Mouth ulcers or recurrent aphthous stomatitis can affect up to 25% of the population. They have been linked with genetic predisposition, local trauma, stress, systemic diseases, immunological disturbances and nutrient deficiencies. Treatment is usually symptomatic and has included, systemic and topical corticosteroids, antibiotics, vitamin B complex, adhesives, topical antiseptics, analgesics, anti-inflammatory agents, mouthwashes with active enzymes, cautery, and photobiomodulation.
The aim of this review was to assess the efficacy of vitamin B in treating mouth ulcers.
Methods
Searches were conducted in the PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases. Randomised controlled trials (RCTs) published in English and Chinese between 2010 and 2021 were considered. Two reviewers independently screened the studies, extracted data and assessed study quality. Data were presented as odds ratio (OR) and its 95% confidence interval (CI) or standardized mean difference (SMD) and its 95% CI and meta-analyses conducted.
Results
- 16 RCTs involving a total of 1534 patients (767 treatment, 767 controls) were included.
- Treatment was significantly more effective in the vitamin B group, OR = 5.24 (95%CI; 3.27 to 7.37) [16 studies].
- Recurrence rate was lower in the in the vitamin B group, OR = 0.194 (95%CI; 0.128 to 0.295) [11 studies].
- Ulcer healing time in the vitamin B group was reduced to 15 days compared with the control group, SMD = –2.15 (95%CI; –2.80 to –1.50) [6 studies].
- Treatment time was reduced in the vitamin B group by 2.32 days compared with controls, SMD = –2.32 (95%CI; -1.96 to -2.67) [6 studies].
Conclusions
The authors concluded: –
…both vitamin B alone or vitamin B combined with pantothenic acid are effective in treating mouth ulcers. In addition to its effectiveness, vitamin B also significantly reduces the possibility of recurrence, accelerates ulcer healing, and shortens the course of treatment. Collectively, vitamin B has a high clinical value in treating patients with mouth ulcers.
Comments
A 2012 Cochrane review looking at systemic interventions for recurrent aphthous stomatitis only included 1 RCT assessing sublingual vitamin B12 which provided insufficient evidence to support or refute its effectiveness (Dental Elf – 14th Sep 2012). This new review has looked at RCTs involving vitamin B published since 2010. A good range of databases has been searched with only English and Chinese publications being included which may have excluded some relevant papers and all the included studies are Chinese. While the authors indicated they have assessed study quality no indication of the approach used, or details of the assessment are presented. Recurrent aphthous stomatitis (RAS) is the most frequent form of mouth ulceration. Major, minor and herpetiform forms of RAS are recognised but there is no indication of the clinical types of ulcers treated in the review although they did exclude ulceration caused by other clinical treatments or diseases. There is also no indication of the duration of treatment and a variety of vitamin B preparations were utilised with 3 studies also including antibiotics as co-interventions. As this review suggests that vitamin B may be helpful for patients their investigating vitamin B levels may be helpful particularly for those who do not respond to topical treatment.
Links
Primary Paper
Shi J, Wang L, Zhang Y, Zhi D. Clinical efficacy of vitamin B in the treatment of mouth ulcer: a systematic review and meta-analysis. Ann Palliat Med. 2021 Jun;10(6):6588-6596. doi: 10.21037/apm-21-1064. Epub 2021 Jun 16. PMID: 34154361.
Other references
Dental Elf – 14th Sep 2012
No single systemic treatment was found to be effective for treatment of mouth ulcers
Dental Elf – 30th Oct 2019
Vitamin D deficiency: Is it a risk factor for recurrent aphthous stomatitis?
Dental Elf – 12th Mar 2021
Picture Credits
“vitamin-b” by vitamina.verde is licensed under CC BY 2.0
Thank you
I am a masters level Registered Nurse