Zinc gluconate exhibits clear adjuvant efficacy in treating oral ulcers, with its mechanism of action, applicable scenarios, and clinical application features detailed as follows:
I. Mechanism of Action: The Link Between Zinc Supplementation and Mucosal Repair
1. Promotion of Epithelial Cell Proliferation
Zinc acts as a coenzyme for multiple enzymes (e.g., DNA polymerase, RNA polymerase), directly participating in the division and repair of oral mucosal epithelial cells to accelerate ulcer healing. Studies show zinc deficiency slows oral mucosal renewal, prolonging ulcer duration, while zinc gluconate supplementation enhances cell proliferation rate and shortens the healing cycle.
2. Immune Regulation and Anti-Inflammation
Zinc enhances T lymphocyte activity, inhibits the release of local inflammatory factors (e.g., TNF-α, IL-6) in oral ulcers, and reduces mucosal edema and pain. Additionally, it maintains neutrophil chemotaxis and phagocytic function, lowering the risk of secondary infection (e.g., in ulcers complicated by bacterial infection).
3. Antioxidant Protection
As the active center of superoxide dismutase (SOD), zinc scavenges oxygen free radicals at ulcer sites, reduces mucosal lipid peroxidation damage, and protects cell membrane integrity, creating a favorable environment for repair.
II. Evidence-Based Basis for Clinical Efficacy
1. Shortening Ulcer Healing Time
Multiple clinical studies show that adding zinc gluconate (10–15 mg zinc daily, divided into 2 doses) to conventional therapy for recurrent aphthous ulcers (RAU) and traumatic ulcers shortens the healing time from an average of 7–10 days to 4–6 days, particularly in zinc-deficient populations. For example, a trial involving 120 children with zinc-deficient oral ulcers showed the zinc supplementation group healed ~30% faster than the control group.
2. Reducing Recurrence Frequency
Chronic zinc deficiency is a risk factor for RAU recurrence. Sustained zinc gluconate supplementation (2–3 months) reduces the annual recurrence frequency in RAU patients from 4–6 to 1–2 times, likely by stabilizing mucosal immune function and improving the local microenvironment.
3. Alleviating Pain and Inflammation
Zinc gluconate reduces local pain in ulcers by inhibiting prostaglandin synthesis. Some studies observe a >50% decrease in visual analog scale (VAS) pain scores within 2–3 days of zinc supplementation, accompanied by reduced redness and swelling.
III. Target Populations and Formulation Selection
1. Primary Candidates
Zinc-deficient oral ulcer patients: Those with serum zinc <70 μg/dL or combined zinc deficiency symptoms (e.g., anorexia, sparse hair) show superior responses.
Recurrent oral ulcers (especially zinc-deficient type): Patients with frequent relapses and poor response to conventional therapy (e.g., mouthwashes, patches) can benefit from combined zinc supplementation.
Traumatic ulcers with malnutrition: For example, children with ulcers from biting or orthodontic friction, accompanied by dietary imbalance (picky eating, vegetarianism), zinc supplementation accelerates healing.
2. Formulations and Administration
Oral preparations: Commonly used zinc gluconate oral solution (10 mg zinc per vial). Adults take 15–20 mg zinc daily, children 0.5–1 mg/kg·d, divided after meals to reduce gastric irritation.
Local combination therapy: Can be paired with zinc lozenges (e.g., watermelon 霜 lozenges containing zinc) or gels (zinc ion-containing oral ulcer pastes). Oral and local administration synergistically increase zinc concentration at ulcer sites for enhanced repair.
IV. Influencing Factors and Precautions
1. Key Roles of Dosage and Course
Dosage threshold: Inadequate dosage (<10 mg zinc daily) may diminish efficacy, while exceeding recommendations (>40 mg/d in adults) can cause nausea or vomiting. Strictly follow medical advice.
Treatment duration: 1–2 weeks for acute ulcers; 2–3 months for recurrence prevention, with regular serum zinc monitoring to avoid overdose.
2. Synergy and Contraindications in Combination Therapy
Synergistic effects: Combining with B vitamins (especially B2, B12) enhances mucosal repair; consider co-supplementation (e.g., compound vitamin B tablets).
Drug interactions: Avoid concurrent use with tetracyclines or quinolones ( ≥2 hours) to prevent complex formation and reduced efficacy; separate from aluminum-containing antacids (e.g., aluminum hydroxide) by ≥1 hour to avoid inhibited zinc absorption.
3. Dietary and Lifestyle Adjuvants
Increase zinc-rich foods (e.g., lean meat, oysters, nuts) during supplementation; avoid spicy/hot foods that irritate ulcers. Maintain regular 作息 and reduce stress (anxiety can trigger RAU) to optimize outcomes.
V. Limitations and Clinical Recommendations
1. Non-Specific Symptomatic Treatment
Zinc gluconate’s efficacy depends on underlying zinc deficiency. In patients with normal zinc levels, supplementation may be limited, requiring combined treatment for other causes (e.g., immunomodulation, anti-Helicobacter pylori therapy).
2. Significant Individual Variation
Efficacy correlates with baseline zinc levels and ulcer type. For example, zinc supplementation achieves 70%–80% efficacy in zinc-deficient RAU patients but only 30%–40% in those with normal zinc levels. Serum zinc testing is recommended before treatment to confirm indications.
3. Safety Considerations
Short-term, standardized zinc gluconate use is safe, but long-term high-dose supplementation (>3 months, >20 mg zinc daily) may interfere with copper absorption, causing anemia or leukopenia. Regular blood routine and trace element monitoring are advised.
Zinc gluconate plays an adjuvant role in oral ulcer treatment by correcting zinc deficiency, particularly for zinc-related ulcer types, accelerating healing and reducing recurrence. Clinically, it should be applied with etiological diagnosis, individualized dosage, and combined interventions (e.g., diet, vitamin supplementation) to optimize efficacy and mitigate risks. For severe, non-healing ulcers, comprehensive etiological screening (e.g., immune markers, trace element testing) is recommended alongside zinc supplementation to formulate integrated treatment plans.
