From the Guidelines
The primary approach to managing Recurrent Aphthous Stomatitis (RAS) involves preventive measures and symptom management, focusing on reducing ulcer duration and alleviating pain. When considering the treatment for RAS, it's crucial to prioritize strategies that minimize discomfort and promote healing.
- Preventive measures are key, including the elimination of sources of trauma and avoidance of painful stimuli such as hot, hard, sharp, or spicy foods and drinks, as suggested by guidelines for managing oral mucosal injury 1.
- Effective oral hygiene is also vital, with patients being educated on oral complications and advised to have regular dental examinations to assess the oral cavity and report any signs or symptoms of oral complications promptly 1.
- For symptom management, topical agents can provide relief, although the specific first-line treatments are not detailed in the provided evidence, general practice includes the use of protective pastes and topical anesthetics to reduce pain.
- Maintaining good oral hygiene with a soft toothbrush and avoiding irritants can help in the healing process and prevent secondary infections.
- While systemic treatments and pain management strategies are important for severe cases, the provided evidence emphasizes the importance of preventive care and oral hygiene in managing RAS 1.
- The goal of treatment is to reduce inflammation, provide pain relief, and promote healing, thereby improving the patient's quality of life and reducing the morbidity associated with RAS.
From the Research
Treatment Options for Recurrent Aphthous Stomatitis
The treatment for Recurrent Aphthous Stomatitis (RAS) is primarily aimed at pain relief and the promotion of healing to reduce the duration of the disease or reduce the rate of recurrence 2. The management of RAS should be based on identification and control of the possible predisposing factors, with the exclusion of possible underlying systemic causes, and the use of a detailed clinical history along with complementary procedures such as laboratory tests, where required 3.
Topical Treatments
A broad range of topical medications are available, including:
- Antiseptics (chlorhexidine)
- Anti-inflammatory drugs (amlexanox)
- Antibiotics (tetracyclines)
- Corticosteroids (triamcinolone acetonide) 3
- Topical anaesthetics and analgesics
- Antiseptic and anti-phlogistic preparations
- Topical steroids as cream, paste or lotions
- Antacids like sucralfate
- Chemically stable tetracycline suspension
- Medicated toothpaste containing the enzymes amyloglucosidase and glucoseoxidase
- Silver nitrate application 4
Systemic Treatments
Systemic therapy is indicated in situations where patients have constant and aggressive outbreaks (major aphthae), and pain is intense and topical treatment is unable to afford symptoms relief 3. Systemic treatments include:
- Corticosteroids (prednisone)
- Thalidomide
- Colchicine
- Pentoxifylline
- Dapsone
- Levamisol
- Azathioprine
- Methotrexate
- Cyclosporin A
- Interferon alpha
- Tumour necrosis factor (TNF) antagonists 4, 5
- Sulodexide, a low-molecular-weight heparin with immunosuppressive activity but few adverse effects 6
Dietary Management
Dietary management supports the treatment of RAS 4.
Effectiveness of Treatments
There is insufficient evidence to support or refute the use of any intervention for RAS, and no single treatment was found to be effective 2. The results remain inconclusive in regard to the best systemic intervention for RAS.