Commentary

The prevalence and severity of recurrent aphthous ulcers varies, and several factors and risks are attributed to the condition. It has been estimated that 20% of the general population will suffer from recurrent aphthous ulcers at some time in their lives.1 The minor type can heal within 10-14 days without treatment and scarring, however for many people pain and discomfort are associated and quality of life is affected. Since frequency and recurrence varies, many products are marketed worldwide to reduce the symptoms and the duration.

A systematic review from 2008 compiled data from questionable quality studies and found that most of the treatment provided with corticosteroid compared to placebo showed a reduction of the healing time and an improvement of pain.2The present study seems to appropriately answer the question with a properly constructed short research design with regard to the effectiveness of a therapy for a common oral lesion seen in clinical practice. Several features are presented to attempt to minimise the risk of bias. The sample size necessary for the study was calculated by a statistical analysis.

The blinded randomisation was done by a computerised system. The drop out rate was minimal. Blinding was done for the patients and treatment, and control groups were treated equally. Monitoring of the sites was done during and after the collection of data. Even though it is mentioned that clinicians and research assistants received training, and that each participant was measured and recorded by the same researcher, it is unclear about the blinding of the evaluator and calibration of them, and it is reported that a possible source of bias could happen in one of the centres.

The authors provided all of the data including confidence intervals, to calculate the true estimate and the magnitude of the treatment effect. Pain reduction was similar for all of the groups. However the variation and the reduction in size seem more clinically relevant in the treatment group than in the control group. At baseline, the treatment group had a mean size of the lesions that was larger than the control group. That difference in the lesion seems more relevant post treatment, which supports the effectiveness of the dexamethasone ointment. Overall, the short trial results seem to positively favour the use of simple application of a short-term steroid for the treatment of recurrent aphthous ulcers. The size of the lesion can be reduced with no immediate side effects. Cost, availability and acceptance are something that needs to be evaluated for the immediate use.

Practice point

  • A short study showed promising results for local dexamethasone ointment as an effective and safe treatment for recurrent aphthous ulcers.

  • Evidence shows that healing time seems to be reduced with dexamethasone but there is not any evidence for variation in pain relief against placebo.