Silver nitrate in the management of recurrent aphthous stomatitis: A systematic review and meta-analysis

Objectives: The aim of this systematic review and meta-analysis was to answer the following PICO question: what is the efficacy of silver nitrate, as compared to placebo, in managing the clinical symptoms of recurrent aphthous stomatitis (RAS)? Methods: A protocol was registered with PROSPERO (CRD42020193435). Four electronic databases (PubMed, Cochrane CENTRAL, EMBASE via OVID, Web of Science) were searched from inception to May 2020. Randomised controlled trials (RCTs) meeting the PICO criteria were included. Risk of bias was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using mean difference (MD) with 95 % confidence intervals (CI). Statistical heterogeneity was assessed through calculation of the I-2 index. Results: Three RCTs were identified comparing silver nitrate to placebo. Silver nitrate was found to resolve the clinical symptoms of RAS significantly quicker than placebo; MD: -2.52 days (95 % CI: -0.63 to -4.41, p = 0.009). Silver nitrate was found to re-epithelise the ulcers quicker than placebo, albeit insignificantly; MD: -1.44 days (95 % CI: 0.26 to -3.14, p = 0.10). No adverse events due to silver nitrate therapy were reported in any of the studies. Conclusions: The findings of this systematic review indicate that silver nitrate may be effective in managing the clinical symptoms of RAS, with no adverse events reported thus far. More high-quality RCTs are needed to validate these findings. (C) 2020 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.