Recurrent Aphthous stomatitis management – current trends and alternative modalities

Recurrent Aphthous Stomatitis (RAS) is sometimes termed as recurrent oral ulceration, but it is important to note there are various causes of recurrent oral mucosal ulceration, hence the term RAS is considered more appropriate. RAS was first described in antiquity and since has been the subject of numerous clinical and laboratory investigations. However, the disease still remains poorly understood. It has been estimated that 20% of the general population will suffer from RAU at some time during their lives. While most aphthae are small and heal within seven to 14 days, larger ulcers can persist for weeks or months. It is the management of aphthous that poses a challenge. Treatment has largely been restricted to provide symptomatic relief to the patients and hardly any success has been achieved in preventing recurrence of the disease. Topical anti-inflammatory agents remain the cornerstone of treatment and myriad of drugs have been researched in curing this condition, rather with limited success. Dietary restrictions, topical steroids, topical antibiotics, topical immunomodulators, and coating agents are the mainstay to reduce pain and inflammation. Systemic drugs are used when the lesions are extensive, (major and herpetiform) and no relief is obtained with topical agents. Several alternative treatment have been tried including certain herbs, natural substances, chemical agents which have shown limited success in treating this self limiting but challenging condition. This review focuses on the various management modalities used in the treatment of RAS.