The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise result (few patients for each comparison).
A Cochrane review [Abstract] 1 included 25 studies with a total of 1 291 subjects evaluating the effectiveness of 21 different interventions for the treatment of recurrent aphthous stomatitis (RAS). Due to heterogeneity and poor reporting in many of the included trials, statistical pooling was not undertaken. The interventions were grouped into two categories: immunomodulatory/anti-inflammatory (beta-glucan, clofazimine, colchicines, levamisole, montelukast, leukotriene receptor antagonist, pentoxifylline, prednisone, sulodexide) and uncertain (camelthorn, homeopathy, LongoVital (herbal + vitamin), LongoVital (herbal alone), propolis, subantimicrobial doxycycline, tetracycline, vitamin B12, multivitamin). None of the evaluated interventions were shown to be of clear benefit for the treatment of RAS. Statistically significant improvements in outcomes were shown for some interventions, however, given that all trials were judged to be at either high or unclear risk of bias, it was felt there was insufficient evidence to currently support their use in clinical practice. Further research of these interventions may be warranted: clofazimine, montelukast, prednisone, sulodexide, camel thorn, subantimicrobial doxycycline, vitamin B12.
For most people, topical therapies, not evaluated in this review, will be the first line of treatment for the management of recurrent aphthous stomatitis.
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