Systemic therapy
Mouth ulcers (canker sores) are one of the most common oral conditions and many people suffer from them repeatedly. They can be painful and slow to heal. This can go so far as to cause significant difficulty in eating and drinking. This review found that many different treatments were used to treat this condition, although the evidence for their effectiveness is inconclusive.
Conclusions of the authors:
No treatment has been shown to be effective and therefore the results are inconclusive regarding the best systemic intervention for RAS. This probably reflects the poor methodological rigor of clinical trials and the lack of studies on some drugs, rather than the actual effect of the intervention. It is also recognized that in clinical practice some drugs appear to work for some patients and therefore interventions are likely to be complex in nature. It should further be noted that systemic interventions are often reserved for patients who have failed to respond to topical treatments and may therefore represent a special group of patients.
Context:
Recurrent aphthous stomatitis (RAS) is the most common form of mouth ulceration, which is characterized by recurrent ulceration of the oral mucosa in a healthy person. In its most distressing form, RAS can cause significant difficulty eating and drinking. Treatment is primarily aimed at relieving pain and promoting healing in order to reduce the duration of the disease or the frequency of recurrence. A variety of topical and systemic treatments are used.
Goals:
To determine the clinical effect of systemic interventions in decreasing pain associated with RAS and in reducing the duration or frequency of episodes.
Literature search strategy:
We undertook electronic searches of: the Cochrane Oral Health Group and the Cochrane Pain and Palliative Care Review Group (PaPaS) Trials Registers (to 6 June 2012), MEDLINE via OVID (from 1950 until June 6, 2012), EMBASE via OVID (from 1980 until June 6, 2012), CINAHL via EBSCO (1980 until June 6, 2012) and AMED via PubMed (from 1950 until June 6, 2012). 2012). We screened reference lists of relevant articles and contacted authors of eligible trials to identify further trials and obtain additional information.
Selection criteria:
We included randomized controlled trials ( RCTs ) in which the primary outcome measures assessed reduction in pain associated with RAS or reduction in duration or frequency of episodes. The trials were not limited by the single outcome. We also included cross-design RCTs.
Data collection and analysis:
Two authors extracted data independently and in duplicate. We contacted trial authors for details of randomisation, blinding and early withdrawals. We assessed risk of bias in six domains. We followed the statistical guidelines of the Cochrane Collaboration and the relative risks (RR) were to be calculated using fixed-effects models (for a meta-analysis including two or three trials) or random-effects models (for a meta-analysis including four or more trials).
Main results:
A total of 25 trials were included, of which 22 were placebo-controlled and eight performed head-to-head comparisons (five trials had more than two treatment groups). Twenty-one different interventions were evaluated. Interventions were grouped into two categories: immunomodulatory/anti-inflammatory and uncertain. Only one study was considered to be at low risk of bias. There were insufficient data to support or refute the use of any intervention.
