Efficacy of Topical Intervention for Recurrent Aphthous Stomatitis: A Network Meta-Analysis

Abstract

Background and objectives: To compare the efficacy and safety of topical interventions used for recurrent aphthous stomatitis. Materials and Methods: This network meta-analysis was conducted in accordance with the PRISMA statement. We searched four electronic databases, PubMed, Web of Science (WOS), Cochrane Central Register of Controlled Trials and Embase, for randomized controlled trials reporting efficacy and safety data on topical interventions for recurrent aphthous stomatitis. We performed a quality evaluation using a methodology based on the Cochrane Handbook. Two authors independently extracted data on healing effect, size reduction effect, symptom reduction effect, recurrence and safety assessment. Network meta-analysis was then performed using ADDIS and RevMan. Results: A total of 72 trials (5272 subjects) involving 29 topical interventions were included. Honey, lnsulin liposome gel, laser, amlexanox, glycyrrhiza and triamcinolone had better efficacy performance. Probiotics and chlorhexidine helped to prolong ulcer intervals and reduce recurrence. Doxycycline and penicillin had a high risk of adverse events. Hematologic evaluation showed no preference. The rank possibility of size-reducing effect and symptom-reducing effect supported the short-term effect of laser and the long-term effect of probiotics. Conclusions: We recommend the use of laser as a short-term intervention during the exacerbation phase of RAS and probiotics as a long-term intervention during the exacerbation and remission phases of RAS.

Effectiveness of Low-Level Laser Therapy in Reducing Pain Score and Healing Time of Recurrent Aphthous Stomatitis: A Systematic Review and Meta-Analysis

“…When there is a symptom of exacerbation, topical glucocorticoids (GCs) are the first-line drug for minor RAS. They are used for the local treatment through their anti-inflammatory and immunosuppressive effects [9,53,54].…”

Common Oral Conditions

“…50,73 Several pharmacological treatments have been used to treat aphthous stomatitis, and topical corticosteroids are the most commonly used treatment (Box 1). 50,73,74 A recent network meta-analysis of 69 RCTs of 29 topical and local therapies for recurrent aphthous stomatitis that included 5272 patients reported that use of topical triamcinolone reduced recurrent ulcers (mean percentage reduction in pain score, 28.4% [95% CI, 10.4% to 46.8%]) and size of lesions (mean percentage reduction in size, 25.8% [95% CI 7.91% to 45.48%]) compared with placebo. 74 Laser therapy has also been used to alleviate symptoms and foster ulcer healing for recurrent aphthous stomatitis.…”

“…50,73,74 A recent network meta-analysis of 69 RCTs of 29 topical and local therapies for recurrent aphthous stomatitis that included 5272 patients reported that use of topical triamcinolone reduced recurrent ulcers (mean percentage reduction in pain score, 28.4% [95% CI, 10.4% to 46.8%]) and size of lesions (mean percentage reduction in size, 25.8% [95% CI 7.91% to 45.48%]) compared with placebo. 74 Laser therapy has also been used to alleviate symptoms and foster ulcer healing for recurrent aphthous stomatitis. 50,[74][75][76][77] The aforementioned network meta-analysis reported that laser was superior to placebo in reducing recurrent aphthous stomatitis symptoms (mean percentage reduction, 32.2% [95% CI, 16.4% to 48.1%]).…”

“…74 Laser therapy has also been used to alleviate symptoms and foster ulcer healing for recurrent aphthous stomatitis. 50,[74][75][76][77] The aforementioned network meta-analysis reported that laser was superior to placebo in reducing recurrent aphthous stomatitis symptoms (mean percentage reduction, 32.2% [95% CI, 16.4% to 48.1%]). 74 However, further studies on laser applications are needed to establish their superiority over topical pharmaceutical treatment and to determine specific recommended laser types, wavelengths, power outputs, and applied energy.…”

“…50,[74][75][76][77] The aforementioned network meta-analysis reported that laser was superior to placebo in reducing recurrent aphthous stomatitis symptoms (mean percentage reduction, 32.2% [95% CI, 16.4% to 48.1%]). 74 However, further studies on laser applications are needed to establish their superiority over topical pharmaceutical treatment and to determine specific recommended laser types, wavelengths, power outputs, and applied energy. 50,[75][76][77] Patients with severe aphthous stomatitis, including those with large ulcers or frequent recurrence, may benefit from systemic medications such as corticosteroids, colchicine, azathioprine, dapsone, thalidomide, and pentoxifylline to reduce symptoms, improve healing, and/or decrease recurrence.…”