Effectiveness of 0.1% triamcinolone acetonide compared with those of other therapies for minor recurrent aphthous stomatitis: a systematic review and meta-analysis of randomized controlled trials.

2025-12-18
BMC oral health 26(1)
- Anas Saeed Al-Zaghruri
- Mohammed M Al Moaleem
- Ahmed Yaseen Alqutaibi
- Abbas Ahmed Abdulqader
- Baleegh Abdulraoof Al-Kadasi
- Nashwan Abduljabbar Noman
- Ayman Ali Saad
- Ammar Ahmed Al-Hiagem
- Magdi Abdullah Abdulsalam

PubMed: 41408255
DOI: 10.1186/s12903-025-07358-4

Study Design

Type: Meta-Analysis
Sample size: n = 1,474
Population: Twenty-five RCTs involving 1474 participants
Methods: A systematic review and meta-analysis were conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From December 2024 to April 2025, PubMed and the Cochrane Central Register of Controlled Trials, Semantic Scholar, and ScienceDirect were searched for randomized controlled trials (RCTs) evaluating 0.1% triamcinolone acetonide in minor RAS treatment.

Background

Recurrent aphthous stomatitis (RAS) is a common oral mucosal condition affecting over 2.5 billion people worldwide. Although 0.1% triamcinolone acetonide is a standard treatment, its comparative efficacy remains uncertain.

Objective

To evaluate and compare systematically the efficacy of 0.1% triamcinolone acetonide with those of alternative therapies for RAS management.

Methods

A systematic review and meta-analysis were conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From December 2024 to April 2025, PubMed and the Cochrane Central Register of Controlled Trials, Semantic Scholar, and ScienceDirect were searched for randomized controlled trials (RCTs) evaluating 0.1% triamcinolone acetonide in minor RAS treatment. Eligible studies reported the outcomes of pain reduction, ulcer size, or healing time. Risk of bias was assessed by using the Cochrane Risk of Bias Tool, and meta-analysis pooled estimates were calculated by employing a random effects model.

Results

Twenty-five RCTs involving 1474 participants were included. Thyme honey, sumac gel, and laser therapies were significantly more effective than 0.1% triamcinolone acetonide in reducing pain and ulcer size. CBD oil, hyaluronic acid, curcumin, amlexanox, and nanoformulated triamcinolone exhibited comparable efficacies as 0.1% triamcinolone acetonide. The outcomes under chamomile, acemannan, and doxycycline benzocaine gel treatments were less favorable than those under 0.1% triamcinolone acetonide treatment. Laser therapy, sumac gel, and Punica granatum extract significantly reduced healing time compared with 0.1% triamcinolone acetonide. The meta-analysis demonstrated that 0.1% triamcinolone acetonide was significantly more effective than thyme honey, Rhus coriaria gel, and nanobased triamcinolone in reducing ulcer size and shortened healing time compared with Salvizan and P. granatum gels. However, no significant effect was observed in pain reduction when 0.1% triamcinolone acetonide was compared with either other treatments or the placebo, and no significant difference in healing time was found when 0.1% triamcinolone acetonide was compared with the placebo.

Conclusion

Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS, especially in patients intolerant to corticosteroids. While 0.1% triamcinolone acetonide significantly reduced ulcer size and shortened healing time compared with several alternative treatments, it demonstrated no significant advantage in pain reduction or healing time over the placebo. The results of this work should be interpreted with caution because of the limited number of placebo-controlled trials and the moderate-to-high risk of bias in the included studies.

Registration

We registered our review protocol in PROSPERO under the ID CRD42024573362.

Research Insights

Aloe Vera→Reduced Pain
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Aloe Vera→Reduced Ulcer Size
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Chamomile→Reduced Pain
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Chamomile→Reduced Ulcer Size
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Honey→Reduced Pain
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Honey→Reduced Ulcer Size
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Sage→Reduced Pain
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Sage→Reduced Ulcer Size
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Turmeric→Reduced Pain
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated
Turmeric→Reduced Ulcer Size
Natural agents, such as honey, sage, and sumac gel, show promise as effective, safe alternatives to 0.1% triamcinolone acetonide in the treatment of minor RAS
Effect
Beneficial
Effect size
Small
Dose
not stated