Aloe vera for treatment of oral submucous fibrosis?

shutterstock_32414035 - Betel leaf

Oral submucous fibrosis (OSF) is an oral potential malignant disorder that commonly involves the buccal mucosa and results in a loss of tissue mobility and rigidity and eventually an inability to open the mouth. It is mainly seen in South east Asia affecting younger individual between the ages of 20-40. It has a marked male predilection and betel quid chewing, the excess use of chillies and spices as well as poor nutrition and iron and vitamin deficiency have been suggested as potential causative agents. A broad range of medical treatments have been used (intralesional steroids, hyaluronidase, lycopene, haemotrypsin, pentoxifylline and collagenase) to mixed effect.  Recently a number of studies have use aloe vera were variable effectiveness.

The aim of this review was to assess the effectiveness of aloe vera on alleviating the symptoms of oral submucous fibrosis.


Searches were conducted in the Medline/PubMed, Scopus and ISI Web of Knowledge databases. Randomised controlled trials (RCTs) published in English comparing topical or systemic aloe vera with other interventions or placebo were considered. Primary outcomes included improvement in severity of mucosal pain/burning sensation, changes in maximal interincisal mouth opening, change in tongue movement and cheek flexibility.

Two reviewers independently selected studies extracted data and assessed risk of bias using the Cochrane assessment tool. Meta‐analysis was undertaken where studies of similar comparisons reported the same outcome measures. Mean difference (MD) for the burning sensation, mouth opening, tongue protrusion, and cheek flexibility was calculated and compared between the two studied interventions.


  • 6 RCTs involving a total of 413 patients were included.
  • 5 studies used topical aloe vera gel, 1 study used topical and systemic aloe vera.
  • 5 studies were considered to be at high risk of bias and 1 at unclear risk.
  • A statistically significant reduction in pain in favour of the aloe vera group was seen a both 1 and two months;
    • 1 month MD =  −1.22 ( 95% CI: −2.35, −0.08)  [ 2 studies]
    • 2 months MD =  −1.33, 95% CI: −1.95, −0.72) [ 2 studies]
  • No statistically significant differences were seen for
    • Mouth opening
    • Tongue protrusion
    • Cheek flexibility


The authors concluded: –

The available evidence suggests that aloe vera may be effective in the management of OSF, without any side effects. Considering the analgesic and anti‐inflammatory benefits of aloe vera and the considerable side effects of other conventional therapies, aloe vera can be considered as a potential alternative therapy for the management of patients with OSF. Further well‐designed randomised controlled clinical trials are warranted to accurately assess the effectiveness of aloe vera in the management of OSF.


Two previous systematic review of treatments for oral submucous fibrosis (Fedorowicz  et al, and Kerr et al ) highlighted a lack of reliable evidence for any treatments for this chronic condition. Both of these reviews were conducted prior to the publication of the trials included in this new review which focuses on the use of aloe vera.

The authors have searched a number of databases but restricting the inclusion to English language articles may have excluded some studies.  Only one of the main outcomes (pain) was seen to improve and while there was a statistically significant improvement after 1 and 2 months this was no longer significant at 3 months follow up. No differences were seen in any of the other outcomes.

In common with limited quality of the studies available in the other reviews the RCTs included in this review were almost all considered to be at high risk of bias so the findings need to be considered very cautiously.  Well conducted and reported studies with larger sample size and commonly agreed outcome sets are clearly needed to properly evaluate potential treatments for this distressing chronic condition which has a malignant transformation rate said to be in the range of 7-13%.


Primary Paper

Al-Maweri SA, Ashraf S, Lingam AS, Alqutaibi A, Abdulrab S, Alaizari N, Halboub E. Aloe vera in treatment of oral submucous fibrosis: A systematic review and meta-analysis. J Oral Pathol Med. 2018 Oct 17. doi: 10.1111/jop.12789. [Epub ahead of print] Review. PubMed PMID: 30329174.

Original review protocol in PROSPERO

Other references

Fedorowicz  Z, Chan Shih‐Yen  E, Dorri  M, Nasser  M, Newton  T, Shi  L. Interventions for the management of oral submucous fibrosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007156. DOI: 10.1002/14651858.CD007156.pub2.

Kerr AR, Warnakulasuriya S, Mighell AJ, Dietrich T, Nasser M, Rimal J, Jalil A, Bornstein MM, Nagao T, Fortune F, Hazarey VH, Reichart PA, Silverman S, Johnson NW. A systematic review of medical interventions for oral submucous fibrosis and future research opportunities. Oral Dis. 2011 Apr;17 Suppl 1:42-57. doi: 10.1111/j.1601-0825.2011.01791.x. Review. PubMed PMID: 21382138.

Dental Elf – 3rd Jan 2012

Little evidence for drug treatments for oral submucous fibrosis



Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+