Treatment Of Recurrent Aphthous Stomatitis Research Articles

Treatment of recurrent aphthous stomatitis with oral roflumilast, a multicenter observational study

AbstractIntroductionSevere recurrent aphthous stomatitis (RAS) represents a therapeutic challenge because of its impact on the patient's quality of life. Additionally, no approved systemic therapies are available. Roflumilast, a phosphodiesterase‐4 inhibitor, has shown promise in other inflammatory dermatological conditions. This study aimed to assess the characteristics, effectiveness, and safety of roflumilast in treating RAS in routine clinical practice.MethodsThis is a single cohort ambispective observational study conducted in five Spanish centers. Twenty‐two patients with RAS treated with roflumilast participated. Data collection included demographic, clinical, and outcome variables. Statistical analysis compared the outcomes of 12 weeks of roflumilast treatment with a similar prior period without treatment.ResultsDuring treatment with roflumilast, a significant reduction in flare‐ups (88%) and oral ulcers (94%) was observed compared to the untreated period. A reduction in pain (66%) and ulcer duration (63%) was observed. Adverse effects (AEs) occurred in 13 patients, predominantly headache and gastrointestinal disturbances. Most of these were self‐limiting or manageable with dose adjustment. Treatment was withdrawn in three cases, mainly because of AEs.ConclusionsThis study suggests that roflumilast may effectively treat RAS by reducing the number of flare‐ups and ulcers, their duration, and the symptomatology produced by the ulcers. In addition, roflumilast has a good safety profile, is well tolerated at low doses, and does not require close monitoring. These characteristics and its favorable economic profile make roflumilast a promising therapeutic option in this pathology.

Natural and Synthetic Drugs Approached for the Treatment of Recurrent Aphthous Stomatitis Over the Last Decade.

Recurrent aphthous stomatitis (RAS) refers to a sore and frequently recurring inflammation of the oral tissues, distinguished by the presence of small ulcers that cause significant discomfort and cannot be attributed to any underlying disease. Different treatments have been used for RAS. This review aims to provide a comprehensive overview of the treatment options over the past decade for recurrent aphthous stomatitis (RAS), encompassing both natural and synthetic treatments. It will utilize clinical efficacy studies conducted in vivo and in vitro, along with a focus on the pharmaceutical approach through advancements in drug delivery development. We conducted a thorough literature search from 2013 to 2023 in prominent databases such as PubMed, Scopus, and Cochrane, utilizing appropriate keywords of recurrent aphthous stomatitis, and treatment. A total of 53 clinical trials with 3022 patients were included, with 35 using natural materials in their research and a total of 16 articles discussing RAS treatment using synthetic materials. All the clinical trials showed that natural and synthetic medicines seemed to benefit RAS patients by reducing pain score, ulcer size, and number of ulcers and shortening the healing duration.

Treatment of Recurrent Aphthous Stomatitis with 940nm Diode Laser

Background & objectives: Ulcers in the mouth (recurrent aphthous stomatitis) are very common and may vary in size from very small to very large. The exact cause of mouth ulcers isn’t known but acidic foods and stress are thought to be factors, as well as local traumatic damage such as that caused vigorous toothbrushing. Although uncomfortable, small ulcers are tolerable, but large ulcers can last for up to 2 weeks and greatly affect the ability to eat, drink and even talk. This study aimed to evaluate the efficacy of treatment of recurrent aphthous stomatitis by application of 940 nm diode laser irradiation & its effect on the duration and pain sensation. Materials and methods: A total number of 32 patients having at least 2 ulcers for each. Those patients were enrolled in this study using a split mouth design. The study included two groups, The experimental (study group) consisted of thirty two ulcers ( in the 32 patients ) were subjected to 940 nm laser irradiation & control group comprised of thirty two ulcers ( in the same 32 patients ) left without laser irradiation. Pain scores were recorded before and after laser treatment. The patient subjected to follow-up visits until complete healing of the ulcers occurred. Results: There were immediate changes in the pain scores of the experimental group just after diode laser application. The duration of the control group lesions ranged between (7-14) days, while the lesion in the experimental group subsided with a range between (4-12) days. Conclusion: 1.Single session of diode laser irradiation can be used to produceimmediate, dramatic and sustained analgesic effect on RAS lesion.2.The lesion duration was significantly reduced to about 40%from that of control lesion.

The effectiveness of fire needle therapy in the treatment of recurrent aphthous stomatitis: A systematic review and meta-analysis.

Recurrent aphthous stomatitis (RAS) is common in clinical practice and imposes both physical and psychological distress on patients. This study aimed to evaluate the clinical effectiveness of fire needle therapy for the treatment of RAS, providing a basis for clinical decision-making. Eight databases, in both Chinese and English, were searched from their inception until December 2022. All randomized controlled trials (RCTs) that utilized fire needle therapy, either alone or combined with other treatments for RAS, were considered. Data evaluation and extraction were conducted independently by 2 authors. The revised Cochrane Risk of Bias Version 2 tool was employed to assess the risk of bias in the included RCTs. A meta-analysis was conducted using Review Manager 5.4 and Stata 15.0. Nine RCTs involving 1469 patients were selected for inclusion. The meta-analysis revealed that, compared to a non-fire-needle control group (primarily utilizing vitamin and transfer factor treatments), fire needle therapy for RAS significantly improved the total effective rate (relative risk = 1.25, 95% confidence interval [CI] [1.14, 1.36], P < .00001), reduced the visual analogue scale score (mean difference = -1.68, 95% CI [-1.82, -1.53], P < .0001), diminished the Traditional Chinese Medicine symptom score (standardized mean difference = -1.20, 95% CI [-1.76, -0.65], P < .0001), and shortened the healing time (mean difference = -1.66, 95% CI [-2.73, -0.59], P = .002). Notably, there was no significant difference in the recurrence rate between the groups (relative risk = -0.18, 95% CI [-0.36, 0.01], P = .06). Further subgroup analysis on total efficacy rate was performed based on variables such as experimental group intervention, control group intervention, and duration of therapy to explore potential sources of heterogeneity. Fire needle therapy appears to be a clinically effective treatment for RAS, offering benefits such as pain alleviation, symptom improvement based on the Traditional Chinese Medicine parameters, and faster recovery. Nonetheless, the overall quality of the RCTs available raises concerns. Future research, involving high-quality RCTs, is essential to confirm the clinical efficacy and safety of this treatment. Registration number: PROSPERO (CRD42023387973).

Effects of honey-lemon spray on recurrent aphthous stomatitis comparing to Triamcinolone ointment

Recurrent aphthous stomatitis (RAS) is recurrent and painful diseases of the oral mucosa that can be very painful and annoying despite their small size. There is no definitive cure for this disease and the usual treatments are mainly based on pain control. The aim of this study was to investigate the effect of honey-lemon spray (mucotin) in the treatment of recurrent aphthous stomatitis. Methods: This study is a randomized controlled clinical trial conducted in 2020 at Zahedan University of Medical Sciences on 46 RAS patients. The participants were randomly assigned to the intervention (mucotin) or control groups (Triamcinolone ointment) equally (23 patients in each group). Patients were evaluated for the severity of pain and ulcer size. Evaluations were performed on days 0, 2, 7 of the treatment using VAS. Data were analyzed using ANOVA statistical test. Results: The inner aspect of the lower lip was the most common site of RAS in the participants (48.8%) and the lowest site went for hard palate (2.4%). Four items including pain, burning sensation, necrosis area, and erythematous area were evaluated in both groups. There was no significant difference in all parameters before the treatment period (day 0). The mean pain score, burning sensation, necrosis, erythematous areas were not different in days 0, 2 and 7 between groups respectively (p=0.849, p=0.105, p=0.917, p=0.442). Conclusion: Honey-lemon spray (Mucotin) and topical corticosteroid have similar effects in RAS treating, So Mucotin can be used as the first line of treatment for RAS lesions. This herbal medicine has no side effects.

Effectiveness of Zhibai Dihuang pill (Chinese herbal formula) in combination with western drugs in the treatment of recurrent aphthous stomatitis: A systematic review and meta-analysis.

The pain caused by recurrent aphthous stomatitis (RAS) and the recurrent nature of RAS lead to diminished quality of life for RAS patients. An alternative treatment for RAS is the oral administration of the Chinese herbal medicine Zhibai Dihuang pill (ZBDHP). Our study aims to investigate the clinical efficacy of ZBDHP when used in combination with Western medicine (WM) for the treatment of RAS and its effectiveness in preventing the recurrence of RAS. Following the PRISMA 2020 guidelines, we conducted a literature search on 7 electronic databases according to predefined criteria. The methodological quality of randomized controlled trials (RCTs) was evaluated based on the Cochrane Handbook, and data analysis was performed using RevMan 5.3 software. A meta-analysis which included 7 studies and 669 participants in total was carried out in this study. The quantitative analysis revealed that the combined treatment of ZBDHP and WM has witnessed significantly improved overall clinical efficacy (RR = 1.20, 95% CI [1.12, 1.28], P < .05), reduced recurrence rate (RR = 0.24, 95% CI [0.13, 0.45], P < .05), decreased ulcer area (MD = -0.75, 95% CI [-0.91, -0.59], P < .05), and reduced pain visual simulation score (MD = -0.42, 95% CI [-0.52, -0.33], P < .05). No significant heterogeneity was observed among the studies. Qualitative analysis showed that the combination therapy significantly reduced serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 and interleukin-10, shortened ulcer healing time and pain disappearance time, with no adverse effects observed. It was found that the combination of ZBDHP and WM is more effective in treating RAS than the use of WM alone, which thus provides clinicians with a more optimal treatment option. However, due to limitations in the methodological quality of the included original studies and the small sample size, we hold the opinion that more rigorous and scientific clinical trials are needed to further evaluate the efficacy of ZBDHP in treating RAS.

Topical betamethasone and systemic colchicine for treatment of recurrent aphthous stomatitis: a randomised clinical trial

BackgroundRecurrent Aphthous Stomatitis (RAS) is painful oral ulceration frequently treated with topical steroids. There is limited published evidence for the efficacy of any treatment for RAS and there remains a need for longitudinal randomised clinical trials to evaluate and compare the effectiveness of different therapies in the management of RAS. The aim of the current project was to assess the efficacy of betamethasone mouthwash and colchicine tablets, individually and combined, for the treatment of RAS, and to establish the optimum treatment period necessary for a significant reduction in the disease severity.MethodologyA randomised, prospective, parallel-group clinical trial was conducted over one year, to compare the efficacy of three therapies in RAS. One hundred and six patients were randomized into three groups; 35 received betamethasone mouthwash, 35 had colchicine tablets and 36 received both therapies. The response was evaluated quantitatively every 3 months for 1 year, using the Ulcer Severity Score (USS).ResultsFor all three treatment regimes, the mean USS decreased by about 30% in the first 3 months (p < 0.001). Further improvement was noted for up to 9 months. At the end of the study, the mean USS had improved by 50% from 34.9 ± 7.2 before treatment to 17.5 ± 8.9 after treatment (p < 0.001). Of included participants, 86% showed significant clinical improvement by the end of the study. There were no significant differences in outcomes between the three regimes (p < 0.05).ConclusionsThis clinical trial has provided evidence for the efficacy of betamethasone mouthwash and for colchicine tablets in the treatment of RAS and has shown that at least six months of treatment may be required for optimum effect.Clinical trial registration number:ISRCTN3267716. Date of clinical trial registration: 15/04/2018

Topical medications for the treatment of recurrent aphthous stomatitis: A network meta-analysis.

The present network meta-analysis aims to answer the question "what is the best topical intervention for the treatment of recurrent aphthous stomatitis that can provide an acceptable pain relief and promote wound healing?" From inception to October 2022, PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched to identify all potentially eligible randomized controlled trials. The primary outcomes were pain scores and/or healing time, while the secondary outcomes were the associated side effects. The Bayesian network meta-analysis accompanied by a random effect model and 95% credible intervals were calculated. Forty-three randomized controlled trials with a total of 3067 participants, comparing 20 different topical medications, were included. Concerning pain reduction, the network meta-analysis failed to show any statistically significant differences when different topical treatments were compared together or even with a placebo at different time intervals. Except for doxycycline, which showed a statistically significant difference in terms of accelerating healing time, other topical interventions showed no statistically significant differences when compared with placebo or with each other. Within the limitations of the current network meta-analysis, it seems that: A low to moderate quality of evidence showed no superiority of any topical treatment over others concerning pain reduction, although rank probability tests revealed sucralfate, doxycycline, hyaluronic acid, and chamomile as the most efficacious treatment options at different evaluation times. Hence, further well-designed clinical trials with larger sample sizes are warranted. Topical doxycycline was shown to be the most efficacious intervention in promoting healing of recurrent aphthous stomatitis.

Efficacy of Oral Mucoadhesive N-Acetylcysteine Tablets in Treatment of Recurrent Aphthous Stomatitis: A Randomized Double-Blind, Placebo-Controlled Clinical Trial.

Objectives: This study aimed to assess the efficacy of oral mucoadhesive N-acetylcysteine (NAC) tablets for treatment of recurrent aphthous stomatitis (RAS). Materials and Methods: Forty-nine patients with RAS were randomized to receive mucoadhesive NAC tablets (n=25) or placebo (n=24). Tablets were prescribed three times a day for 7 days in each group. Pain intensity was evaluated with visual analog scale (VAS) three times a day from day 1 to day 7. Also, patients were clinically examined on days 0 (before entering the study), 3, 5, and 7 using a metal caliper to measure the diameter of the lesions. The data were statistically analyzed and P<0.05 was considered statistically significant. Results: Regarding the VAS score, all participants in the treatment group showed complete recovery on day 7 (P<0.01). Also, the diameter of the lesions was significantly smaller in the treatment group than the placebo group at the end of the study (P<0.001). Conclusion: The results of this clinical trial showed for the first time that mucoadhesive NAC tablets can significantly decrease pain and the diameter of RAS lesions without any systemic complications.

A Comparative Study of Dexamethasone Ointment along with Triamcinolone Acetonide in Treatment of Recurrent Aphthous Stomatitis.

To assess and compare the efficacy of dexamethasone ointment with triamcinolone acetonide, the gel form, in the treatment of minor recurrent aphthous stomatitis (RAS). This was a randomized clinical trial of 60 patients of either sex with clinically diagnosed RAS who were randomly divided into two groups-the dexamethasone ointment group (Group I) and the triamcinolone acetonide gel group (Group II). Patients were asked to apply the gel three times a day on each ulcer. Estimation of the efficacy of gel was done based on the time required for regression in pain, size, and number of ulcers. The results showed there was a significant difference in size, pain, number, and duration of ulcers in Group I and Group II within 7 days. However, in both groups, no significant difference was noted in the treatment of RAS. Dexamethasone ointment was found to be efficient in this treatment and was safe as evaluated using clinical assessments.

The effect of sage (Salvizan gel) compared to triamcinolone acetonide on the treatment of recurrent aphthous stomatitis: a double-blinded randomized clinical trial

BackgroundRecurrent Aphthous Stomatitis (RAS) is one of the most common lesions of the oral mucosa. Herbal medicine can be used for the treatment of this disease. The present study aimed to compare the effects of topical application of Sage (Salvizan) and triamcinolone acetonide gels on RAS.MethodsThis double-blind clinical study recruited sixty patients with minor aphthous ulcers. Half of the patients were treated with Salvizan gel, and the other half were treated with oral triamcinolone acetonide gel. The effect of Salvizan topical gel was evaluated and compared with that of oral triamcinolone acetonide gel. Factors such as Pain recovery time, wound healing time, and pain level was evaluated. Data were analyzed by SPSS version 22 using independent t-test, paired t-test, repeated measures ANOVA, and survival analysis, including Kaplan-Meier and Cox regression.ResultsThe mean duration of pain recovery was 1.5 days for Salvizan and 2.5 days for triamcinolone acetonide (p < 0.001). Moreover, the duration of wound healing was 3.3 days for Salvizan and 6 days for triamcinolone acetonide (p < 0.001). Patients’ satisfaction from factors such as taste and smell had no significant difference between the two groups.ConclusionThe results of this study showed that Salvizan gel is very effective in the treatment of RAS. It was significantly better than triamcinolone acetonide in the pain recovery and wound healing. These promising results favor herbal treatments and show that they can be used more commonly for treating diseases such as RAS.Trial registrationThis study was approved by the ethics committee of Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1399.834) on 17/03/2021. It was also registered in the Iranian Registry of Clinical Trials (IRCT20100202003251N7).

The Clinical Efficiency of Thuja Extract Compared with Kenalog in Orabase in Treatment of Recurrent Aphthous Stomatitis

The Clinical Efficiency of Thuja Extract Compared with Kenalog in Orabase in Treatment of Recurrent Aphthous Stomatitis

Effectiveness of low-level Diode laser therapy in recurrent aphthous stomatitis treatment at Can Tho University of Medicine And Pharmacy Hospital in 2020-2022

Background: Recurrent aphthous stomatitis (RAS) are the most common oral ulceration in lesions of the oral mucosa. Treatment aims to reduce pain and healing time. Low-level Diode laser therapy can relieve pain, anti-inflammatory, reduce edema, stimulate cell biology, and stimulate healing. Low-level Diode laser therapy is an alternative therapy to conventional drug use, promising to help improve the quality of life, improve the patient's quality of life and avoid complications caused by long-term drug use. Objectives: To evaluate the therapeutic effect of a low-level Diode laser on RAS treatment to reduce pain, size of ulcers, and healing time. Materials and methods: A clinical study was conducted on 30 patients who presented RAS lesions were treated with low-level laser therapy. The patients were evaluated for the size, position, pain score, form of ulcers, healing time before and immediately, fourth and sixth day after treatment. The data was analyzed using SPSS 20. Results: The VAS score pre-treatment was 4.33±1.65, immediately post-treatment was 1.20±1.06. The size of ulcers pre-treatment was 4.58±2.35mm, and post-treatment fourth day was 2.47±2.30mm. The healing time was 5.04±0.32 days. Conclusion: Low-level Diode laser therapy is effective in RAS treatment to reduce pain, size of ulcers, and healing time.

The Effect of Duration of Laser Radiation with the Same Dose in the Treatment of Recurrent Aphthous Stomatitis

Introduction: Recurring aphthous ulcers is a common and painful ulcer in the oral area. The aim of this study was to evaluate the impact of length of radiation in the same dose for the treatment of recurrent aphthous stomatitis. To date no similar study is available.&#x0D; Materials &amp; Methods: In this double-blinded clinical trial, 30 patients with minor aphthous ulcer that were referred to Oral medicine department of Islamic Azad university were selected according to convenience sampling and inclusion exclusion criteria and were randomly divided into two similar groups. Low level laser therapy with diode 660nm was used in group A with 200 mW and 20 seconds setting and in group B with 20 mW and 200 seconds setting in two sessions on the first and third days were used. The time of clinical healing and the pain intensity as VAS were recorded. Data were analyzed by Independent t-test and Mann-Whitney test (p value &lt; 0.05).&#x0D; Results: The pain intensity from first day after the laser until the seventh day in group B was significantly less than group A (p value &lt; 0.001). The mean size of lesion was significantly lower in the third day (p value = 0.03), fifth (p value &lt; 0.001) and seventh (p value = 0.001). The mean clinical healing time in group B was significantly lower than group A (p value &lt; 0.001).&#x0D; Conclusion: According to this study's findings, longer time of irradiation in lower output power of 660 nm diode laser was suggested for treatment of recurrent aphthous ulcer.

The Efficacy and Safety of Pentoxifylline in the Treatment of Recurrent Aphthous Stomatitis: A Systematic Review

Several evidence have shown the beneficial effects of pentoxifylline in the improvement of oral aphthous ulcers. However, the data in this regard are sparse. So, the efficacy and safety of pentoxifylline in oral route was systematically reviewed to elucidate its effects on the size and number of ulcers, as well as the healing time and recurrence frequency in Recurrent Aphthous Stomatitis (RAS) patients. PubMed (Medline), Web of Science, Scopus, ScienceDirect, Cochrane Library, ProQuest, and Clinicaltrial.gov were searched for related articles. The investigated outcomes were pain level, the size and number of ulcers, the frequency of recurrence, the healing time, and finally the pentoxifylline related side effects. Only 6 related study that investigate the efficiency of Pentoxifylline on RAS (n =107) were identified. Decreasing in the pain level, improving the ulcer size and number were established in approximately all studies. Pentoxifylline established its ability to shorten the healing time of this type of mouth ulcers. However, its potential to prevent the recurrence of the disease could not establish based the data presented here. In conclusion, this systematic review suggests pentoxifylline in RAS patients because it confirmed that RAS patients who received this agent as oral administration reported suitable response. However, conducting more clinical trials with larger sample size and long follow-up time especially to efficiently judge about its ability to the recurrence prevention still is necessary to develop clinical practice guidelines for management of RAS.

Recurrent Aphthous Stomatitis – An Overview

Abstract Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence and knowledge of many etiological factors, the exact mechanism of disease is still not fully understood. There are three different clinical forms of recurrent aphthous stomatitis and the therapy differs depending on it. The aim of this article is to provide an overview of current knowledge about the possible causes and treatment of recurrent aphthous stomatitis. We discuss its pathogenesis which is currently the least explained in the literature. This review offers scientists and clinicians useful information about clinical presentation, diagnosis, predisposing aetiological factors and recent trends in the management of recurrent aphthous stomatitis.

PERBANDINGAN EFEKTIFITAS EKSTRAK DAUN KAMBOJA (Plumeria acuminata Ait) DENGAN EKSTRAK DAUN JARAK JAUH (Jatropha curcas L) TERHADAP PENYEMBUHAN MINOR RECURRENT APHTOSA STOMATITIS (RAS)

Introduction:Recurrent aphthous stomatitis (RAS), also known as canker sores, is an inflammation that occurs in the oral mucosa. Frangipani leaf extract and jatropha leaf extract are known to contain saponins, tannins and flavonoids that function as wound healers and antimicrobials. Purpose:Determine whether the administration of frangipani leaf extract (Plumeria acuminata Ait) is more effective in curing recurrent aphthous stomatitis than jatropha leaf extract (Jatropha curcas L). Materials and Methods: The method used is experimental study with a purposive sampling of 30 people. frangipani leaf extract (Plumeria acuminata Ait) and jatropha leaf extract (Jatropha curcas L) were applied to each of 15 samples. Statistical calculations using the Independent T-test. Result and Discussion: The results showed that the mean difference in diameter reduction of recurrent aphthous stomatitis in the first sample group of frangipani leaf extract (Plumeria Acuminata Ait) was 1.13 mm, while in the second sample group Jatropha leaf extract (Jatropha curcas L) was 0.47 mm. From the results of the Independent T-Test test on frangipani leaf extract (Plumeria acuminata Ait) obtained a sig value of 0.002 (p&lt;0.05) and jatropha leaf extract (Jatropha curcas L) of 0.002 (p&lt;0.05), indicating that there is the difference between the use of frangipani leaf extract (Plumeria acuminata Ait) and jatropha leaf extract (Jatropha curcas L) in the treatment of recurrent aphthous stomatitis. Conclusion: frangipani leaf extract (Plumeria acuminata Ait) was more effective in curing recurrent aphthous stomatitis (SAR) than jatropha leaf extract (Jatropha curcas L)

Appraising the Clinical Efficacy of Herbal Topical Medications in the Treatment of Recurrent Aphthous Stomatitis - A Review

: Oral ulcers are common complaints to the dental clinic. Among these, Recurrent Aphthous Stomatitis/Ulcer (RAS) is frequently reported lesions of which recurrent minor aphthous ulcers are most prevalent. Though these mucosal lesions are self-limiting, painful ulcerative and inflamed mucosa could affect the patient’s daily routine such as food intake, speaking and swallowing. Since precise etiology is unknown, various treatment options are tailor made to each individual patient’s condition. Topical steroids are the widely prescribed medication as local therapy. In spite of a dearth in evidence based data on the effectiveness of plant based topical therapies for oral aphthous ulcers, these are used as primary medications which aids in natural cure of such lesions. These alternative medications are also useful to patients who refuse to take allopathic medicines, having history of drug allergies, history of multiple drug therapy, when allopathic medication is not recommended and in refractory cases. Hence the aim of this paper is to review the clinical efficacy of potential herbal medications for the topical management of recurrent aphthous ulcers. An electronic data search was performed using different search engines and the relevant articles were reviewed. All the placebo controlled studies have shown clinically significant results in the treated group in various outcome measures without noticeable side effects. Generally, topical herbal treatment were effective on RAS as palliative therapy, however more scientific evidence is needed for clinical recommendation in repeated cases.Key words: Aphthous stomatitis /ulcer, Alternative medications, Topical herbs, Topical treatment, Recurrent oral ulcer,Herbal medications.

CLINICAL EFFICACY AND SAFETY OF HERBAL MEDICINE THERAPY IN RECURRENT APHTHOUS STOMATITIS: A SYSTEMATIC REVIEW

Recurrent aphthous stomatitis is the most common oral mucous ulcerative lesion with challenging treatment. Herbal medicine therapy can propose clinical efficacy and safety due to its large biological activities. The objective was to review the clinical efficacy and safety of herbal medicine therapy in terms of ulcer size, pain score, healing duration, and adverse effects in recurrent aphthous stomatitis. A systematic was conducted based on the PRISMA statement. The search was performed using four electronic databases, namely PubMed, Cochrane, Science Direct, and Google Scholar for articles published from 2016 until 2021 using specific keywords. The search was limited to randomized controlled trials (RCTs), in English, full text, and study in humans. The main outcome is expected to be ulcer size, pain score, healing duration, and adverse effects. Quality assessment of selected articles was conducted using the Quality Appraisal of Randomized Trials Checklist (Cochrane Risk of Bias tool). The methodology quality of studies was evaluated using the Cochrane Handbook for Systematic Review of Interventions and Rev Man software. Five articles were eligible for analysis. The population of the sample study ranged from 34-70 patients of 15-65 y old. The herbs used were Aloe vera (Aloe barbadensis Miller), curcumin (Curcuma longa), licorice (Glycyrrhiza glabra), tobacco (Nicotiana tabacum L.), and pomegranate (Punica granatum Linn.). This review showed that there is some evidence of the clinical efficacy and safety of herbal medicine therapy in improved outcomes of recurrent aphthous stomatitis treatment with minimum adverse effects.

The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials

This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.