A look at the current management of recurrent aphthous stomatitis


Authors

DOI:

https://doi.org/10.22517/25395203.24938

Keywords:

Stomatitis, Aphthous, Oral Ulcer, Anti-Inflammatory Agents, Anesthetics, Laser Therapy

Abstract

Recurrent Aphthous Stomatitis (RAS) is an idiopathic chronic ulcerative pathology. Although it does not compromise the life of the patients, it can impair their quality of life. It presents a high incidence in the population and a high percentage of recurrence. In view of its importance, the aim of this review is to provide an update on pharmacological and laser therapies that are being implemented for the management of RAS. A bibliographic search of literature that was published between January 2010 and October 2020 was performed in PubMed, Science Direct, EBSCOhost, and LILACS databases, identifying publications in English and Spanish languages.

The articles that were included had to be related to aphthous stomatitis and its treatment, focusing on pharmacological or laser management. 4536 bibliographic citations were found and 19 of them were included in this review. Most of the studies were randomized clinical trials in which the target population were adults that reported the use of anti-inflammatory drugs, immunomodulators, monoclonal antibodies, antiseptics, anesthetics, among others for the treatment of recurrent aphthous stomatitis. From the articles analyzed, it was possible to conclude that pharmacological therapy should be established in a particular way according to the patient's symptoms and medical record. The first-choice drugs are of topical use, reserving those of systemic use for moderate or severe cases and for patients with refractory treatment. Likewise, adjuvant recommendations such as nutrition and hygiene can help in the resolution of the disease. Laser therapy emerges as an alternative treatment with low risk and positive results for recurrent aphthous stomatitis.

Downloads

Download data is not yet available.

Author Biographies

Jorge Andrés Contreras Escobar, Corporación Universitaria Rafael Núñez

Estudiante de odontología. Corporación Universitaria Rafael Núñez

Patricia Benítez Suárez, E.S.E. Hospital Francisco Valderrama.

Odontóloga

 

Lizette Paola Prieto Vélez, Corporación Universitaria Rafael Núñez

Dirección general de sanidad militar, Armada Nacional.

References

Rodríguez-Archilla A, Raissouni T. Estudio clínico de 200 pacientes con estomatitis aftosa recurrente. GMM. 2018;154(2):598.

Saikaly SK, Saikaly TS, Saikaly LE. Recurrent aphthous ulceration: a review of potential causes and novel treatments. Journal of Dermatological Treatment. 2018;29(6):542-52.

Ranganath SP, Pai A. Is Optimal Management of Recurrent Aphthous Stomatitis Possible? A Reality Check. J Clin Diagn Res. 2016;10(10):ZE08-ZE13. doi:10.7860/JCDR/2016/19519.8643

Sánchez-Bernal J, Conejero C, Conejero R. Aftosis oral recidivante. Actas Dermo-Sifiliográficas. 2020;111(6):471-80.

Casariego Z, Perez A, Madrazo J. El proceso vasculítico de las úlceras aftosas recidivantes orales podría ser inducido por una microbiota intestinal alterada. Primera parte. Archivos de Alergia e Inmunología Clínica. 2015;46(3):106-11.

Chiang C-P, Yu-Fong Chang J, Wang Y-P, Wu Y-H, Wu Y-C, Sun A. Recurrent aphthous stomatitis – Etiology, serum autoantibodies, anemia, hematinic deficiencies, and management. J Formos Med Assoc. 2019;118(9):1279-89.

Edgar NR, Saleh D, Miller RA. Recurrent Aphthous Stomatitis: A Review. J Clin Aesthet Dermatol.2017;10(3):26-36.

Zeng Q, Shi X, Yang J, Yang M, Zhao W, Zhao X, et al. The efficacy and safety of thalidomide on the recurrence interval of continuous recurrent aphthous ulceration: A randomized controlled clinical trial. J Oral Pathol Med.2020;49(4):357-64.

Hegde S, Ajila V, et al. Evaluation of salivary tumour necrosis factor–alpha in patients with recurrent aphthous stomatitis. Eur Oral Res. 2019;52(3):157-61.

Bilodeau EA, Lalla RV. Recurrent oral ulceration: Etiology, classification, management, and diagnostic algorithm. Periodontol 2000. 2019;80(1):49-60.

Rivera C. Essentials of recurrent aphthous stomatitis. Biomed Rep. 2019; 11(2): 47–50. doi: 10.3892/br.2019.1221.

Rocca J-P, Zhao M, Fornaini C, Tan L, Zhao Z, Merigo E. Effect of laser irradiation on aphthae pain management: A four different wavelengths comparison. J Photochem Photobiol B. 2018;189:1-4. doi: 10.1016/j.jphotobiol.2018.09.016.

Boza Oreamuno DDS, MSc YV, Rugama Flores BSND MF. Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review. Odovtos - Int J Dent Sc. 2019;93-103.

Altenburg A, El-Haj N, Micheli C, Puttkammer M, Abdel-Naser M, Zouboulis CC. The Treatment of Chronic Recurrent Oral Aphthous Ulcers. Dtsch Arztebl Int. 2014; 111(40): 665–673. doi: 10.3238/arztebl.2014.0665.

Ghorbani A, Akbari J, Boorboor M, Nekoukar Z, Eslami G. Evaluation of zinc sulfate mucoadhesive formulation on recurrent aphthous stomatitis: a randomized double-blind, placebo-controlled clinical trial. BMC Oral Health. 2020;20(1):212.

Queiroz SIML, Silva MVA da, Medeiros AMC de, Oliveira PT de, Gurgel BC de V, Silveira ÉJD da. Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis. An Bras Dermatol. 2018;93(3):341-6.

Liu J, Zeng X, Chen Q, Cai Y, Chen F, Wang Y, et al. An evaluation on the efficacy and safety of amlexanox oral adhesive tablets in the treatment of recurrent minor aphthous ulceration in a Chinese cohort: a randomized, double-blind, vehicle-controlled, unparallel multicenter clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2006;102(4):475-81.

Bahramian A, Falsafi P, Abbasi T, Ghanizadeh M, Abedini M, Kavoosi F, et al. Comparing Serum and Salivary Levels of Vitamin D in Patients with Recurrent Aphthous Stomatitis and Healthy Individuals. J Dent (Shiraz). 2018;19(4):295-300.

Belenguer-Guallar I, Jiménez-Soriano Y, Claramunt-Lozano A. Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent. 2014;6(2):e168-174.

Fitzpatrick SG, Cohen DM, Clark AN. Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review. Head and Neck Pathol. 2019;13(1):91-102.

Shah K, Guarderas J, Krishnaswamy G. Aphthous stomatitis. Annals of Allergy, Asthma & Immunology.2016;117(4):341-3.

Mimura MAM, Hirota SK, Sugaya NN, Sanches Jr JA, Migliari DA. Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial. Clinics. marzo de 2009;64(3):193-8.

Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN, Alaizari N. Guideline for the diagnosis and treatment of recurrent aphthous stomatitis for dental practitioners. J Int Oral Health.2015;7(5):74-80.

Ofluoglu D, Ergun S, Warnakulasuriya S, Namdar-Pekiner F, Tanyeri H. An evaluation of the efficacy of a topical gel with Triester Glycerol Oxide (TGO) in the treatment of minor recurrent aphthous stomatitis in a Turkish cohort: A randomized, double-blind, placebo-controlled clinical trial. Med Oral. 2017;0-0.

Soylu Özler G, Okuyucu Ş, Akoğlu E. The Efficacy of Sucralfate and Chlorhexidine as an Oral Rinse in Patients with Recurrent Aphthous Stomatitis. Advances in Medicine. 2014;2014:1-3.

Kaya Ozden H, Selcuk AA. Is there a role of toothpastes in the development of recurrent aphthous stomatitis? A prospective controlled clinical trial with skin patch testing. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131(1):43-48. doi: 10.1016/j.oooo.2020.10.006.

Liu H-L, Chiu S-C. The Effectiveness of Vitamin B12 for Relieving Pain in Aphthous Ulcers: A Randomized, Double-blind, Placebo-controlled Trial. Pain Management Nursing.2015;16(3):182-7.

Öztekin A, Öztekin C. Vitamin D levels in patients with recurrent aphthous stomatitis. BMC Oral Health.2018;18(1):186.

Volkov I, Rudoy I, Abu-Rabia U, Masalha T, Masalha R. Case report: Recurrent aphthous stomatitis responds to vitamin B12 treatment. Can Fam Physician. 2005;51:844-5.

Ślebioda Z, Szponar E, Kowalska A. Etiopathogenesis of Recurrent Aphthous Stomatitis and the Role of Immunologic Aspects: Literature Review. Arch Immunol Ther Exp.2014;62(3):205-15.

Gasparini G, Saponaro G, Gasparini D, Foresta E, Azzuni C, Adduci A, et al. The Use of Ropivacaine in Therapeutic Treatment of Oral Aphthosis. BioMed Research International. 2018;2018:1-8.

Quijano D, Rodríguez M. Topical Corticosteroids in Recurrent Aphthous Stomatitis. Systematic Review. Acta Otorrinolaringologica (English Edition).2008;59(6):298-307.

Shrivastava K, Naidu G, Deshpande A, Handa H, Raghuvanshi V, Gutpa M. Comparative evaluation of the efficacy of topical amlexanox 5% oral paste and triamcinolone acetonide 0.1% oral paste in the treatment of Recurrent Aphtous Stomatitis (RAS). J Indian Acad Oral Med Radiol. 2018;30:235-40.

Abbasi F, Raoof M, Khatami R, Shadman N, Borjian-Boroojeni F, Nazari F. Effectiveness of Amlexanox and Adcortyl for the treatment of recurrent aphthous ulcers. J Clin Exp Dent.2016;8(4):e368-72.

Akbari N, Asadimehr N, Kiani Z. The effects of licorice containing diphenhydramine solution on recurrent aphthous stomatitis: A double-blind, randomized clinical trial. Complementary Therapies in Medicine. 2020;50:102401.

Geckili O, Bektas-Kayhan K, Eren P, Bilgin T, Unur M. The efficacy of a topical gel with triester glycerol oxide in denture-related mucosal injuries. Gerodontology.2012;29(2):e715-720.

Yang Z, Li M, Xiao L, Yi Z, Zhao M, Ma S. Hyaluronic acid versus dexamethasone for the treatment of recurrent aphthous stomatitis in children: efficacy and safety analysis. Braz J Med Biol Res. 2020;53(8):e9886.

Gong K, Zou X, Fuchs PN, Lin Q. Minocycline inhibits neurogenic inflammation by blocking the effects of tumor necrosis factor-α. Clin Exp Pharmacol Physiol.2015;42(9):940-9.

Yarom N, Zelig K, Epstein JB, Gorsky M. The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: a randomized, double-blind, crossover study assessing different doses of oral rinse. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(6):675-679. doi: 10.1016/j.oooo.2017.02.013.

Schibler F, Heidemeyer K, Klötgen H-W, Keshavamurthy V, Yawalkar N. Apremilast for treatment of recalcitrant aphthous stomatitis. JAAD Case Reports.2017;3(5):410-1.

Kolios AGA, Yawalkar N, Feusi A, Kündig T, Boyman O, Nilsson J. Apremilast in Treatment-Refractory Recurrent Aphthous Stomatitis. N Engl J Med. 2019;381(20):1975-7.

Perosanz‐Lobo D, Latour I, Ortega‐Quijano D, Fernández‐Guarino M, Torrelo A. Severe recurrent aphthous stomatitis treated with adalimumab: A case report in a teenage patient. Pediatr Dermatol.2019;36(6):986-987. doi: 10.1111/pde.14003.

Sand FL, Thomsen SF. Efficacy and safety of TNF-α inhibitors in refractory primary complex aphthosis: a patient series and overview of the literature. Journal of Dermatological Treatment.2013;24(6):444-6.

Rzepecki V, Reynes J, Le Moing V, Braquet P, Faucherre V, Lohan L, et al. Severe HIV-associated aphthous stomatitis treated with etanercept. Med Mal Infect. 2019;49(3):219-220. doi: 10.1016/j.medmal.2018.11.005.

Mustafa N shaban, Kashmoola MA, ZulhelmiBaharudin M, Hashim HI, Jabbar OA, Alahmad BEM. A pilot study on the use of biolase in the treatment of recurrent aphthous ulcer. Braz J Oral Sci.2018;17:e18464.

Jijin MJ, Rakaraddi M, Pai J, Jaishankar HP, Krupashankar R, Kavitha AP, et al. Low-level laser therapy versus 5% amlexanox: a comparison of treatment effects in a cohort of patients with minor aphthous ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 ;121(3):269-73. doi: 10.1016/j.oooo.2015.11.021.

Bardellini E, Veneri F, Amadori F, Conti G, Majorana A. Photobiomodulation therapy for the management of recurrent aphthous stomatitis in children: clinical effectiveness and parental satisfaction. Med Oral. 2020;e549-53.

Evans DH, Abrahamse H. Efficacy of three different laser wavelengths for in vitro wound healing. Photodermatol Photoimmunol Photomed. 2008;24(4):199-210.

Han M, Fang H, Li Q-L, Cao Y, Xia R, Zhang Z-H. Effectiveness of Laser Therapy in the Management of Recurrent Aphthous Stomatitis: A Systematic Review. Scientifica. 2016;2016:1-12.

Nosratzehi T, Akar A. Efficacy of Omega-3 in Treatment of Recurrent Aphthous Stomatitis: A Randomised, Double-blind, Placebo-controlled Study. Chin J Dent Res. 2016;19(3):159-64.

El Khouli AM, El-Gendy EA. Efficacy of omega-3 in treatment of recurrent aphthous stomatitis and improvement of quality of life: a randomized, double-blind, placebo-controlled study. Oral Surg Oral Med Oral Pathol Oral Radiol.2014;117(2):191-6.

Mimura MAM, Borra RC, Hirata CHW, de Oliveira Penido N. Immune response of patients with recurrent aphthous stomatitis challenged with a symbiotic. J Oral Pathol Med.2017;46(9):821-8.

Trinchieri V, Di Carlo S, Bossu’ M, Polimeni A. Use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial. Ulcers. 2011;2011:1-6.

Downloads

Published

2022-02-14 — Updated on 2022-08-24

Versions

How to Cite

Contreras Escobar, J. A., Benítez Suárez, P., Prieto Vélez, L. P., & Orozco Páez, J. (2022). A look at the current management of recurrent aphthous stomatitis. Revista Médica De Risaralda, 28(1). https://doi.org/10.22517/25395203.24938 (Original work published February 14, 2022)

Issue

Vol. 28 No. 1 (2022): Vol. 28 Number 1 (2022): January- June 2022

Section

Scoping Review

License

Cesión de derechos y tratamiento de datos

La aceptación de un artículo para su publicación en la Revista Médica de Risaralda implica la cesión de los derechos de impresión y reproducción, por cualquier forma y medio, del autor a favor de  Facultad de Ciencias de la Salud de la Universidad Tecnológica de Pereira. 1995-2018. Todos los derechos reservados ®

por parte de los autores para obtener el permiso de reproducción de sus contribuciones. La reproducción total o parcial de los trabajos aparecidos en la Revista Médica de Risaralda, debe hacerse citando la procedencia, en caso contrario, se viola los derechos reservados.

Asimismo, se entiende que los conceptos y opiniones expresados en cada trabajo son de la exclusiva responsabilidad del autor, sin responsabilizarse ni solidarizarse, necesariamente, ni la redacción, ni la editorial.

Es responsabilidad de los autores poder proporcionar a los lectores interesados copias de los datos en bruto, manuales de procedimiento, puntuaciones y, en general, material experimental relevante.

Asimismo, la Dirección de la revista garantiza el adecuado tratamiento de los datos de carácter personal