Review Article

Effectiveness of Laser Therapy in the Management of Recurrent Aphthous Stomatitis: A Systematic Review

Table 4

Details of the effects of different intervention measures for RAS patients in the included studies.

StudyIntervention measures Pain scoring systemsOutcomesSide effects
(Laser group/control group)

Zand et al., 2009 [36]CO2 laser/placebo “laser”VAS (10 cm) systemHealing time: NR
Changes in pain level: immediately after treatment, these differences were statistically significant between study groups ()
Laser group: noncontact pain: 6.2 ± 1.3 (baseline) → 0.07 ± 0.3 (immediately); contact pain: 8.4 ± 1.3 (baseline) → 0.7 ± 0.8 (immediately)
Placebo group: not changed
At 4 h, 8 h, 12 h, 24 h, 48 h, 72 h, and 96 h after laser treatment, these differences of both noncontact and contact pain were significant compared to control group ()
Size of ulcers: NR
No

Zand et al., 2012 [37]CO2 laser/placebo “laser”NRHealing time: 4.8 ± 2.4 days in the laser group and 7.6 ± 2.5 days in the placebo group ( = 0.02)
Changes in pain level: NR
Size of ulcers: NR
No

Prasad and Pai, 2013 [38]CO2 laser/placebo “laser”A numerical rating scale of 0–10Healing time: 4.08 ± 0.81 days in the laser group and 7.84 ± 0.90 days in the placebo group ()
Changes in pain level: Immediately after treatment, these differences were statistically significant between study groups ().
Laser group: 8.48 ± 0.71 (baseline) → 0.68 ± 0.63 (immediately); Placebo group: 8.08 ± 0.70 (baseline) → 7.96 ± 0.84 (immediately)
At day 1, laser group also showed a significant reduction in pain compared to placebo group ()
Size of ulcers: NR
No

Sattayut et al., 2013 [40]CO2 laser/placebo “laser”VAS (100 mm) systemHealing time: NR
Changes in pain level: Although the pain scores after treatment and daily activity-disturbance scores of the laser group were lower than the placebo group in every point of assessment, a statistically significant difference of the pain score between the groups was found only on day 3 (). The immediate pain reliefs between the groups were not achieved.
Pain scores after treatment (Laser group; Placebo group):
40.99 (baseline 1) → 42.67 (baseline 2) → 25.39 (immediately) → 38.92 (day 1) → 33.25 (day 2) → 21.45 (day 3) → 3.03 (day 5) → 0 (day 7);
45.17 (baseline 1) → 56.85 (baseline 2) → 32.98 (immediately) → 42.43 (day 1) → 34.98 (day 2) → 33.22 (day 3) → 7.36 (day 5) → 0.44 (day 7)
Daily activity-disturbance scores (Laser group; Placebo group):
39.38 (baseline 1) → 43.54 (baseline 2) → 24.25 (immediately) → 34.31 (day 1) → 28.21 (day 2) → 17.98 (day 3) → 0 (day 5) → 0 (day 7);
52.40 (baseline 1) → 65.65 (baseline 2) → 39.70 (immediately) → 52.61 (day 1) → 40.12 (day 2) → 39.82 (day 3) → 7.22 (day 5) → 0 (day 7)
Size of ulcers (mm2): There was no statistically significant difference in the size of ulcers between the laser groups and the placebo groups.
Laser group: 4.25 (baseline 1) → 4.00 (baseline 2) → 4.75 (day 1) → 5.25 (day 2) → 7.00 (day 3) → 4.50 (day 5) → 2.00 (day 7);
Placebo group: 3.00 (baseline 1) → 4.75 (baseline 2) → 6.25 (day 1) → 6.00 (day 2) → 4.50 (day 3) → 2.50 (day 5) → 1.00 (day 7)
No

Aggarwal et al., 2014 [34]AMD laser/placebo “laser”VAS (10 cm) systemHealing time: 3.05 ± 1.10 days in the laser group and 8.90 ± 2.45 days in the placebo group ()
Changes in pain level: The laser group showed a statistically significant reduction in pain scores from baseline values as compared to the sham controlled group at immediately, day 1, day 2, day 3 after laser treatment.
Laser group: 4.79 ± 0.86 (immediately); 4.58 ± 1.2 (day 1); 5.41 ± 2.04 (day 2); 4.72 ± 1.22 (day 3)
Placebo group: 0.13 ± 0.35 (immediately); 0.17 ± 0.38 (day 1); 0.48 ± 1.57 (day 2); 0.79 ± 0.62 (day 3)
Size of ulcers (mm): The laser group showed a statistically significant reduction in lesion size from baseline values as compared to the controlled group at immediately, day 1, day 2, day 3 after laser treatment.
Laser group: no change (immediately); 0.65 ± 0.6 (day 1); 1.79 ± 0.94 (day 2); 3.17 ± 1.03 (day 3)
Placebo group: no change (immediately); 0.10 ± 0.3 (day 1); 0.17 ± 0.38 (day 2); 0.48 ± 0.57 (day 3)
No

Albrektson et al., 2014 [35]GaAlAs laser/placebo “laser”VAS (100 mm) systemHealing time: NR
Changes in pain level: the laser group showed a statistically significant reduction in pain scores as compared to the placebo group ()
Laser group: 81.7 (baseline) → 56.2 (day 1) → 31.5 (day 2); Placebo group: 84.7 (baseline) → 80.7 (day 1) → 76.1 (day 2)
The difference was also significant when comparing the percentage for participants who reported moderate or severe difficulty with daily activities between the laser and the placebo group ()
Size of ulcers: NR
No

Tezel et al., 2009 [41]Nd:YAG laser/medication (triamcinolone acetonide)VAS (10 cm) systemHealing time: NR
Changes in pain level: laser treatment always presented with a significantly greater efficacy in ulcer pain relieving than medical therapy on days 1, 4, and 7 ().
Laser group: 7.87 ± 0.78 (before treatment) → 1.34 ± 0.76 (day 1) → 0.18 ± 0.23 (day 4) → 0 (day 7)
Medication group: 7.72 ± 0.67 (before treatment) → 6.19 ± 0.76 (day 1) → 3.71 ± 0.69 (day 4) → 0.54 ± 0.60 (day 7)
The difference was also significant when comparing the pains of daily activity-disturbance such as chewing and speaking between the laser and the medication group ()
Change in erythema and exudation level (signs of healing): there were no statistically significant differences at any time point during the study between groups in erythema. Laser group had a significantly lower exudation ( < 0.05) than medication group at the final patient visit at the end of the study
Erythema (laser group; medication group): 1.91 ± 0.43 (baseline) → 0.09 ± 0.29 (posttreatment); 2.04 ± 0.48 (baseline) → 0.17 ± 0.39 (posttreatment)
Exudation (laser group; medication group): 2.23 ± 0.61 (baseline) → 0.14 ± 0.57 (posttreatment); 2.34 ± 0.77 (baseline) → 0.43 ± 0.51 (posttreatment)
Size of ulcers: NR
No

De Souza et al., 2010 [39]InGaA1P diode laser/medication (triamcinolone acetonide)A numerical rating scale of 0–3Healing time: there was no statistically significant difference in the healing times between the laser group and the medication group ( = 0.4345)
Changes in pain level: NR
Size of ulcers: NR
No

Lalabonova and Daskalov, 2014 [42]SIX Laser TS diode laser system/medication (Granofurin and solcoseryl)A 10-point visual analog scale systemThe authors reported the percentage of patients in pain levels and erythema and epithelization levels at different time point of assessment (before treatment and on days 1, 2, 3, and 5)
Changes in pain levels: 0 points (no pain); 1 to 5 points (mild pain); 6 to 10 points (severe pain)
Laser group showed a statistically significant reduction in pain levels as compared to medication group in every point of assessment (excepting on day 1, mild pain) with a value < 0.01.
Healing time/change in erythema and epithelization levels (signs of healing)Erythema levels: erythema, erythema decreases, no erythema; epithelization levels: no epithelization, initial epithelization, epithelization completed
At day 3 in laser group, all of the patients were pain-free and had their ulcers successfully treated, while the patients in medication group still felt some pain and their ulcers were failed to be successfully treated even at day 5
Erythema and epithelization processes were evolving through several levels. In nearly every point of assessment (days 1, 4, and 7), laser treatment presented with a significantly greater efficacy in patients than medical therapy ()
Size of ulcers: NR
No

Jijin et al., 2016 [43]AMD laser/medication (5% amlexanox)A numerical rating scale of 0–10Healing time: NR
Changes in pain level: the difference in pain levels between the amlexanox group and the laser group was significant on the third day ( = 0.006); however, the difference was not significant on the seventh day ( = 0.171)
Laser group: 6.80 (day 1) → 5.20 (day 3) → 2.64 (day 7); Medication group: 6.36 (day 1) → 4.16 (day 3) → 1.8 (day 7)
Size of ulcers (mm): both therapies resulted in a significant reduction in the sizes of ulcers on day 3 and day 7 compared with the first day of treatment. However, the difference was not statistically significant between these two therapies both on day 3 () and on day 7 ()
No

NR: not reported.