Discussion
pain, OLP
ADHESION, ADVERSE DRUG EFFECTS, OXIDATIVE STRESS
The chronic nature of OLP, prolonged course of treatment, and frequent exacerbation of the condition increase the incidence of steroid side effects [In addition to the antioxidant and anti-inflammatory effects of CoQ10, its topical use in the form of mucoadhesive tablets in the present study has many advantages including intimate contact with the target mucous membrane, sustained drug release, increased drug absorption, and bioavailability, avoidance of enzymatic degradation in the GIT, and decreased adverse drug effects [The mucoadhesiveness of these tablets is gained from the use of mucoadhesive carbapol polymer that rapidly swells when touching the target area, thus providing sustained and controlled release of the drug from 6–8 h, and a strong mucosal adhesion effect [Up to our knowledge, the current study is the first randomized control clinical trial evaluating the effectiveness of topical use of CoQ10 in the management of symptomatic OLP. Consequently, no similar previous studies are available for comparison with our results. Shoukheba and Elgendy’s [The results of the current study showed that the topical use of CoQ10 mucoadhesive tablets significantly reduced both pain sensation and clinical signs with maximum clinical improvement at the fourth week and no significant differences when compared with the results of topical corticosteroid. The effective role of the topical use of CoQ10 was also seen in the study conducted by Shoukheba and Elgendy [In addition to the clinical assessment, the salivary levels of MDA in both groups decreased after treatment with no significant difference. Therefore, we could assume that the clinical improvement in both groups might be due to the anti-inflammatory effect of both corticosteroids [However, it is expected that corticosteroids would have a more potent anti-inflammatory effect than CoQ10. Thus, it seems that while the decrease in oxidative stress in the case of triamcinolone could be totally a result, in the case of CoQ10, it is partly a result and partly due to the powerful antioxidant role of CoQ10 which was previously detected by Ushikoshi-Nakayama et al. [Topical CoQ10 has been previously investigated in other oral conditions, such as periodontal and gingival conditions, and showed a great clinical reduction in the inflammatory condition after a few weeks [Comparing our study with other studies using antioxidant agents in the management of OLP, such as selenium -ACE [