Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review


The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7–90 for the laser and 5–90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO2 laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO2 laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Zain RB (2000) Oral recurrent aphthous ulcers/stomatitis: prevalence in Malaysia and an epidemiological update. J Oral Sci 42:15–19

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Chattopadhyay A, Shetty KV (2011) Recurrent aphthous stomatitis. Otolaryngol Clin North Am 44:79–88

    Article  PubMed  Google Scholar 

  3. 3.

    Axéll T, Henricsson V (1985) The occurrence of recurrent aphthous ulcers in an adult Swedish population. Acta Odontol Scand 43:121–125

    Article  PubMed  Google Scholar 

  4. 4.

    Davatchi F, Tehrani-Banihashemi A, Jamshidi AR, Chams-Davatchi C, Gholami J, Moradi M, Akhlaghi M, Foroozanfar MH, Barghamdi M, Noorolahzadeh E, Samadi F, Hadj-Aliloo M, Ghaznavi K, Ghaznavi K, Soroosh M, Khabazi A, Salari AH, Sharif SK, Karimifar M, Salessi M, Essalat-Manesh K, Nadji A, Shahram F (2008) The prevalence of oral aphthosis in a normal population in Iran: a WHO-ILAR COPCORD study. Arch Iran Med 11:207–209

    PubMed  Google Scholar 

  5. 5.

    McCullough MJ, Abdel-Hafeth S, Scully C (2007) Recurrent aphthous stomatitis revisited; clinical features, associations, and new association with infant feeding practices? J Oral Pathol Med 36:615–620

    Article  PubMed  Google Scholar 

  6. 6.

    Slebioda Z, Szponar E, Kowalska A (2014) Etiopathogenesis of recurrent aphthous stomatitis and the role of immunologic aspects: literature review. Arch Immunol Ther Exp (Warsz) 62:205–215

    CAS  Article  Google Scholar 

  7. 7.

    Al-Omiri MK, Karasneh J, Alhijawi MM, Zwiri AM, Scully C, Lynch E (2015) Recurrent aphthous stomatitis (RAS): a preliminary within-subject study of quality of life, oral health impacts and personality profiles. J Oral Pathol Med 44:278–823

    Article  PubMed  Google Scholar 

  8. 8.

    Truelove SC, Morris-Owen RM (1958) Treatment of aphthous ulceration of the mouth. BMJ 15:603–607

    Article  Google Scholar 

  9. 9.

    Cook BE (1960) The diagnosis of bullous lesions affecting the oral mucosa. I. Br Dent J 109:83–96

    CAS  PubMed  Google Scholar 

  10. 10.

    Scully C, Porter S (2008) Oral mucosal disease: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 46:198–206

    Article  PubMed  Google Scholar 

  11. 11.

    Jurge S, Kuffer R, Scully C, Porter SR (2006) Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis 12:1–21

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S (2012) Recurrent aphthous stomatitis: a review. J Oral Pathol Med 41:577–583

    Article  PubMed  Google Scholar 

  13. 13.

    Baccaglini L, Lalla RV, Bruce AJ, Sartori-Valinotti JC, Latortue MC, Carrozzo M, Rogers RS 3rd (2011) Urban legends: recurrent aphthous stomatitis. Oral Dis 17:755–770

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Graykowski EA, Barile MF, Lee WB, Stanley HR Jr (1966) Recurrent aphthous stomatitis. Clinical, therapeutic, histopathologic, and hypersensitivity aspects. JAMA 196:637–644

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Koybasi S, Parlak AH, Serin E, Yilmaz F, Serin D (2006) Recurrent aphthous stomatitis: investigation of possible etiologic factors. Am J Otolaryngol 27:229–232

    Article  PubMed  Google Scholar 

  16. 16.

    Taylor J, Glenny AM, Walsh T, Brocklehurst P, Riley P, Gorodkin R, Pemberton MN (2014) Interventions for the management of oral ulcers in Behçet’s disease. Cochrane Database Syst Rev 9:CD011018

    Google Scholar 

  17. 17.

    Belenguer-Guallar I, Jiménez-Soriano Y, Claramunt-Lozano A (2014) Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent 6:e168–174

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Brocklehurst P, Tickle M, Glenny AM, Lewis MA, Pemberton MN, Taylor J, Walsh T, Riley P, Yates JM (2012) Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 9:CD005411

    Google Scholar 

  19. 19.

    Ship JA (1996) Recurrent aphthous stomatitis. An update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81:141–147

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Zand N, Ataie-Fashtami L, Djavid GE, Fateh M, Alinaghizadeh MR, Fatemi SM, Arbabi-Kalati F (2009) Relieving pain in minor aphthous stomatitis by a single session of non-thermal carbon dioxide laser irradiation. Lasers Med Sci 24:515–520

    Article  PubMed  Google Scholar 

  21. 21.

    Zand N, Fateh M, Ataie-Fashtami L, Djavid GE, Fatemi SM, Shirkavand A (2012) Promoting wound healing in minor recurrent aphthous stomatitis by non-thermal, non-ablative CO2 laser therapy: a pilot study. Photomed Laser Surg 30:719–723

    Article  PubMed  Google Scholar 

  22. 22.

    Prasad RS, Pai A (2013) Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol 116:189–193

    Article  Google Scholar 

  23. 23.

    Tezel A, Kara C, Balkaya V, Orbak R (2009) An evaluation of different treatments for recurrent aphthous stomatitis and patient perceptions: Nd:YAG laser versus medication. Photomed Laser Surg 27:101–106

    Article  PubMed  Google Scholar 

  24. 24.

    Aggarwal H, Singh MP, Nahar P, Mathur H, Gv S (2014) Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers—a sham controlled, split mouth follow up study. J Clin Diagn Res 8:218–221

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    De Souza TO, Martins MA, Bussadori SK, Fernandes KP, Tanji EY, Mesquita-Ferrari RA, Martins MD (2010) Clinical evaluation of low-level laser treatment for recurring aphthous stomatitis. Photomed Laser Surg 28:S85–S88

    Article  Google Scholar 

  26. 26.

    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Salman H, Kashmoola MA, Al-Waiz MM, Al-Sandooq TA (2008) Differences between low level laser therapy and triamcinolone acetonide kenalog on healing of recurrent aphthous ulceration. Ann Coll Med 34:35–41

    Google Scholar 

  28. 28.

    Hazeem MI, Rajab MS, Badeia RA (2013) Treatment of recurrent aphthous stomatitis with 940 nm diode laser. Tikrit J Dental Sci 1:77–82

    Google Scholar 

  29. 29.

    Lalabonova H, Daskalov H (2014) Clinical assessment of the therapeutic effect of low-level laser therapy on chronic recurrent aphthous stomatitis. Biotechnol Biotechnol Equip 28:929–933

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Sattayut S, Trivibulwanich J, Pipithirunkarn N, Danvirutai N (2013) A clinical efficacy of using CO2 laser irradiating to transparent gel on aphthous stomatitis patients. Laser Ther 22:283–289

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Albrektson M, Hedström L, Bergh H (2014) Recurrent aphthous stomatitis and pain management with low-level laser therapy: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 117:590–594

    Article  PubMed  Google Scholar 

  32. 32.

    Bornstein MM, Suter VG, Stauffer E, Buser D (2003) The CO2 laser in stomatology. Part 2. Schweiz Monatsschr Zahnmed 113:766–785 (in German, in French)

    PubMed  Google Scholar 

  33. 33.

    Suter VG, Altermatt HJ, Dietrich T, Warnakulasuriya S, Bornstein MM (2014) Pulsed versus continuous wave CO2 laser excisions of 100 oral fibrous hyperplasias: a randomized controlled clinical and histopathological study. Lasers Surg Med 46:396–404

    Article  PubMed  Google Scholar 

  34. 34.

    Carvalho PA, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA (2011) Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol 47:1176–1181

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Doeuk C, Hersant B, Bosc R, Lange F, SidAhmed-Mezi M, Bouhassira J, Meningaud JP (2015) Current indications for low level laser treatment in maxillofacial surgery: a review. Br J Oral Maxillofac Surg 53:309–315

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    NAALT (2017) https://www.naalt.org/index.php/whitepapers/25-nomenclature-whitepaper. Last accessed 8 February 2017

  37. 37.

    Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RA (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg 24:158–168

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40:516–533

    Article  PubMed  Google Scholar 

  39. 39.

    He WL, Yu FY, Li CJ, Pan J, Zhuang R, Duan PJ (2015) A systematic review and meta-analysis on the efficacy of low-level laser therapy in the management of complication after mandibular third molar surgery. Lasers Med Sci 30:1779–1788

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Miloro M, Halkias LE, Mallery S, Travers S, Rashid RG (2002) Low-level laser effect on neural regeneration in Gore-Tex tubes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:27–34

    Article  PubMed  Google Scholar 

  41. 41.

    Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Sanford LE, Woodruff LD (2004) The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg 22:323–329

    Article  PubMed  Google Scholar 

  42. 42.

    Vale FA, Moreira MS, de Almeida FC, Ramalho KM (2015) Low-level laser therapy in the treatment of recurrent aphthous ulcers: a systematic review. ScientificWorldJournal 2015:150412. doi:10.1155/2015/150412

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    Greer RO Jr, Lindenmuth JE, Juarez T, Khandwala A (1993) A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. J Oral Maxillofac Surg 51:243–248

    Article  PubMed  Google Scholar 

  44. 44.

    de Freitas LF, Hamblin MR (2016) Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron 22:348–364

    Article  Google Scholar 

  45. 45.

    Mester E, Spiry T, Szende B, Tota JG (1971) Effect of laser rays on wound healing. Am J Surg 122:532–535

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Mester E, Nagylucskay S, Döklen A, Tisza S (1976) Laser stimulation of wound healing. Acta Chir Acad Sci Hung 17:49–55

    CAS  PubMed  Google Scholar 

  47. 47.

    Wagner VP, Meurer L, Martins MA, Danilevicz CK, Magnusson AS, Marques MM, Filho MS, Squarize CH, Martins MD (2013) Influence of different energy densities of laser phototherapy on oral wound healing. J Biomed Opt 18:128002. doi:10.1117/1.JBO.18.12.128002

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Pereira Tdos S, Silva Alves Jde F, Gomes CC, Rocha do Nascimento A, Stoianoff MA, Gomez RS (2014) Kinetics of oral colonization by Candida spp. during topical corticotherapy for oral lichen planus. J Oral Pathol Med 43:570–575

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Michael M. Bornstein.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.


The study was funded by departmental funds of the Department of Oral Surgery and Stomatology, University of Bern.

Ethical approval

Ethical approval was not needed for this systematic review.

Informed consent

Informed consent was not needed for this systematic review.

Additional information

Valerie G. A. Suter and Sophia Sjölund contributed equally to this work.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Suter, V.G.A., Sjölund, S. & Bornstein, M.M. Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review. Lasers Med Sci 32, 953–963 (2017). https://doi.org/10.1007/s10103-017-2184-z

Download citation


  • Aphthous ulcer
  • CO2 laser
  • Diode laser
  • Nd:YAG laser
  • Low-level laser
  • Photobiostimulation
  • Photobiomodulation