Bridging Conventional and Natural Therapies for Recurrent Aphthous Stomatitis: A Systematic Review and Meta-Analysis of Triamcinolone and Non-Steroidal Alternatives

Abstract

Background: Recurrent aphthous stomatitis (RAS) is a chronic inflammatory condition that causes painful oral ulcers that impair eating and speech. Topical triamcinolone is commonly used, but non-steroidal natural and synthetic alternatives are increasingly studied. This systematic review and meta-analysis compared alternative topical therapies for pain outcomes (VAS, pain recovery time) and ulcer-healing time with topical triamcinolone. Methods: A PRISMA-guided search of five electronic databases for randomized controlled trials (RCTs) published between March 2014 and March 2025 was carried out. Eligible studies that compared alternative or natural treatments with topical triamcinolone for RAS based on randomized clinical trials were considered. Data were synthesized with random-effects models using standardized mean differences (SMDs) and 95% confidence intervals (CIs). Random-effects analyses combining different interventions were interpreted as secondary, exploratory syntheses. Results: Twenty-six RCTs were included qualitatively; 14 RCTs (n = 836) contributed to the pain (VAS) meta-analysis (428 experimental; 408 triamcinolone). Alternative treatments had a similar reduction in pain to triamcinolone (SMD = 0.37, 95% CI 0.04–0.69; p < 0.03), with substantial heterogeneity (I2 ≈ 80%). Pain recovery time (4 RCTs; n = 182) did not differ significantly (SMD = 2.62; p = 0.36) and was highly heterogeneous. Ulcer-healing time (5 RCTs; n = 245) was shorter with alternatives (SMD = −1.28, 95% CI −2.33 to −0.23; p < 0.05). Reported alternatives included natural agents (e.g., honey, sage, pomegranate, curcumin) and synthetic modalities (e.g., hyaluronic acid, mucoadhesive patches, laser therapy). Conclusions: Some individual studies reported favourable pain or healing outcomes with alternatives to topical triamcinolone. However, limited treatment-specific evidence and substantial clinical heterogeneity restrict firm conclusions. Pooled estimates across different interventions should be considered exploratory. Further rigorous trials are needed to establish the comparative effectiveness and safety of individual treatments.