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Efficacy of hyaluronic acid for recurrent aphthous stomatitis: a systematic review of clinical trials

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Abstract

Objectives

Recurrent aphthous stomatitis (RAS) is a very common oral mucosal disease, and its management is quite challenging with no definitive cure being available so far. Many studies have tried hyaluronic acid (HA) for alleviating signs and symptoms of RAS. The present systematic review sought to assess the available evidence regarding the efficacy of HA in management of RAS.

Methods

Two reviewers independently conducted extensive search in four online databases (PubMed, Scopus, Web of Science, and Google Scholar) and the gray literature, with no restriction to date or language of the publication. All clinical trials that assessed the efficacy of HA in reducing signs and symptoms of RAS were included. Risk of bias was assessed by two reviewers independently, using the Cochrane assessment tool. Due to substantial heterogeneity, no meta-analysis was feasible.

Results

Out of the 75 identified articles, nine clinical trials involving 538 RAS patients (259 in HA group) were included. The risk of bias was high in five studies, low in one study, and unclear in three studies. The comparative groups varied greatly across the included studies: triamcinolone (in three studies), chlorhexidine mouthwash, lidocaine, placebo, iodine glycerin, diclofenac, and laser therapy. Overall, the results revealed a good efficacy of HA in alleviating pain and shortening the healing time of RAS, without any reported side effects. Compared to triamcinolone, HA showed superior results in one study, and comparable results in two studies.

Conclusions

The available evidence suggests that HA is a promising treatment option for RAS. However, given the huge heterogeneity of the included studies and high risk of bias in some of these studies, the evidence is inconclusive. Further well-designed clinical trials with standardized methodologies and adequate sample sizes are warranted to discern the efficacy of HA for RAS.

Clinical relevance

Hyaluronic acid might be a viable alternative therapeutic option for patients with RAS.

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Authors and Affiliations

  1. Department of Oral Medicine and Diagnostic Sciences, Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia

    Sadeq Ali Al-Maweri, Nader Alaizari & Sajna Ashraf

  2. College of Dental Medicine, QU Health, Qatar University, Doha, Qatar

    Sadeq Ali Al-Maweri

  3. Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana’a University, Sana’a, Yemen

    Sadeq Ali Al-Maweri & Esam Halboub

  4. Department of Oral and Maxillofacial Surgery, Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia

    Rawan Hejji Alanazi

  5. Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia

    Rania Hejji Alanazi

  6. Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen

    Hesham Mohammed Al-Sharani

  7. Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China

    Hesham Mohammed Al-Sharani

  8. Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia

    Esam Halboub

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  1. Sadeq Ali Al-Maweri
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Correspondence to Sajna Ashraf.

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Al-Maweri, S.A., Alaizari, N., Alanazi, R.H. et al. Efficacy of hyaluronic acid for recurrent aphthous stomatitis: a systematic review of clinical trials. Clin Oral Invest 25, 6561–6570 (2021). https://doi.org/10.1007/s00784-021-04180-4

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