Recurrent aphthous stomatitis – topical drugs


Recurrent aphthous stomatitis or recurrent aphthous ulceration is a typical drawback with a prevalence estimated to fluctuate between 5 – 60%. Peak onset is between the ages of 10 – 19 years of age however they’ll persist into maturity. Three main kinds are described, minor, main and herpetiform. Whereas widespread the aetiopathogenesis of recurrent aphthous stomatitis in not totally understood and coverings are primarily symptomatic.

The intention of this assessment was to analyze and evaluate the efficacy of various topical drugs within the administration of recurrent aphthous stomatitis (RAS) utilizing a community meta-analysis (NMA) .


A protocol for the assessment was registered on the PROSPERO database. Searches had been undertaken on the PubMed, Embase, Cochrane Central, Scopus, and China Nationwide Information Infrastructure databases. Randomised managed trials (RCTs)evaluating using Triamcinolone acetonide, Doxycycline, Curcumin, Amlexanox, Hyaluronic acid, Chlorhexidine, N-acetylcysteine, Sucralfate, Placebo, Chamomile, Coconut oil, Diosmectite (DS) paste, Fundamental fibroblast progress issue (bFGF) paste, Benzocaine, Dexamethasone, Berberine, Triester glycerol oxide, Myrrh, and Aloe vera for RAS had been thought of. Two reviewers independently searched and chosen research extracted knowledge and assessed threat of bias utilizing the Cochrane instrument (RoB2). The first outcomes had been ache discount and/or therapeutic time Standardised imply distinction (SMD) and 95% CI had been calculated, and pairwise meta-analysis carried out. A Bayesian community meta-analysis with 95% credible intervals was additionally carried out.


  • 43 RCTs involving a complete of three,067 sufferers had been included.
  • 20 completely different interventions had been examined.
  • Imply age of sufferers ranged from 41 to 40.09 years.
  • Most research concerned sufferers with minor RAS with a comply with up interval of seven days.
  • 4 research reported uncomfortable side effects with the rest reporting no uncomfortable side effects or not mentioning them.
  • 29 RCTs had been thought of to have a excessive threat of bias and 14 an unclear threat.
  • For ache discount – NMA didn’t present any statistically important variations when completely different topical therapies had been in contrast collectively and even with a placebo at completely different time intervals.
  • For therapeutic time – doxycycline confirmed a big distinction in comparison with placebo, however no important variations had been seen for different topical drugs in comparison collectively or with placebo.


The authors concluded: –

… very low to reasonable proof to supply a advice concerning which topical therapy is the perfect for assuaging the signs of RAS. Rank likelihood assessments regarding ache discount revealed sucralfate, doxycycline, hyaluronic acid, chamomile, and diosmectite mixed with fundamental fibroblast progress issue paste as probably the most efficacious therapy choices at completely different analysis occasions; subsequently, no single remedy was discovered to be superior to others at completely different evaluation occasions. Doxycycline adopted by curcumin and sucralfate had been proven to be probably the most efficacious therapy choices in lowering ulcer therapeutic time. Taking this into consideration, the present NMA can’t present a definitive conclusion concerning which topical treatment is the perfect for RAS, and additional high-quality RCTs with massive pattern sizes and standardized methodologies are nonetheless required.


The authors registered the protocol within the PROSPERO database and adopted a typical assessment and NMA course of and quantity if main databases. In all 43 RCTs had been included within the assessment which is fewer than an earlier assessment by Lui et al (Dental Elf – 28th Nov 2022) which included 73 research.  Not one of the research included on this new assessment had been thought of to be at low threat of bias and 29 of the 43 research (76%) had been thought of to be at excessive threat of bias. Each the Lui et al assessment and this present assessment discovered no important variations amongst the topical intervention. Nonetheless, the poor methodological rigour of the trials is a priority. As well as, there was heterogeneity in relation to the dimensions, quantity, websites, and length of the ulcers in addition to variation within the dosages and focus of the energetic elements in addition to the timing and evaluation of the end result measures.  Because the authors be aware top quality effectively -conducted trials of applicable measurement and length are wanted to supply higher proof on topical measures for the administration of RAS.  The usage of agreed widespread end result measures (COMET ) would even be helpful for future comparisons.


Main Paper

Mashrah MA, Fang Y, Tune W, Al-Maweri SA, Lan Y, Linhu G, Wang L. Topical drugs for the therapy of recurrent aphthous stomatitis: A community meta-analysis. J Oral Pathol Med. 2023 Oct;52(9):811-825. doi: 10.1111/jop.13480. Epub 2023 Sep 27. PMID: 37753744.

Evaluate protocol on PROSPERO

Different references

Dental Elf – 28th Nov 2022

Recurrent aphthous stomatitis – topical interventions

Dental Elf RAS blogs



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