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Recurrent aphthous stomatitis (RAS) is the most common chronic disease of the oral cavity, affecting 5-25% of the
population. The underlying etiology remains unclear, and no curative treatment is available.
The present review examines the existing treatments for RAS with the purpose of answering a number of questions:
How should these patients be treated in the dental clinic? What topical drugs are available and when should they be
used? What systemic drugs are available and when should they be used?
A literature search was made of the PubMed, Cochrane and Scopus databases, limited to articles published between
2008-2012, with scientific levels of evidence 1 and 2 (metaanalyses, systematic reviews, phase I and II randomized
clinical trials, cohort studies and case-control studies), and conducted in humans.
The results obtained indicate that the management of RAS should be based on identification and control of the
possible predisposing factors, with the exclusion of possible underlying systemic causes, and the use of a detailed
clinical history along with complementary procedures such as laboratory tests, where required.
Only in the case of continuous outbreaks and symptoms should drug treatment be prescribed, with the initial application
of local treatments in all cases. A broad range of topical medications are available, including antiseptics
(chlorhexidine), antiinflammatory drugs (amlexanox), antibiotics (tetracyclines) and corticosteroids (triamcinolone
acetonide).
In patients with constant and aggressive outbreaks (major aphthae), pain is intense and topical treatment is unable to
afford symptoms relief. Systemic therapy is indicated in such situations, in the form of corticosteroids (prednisone)
or thalidomide, among other drugs.
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