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Oral Medicine

Review: What are the systematic interventions for recurrent aphthous stomatitis (mouth ulcers)?


This summary is based on the Cochrane systematic review: Systemic interventions for recurrent aphthous stomatitis (mouth ulcers)


  • Recurrent aphthous stomatitis (RAS) is the most frequent form of oral ulceration, characterized by recurrent oral mucosal ulceration in an otherwise healthy individual. At its worst RAS can cause significant difficulties in eating and drinking.
  • Treatment is primarily aimed at pain relief and the promotion of healing to reduce the duration of the disease or reduce the rate of recurrence. A variety of topical and systemic therapies have been utilized.

Purpose of the Review

The objectives of this review are to determine the clinical effectiveness and safety of systemic interventions in the reduction of pain associated with recurrent aphthous stomatitis, a reduction in episode duration or a reduction in episode frequency.

Conclusion and Implications for Practice

  • In general, systemic interventions are used following ineffective topical therapy.
  • No single treatment was found to be effective and therefore the results remain inconclusive as regards to the best systemic intervention for RAS. This is likely to reflect the poor methodological rigour of trials, and lack of studies for certain drugs, rather than the true effect of the intervention.
  • It is also recognized that in clinical practice, individual drugs appear to work for individual patients and so the interventions are likely to be complex in nature.
  • Although comprehensive, this review did not find trials involving several of other systemic interventions used for RAS, for example thalidomide in the absence of any systemic condition, despite its limitations on safety.


Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

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