EVOLVING TREATMENT STRATEGIES FOR RECURRENT APHTHOUS ULCERS: A COMPREHENSIVE REVIEW

Background:Recurrent aphthous stomatitis (RAS) is the most prevalent chronic ulcerative condition of the oral mucosa, affecting 5–25% of the population. Despite its benign and self-limiting nature, recurrent painful lesions significantly impair speech, mastication, and quality of life. The precise etiology remains elusive, with multifactorial influences including genetic predisposition, immune dysregulation, nutritional deficiencies, stress, and systemic associations.
Aim:This review synthesizes current evidence on the clinical features, diagnostic considerations, and therapeutic
strategies for RAS, with emphasis on evolving modalities and a stepwise management algorithm.
Methods:A comprehensive literature search was conducted across PubMed, Scopus, and ScienceDirect databases,
focusing on articles published between 1996 and 2025. Key domains included epidemiology, clinical classification,
diagnostic pathways, conventional treatments, novel therapies, and integrative approaches. A total of 50 relevant studies were included in this narrative review.
Results:Conventional management remains centered on topical corticosteroids, antiseptics, and analgesics, while
systemic agents are reserved for severe or refractory cases. Adjunctive therapies such as hyaluronic acid, probiotics, zinc and vitamin B12 supplementation, and herbal formulations (e.g., curcumin, aloe vera, Myrtus communis) demonstrate promising outcomes. Low-level laser therapy and advanced drug delivery systems, including bioadhesive films and dissolvable microneedles, represent significant innovations. Artificial intelligence–based diagnostic tools and integrative medicine approaches provide additional frontiers. Based on current evidence, a stepwise management algorithm is proposed to guide clinical decision-making.
Conclusion:RAS continues to pose diagnostic and therapeutic challenges due to its multifactorial etiology and recurrent nature. While conventional therapies remain essential, the incorporation of novel pharmacological, technological, and holistic strategies holds promise for personalized, effective, and patient-friendly care.