Triamcinolone versus nonsteroidal treatments for recurrent oral aphthous ulcers: A systematic review and meta-analysis of randomized controlled trials

Recurrent apthous stomatitis (RAS) is associated with small to large ulcers and pain and may cause difficulty in speech and eating. Treatment modalities such as topical applications, mouthwashes, and tablets are available to manage symptoms. The most common pharmacological topical agents are corticosteroids, analgesics, probiotics, and antibiotics. This systematic review and meta-analysis aimed to compare the efficacy of topical triamcinolone with alternative topical treatments for recurrent oral aphthous ulcers, considering factors such as pain reduction, VAS score and ulcer healing time. It was registered in PROSPERO (registration number: CRD420250655772) with the title “Comparative evaluation of pain recovery and healing duration of Triamcinolone with non-steroidal treatment for recurrent oral aphthous ulcers- A systematic review and meta-analysis of Randomized Controlled Trials”. Randomized control trials published in English from March 2014 to March 2025 and available in five electronic databases, viz., Medline, the Cochrane Central Register of Controlled Trials (Central), Embase, Scopus and Web of Science, evaluating treatments for aphthous ulcers and which reported outcomes during follow-up were included. Studies reporting aphthous ulcers with systemic involvement, such as Behcet’s disease, Crohn's disease, and ulcerative colitis and those that included systemic treatment were excluded. A total of 26 studies were included for final qualitative and quantitative review. Risk of bias analysis was performed using the Cochrane ROB version 2 tool. The quantitative analysis and generation of Forest plots were done using the validated web-based tool available at https://metaanalysisonline.com. Natural and synthetic alternatives may provide effective, safer patient options, challenging the traditional reliance on corticosteroids such as triamcinolone. These findings indicate that natural agents such as honey, sage, and pomegranate could be considered first-line treatments for patients with RAS, particularly those who are intolerant to corticosteroids or experiencing frequent recurrences. Laser-based therapies and novel agents such as hyaluronic acid‒microbiome combinations may be effective for severe cases with the same efficacy as corticosteroids but fewer side effects. When evaluating patient satisfaction, natural therapies such as curcumin, aloe vera, Rhus coriaria and cannabidiol were preferred over triamcinolone. However, the current study has limitations, including variations in the study outcomes, ulcer types, and follow-up intervals. This study had no funding.