Evidence-based recommendations for the treatment of recurrent aphthous stomatitis: insights from an umbrella review

To compare the effectiveness and safety of pharmacological, physical, and complementary interventions for recurrent aphthous stomatitis (RAS) across clinically relevant outcomes.

This umbrella review was conducted according to PRISMA and Cochrane guidance and registered in PROSPERO (CRD42024594292). PubMed, Scopus, and the Cochrane Library were searched through August 2025. Eligible studies were systematic reviews, meta-analyses, or network meta-analyses evaluating treatments for RAS. Methodological quality was assessed using AMSTAR 2, and overlap of primary studies was quantified using the corrected covered area.

A total of 41 reviews were included. Topical corticosteroids and low-level laser therapy consistently reduced pain and shortened healing time, although evidence for recurrence prevention was limited. Hyaluronic acid and herbal agents demonstrated favorable short-term efficacy with good safety profiles. Systemic agents such as colchicine and thalidomide showed benefit in severe or refractory RAS, but were constrained by the adverse effects and low-certainty evidence.

Evidence supports topical corticosteroids, hyaluronic acid, and laser therapy for short-term symptom control in RAS, while systemic agents should be reserved for selected refractory cases.