop a gel that would stick to tongue and gum tissue without being washed away by the saliva. This we achieved as Gengigel adheres to the tissue irrespective of salivary output for 2-4 hours releasing the Hyaluronic acid.

From the long list of preparations available, why should we use Gengigel?

You should use Gengigel for the following reasons:-

1) It is effective and natural – there are many clinical studies which demonstrate the ability of Hyaluronic acid to heal tissue. It does not only reduce the pain but it actually heals the ulcer.

2) No known side effects

3) No contraindications- can be used by children, pregnant women, diabetics, vegetarians and people on different medicines including radio and chemo therapy patients.

4) It works and it is safe!!

As part of our current promotion for Gengigel and gum disease, we are sponsoring National Gum Disease Awareness Week (February 23-29th 2004) for which there will hopefully be a lot of coverage in the national press. We have included in this Ulcers as well and there is a new web site to go with the Awareness week, which is found at www.gumdiseaseinfo.co.uk.

Many thanks for your time and sharing some of your knowledge Richard. I hope the National Gum Disease Awareness Week goes well.   Dom Walton, 11 Feb 2004.

You can now purchase Gengigel in the Mouth Ulcers Shop.