Oral Ulceration and Medicinal Plants for Treatment: A Critical Narrative Review with Emphasis on Recurrent Aphthous Stomatitis

Abstract

Oral ulcers are a frequent clinical problem but represent a heterogeneous group of lesions rather than a single disease. Their management therefore begins with diagnosis: traumatic, infectious, immune-mediated, drug-associated, systemic and potentially malignant causes require different responses. Recurrent aphthous stomatitis is the principal focus of botanical treatment research because it is common, painful, self-limiting and often recurrent despite conventional symptomatic therapy. This critical narrative review integrates evidence on the clinical assessment of oral ulceration, the pathobiology and management of recurrent aphthous stomatitis, and the therapeutic potential of medicinal plants. Literature was selected from major open scholarly sources using combinations of terms for oral ulceration, recurrent aphthous stomatitis, medicinal plants, herbal medicine, phytochemicals, randomised trials, pain, ulcer size, healing and recurrence. The evidence is strongest for topical botanical preparations evaluated in minor recurrent aphthous stomatitis, particularly curcumin derived from Curcuma longa, Aloe vera preparations, chamomile, liquorice, myrtle, pomegranate, sage and sumac. Across trials and systematic reviews, several agents reduce pain, ulcer dimensions or healing time, but confidence is constrained by small single-centre samples, variable plant identity and extraction methods, heterogeneous formulations and doses, short observation periods, incomplete blinding, active-comparator designs without non-inferiority margins, and the naturally resolving course of minor ulcers. Mechanistic plausibility based on anti-inflammatory, antioxidant, analgesic, antimicrobial and wound-healing actions is supportive but cannot substitute for clinical evidence. Botanical products should therefore be considered formulation-specific therapeutic candidates rather than interchangeable plant remedies. Progress requires authenticated plant material, chemically characterised preparations, placebo-controlled and adequately powered trials, recurrence-focused outcomes, rigorous adverse-event monitoring and direct comparisons with accepted topical therapy. Medicinal plants are promising adjuncts for appropriately diagnosed recurrent aphthous stomatitis, but they should not delay investigation of persistent, atypical or systemically associated oral ulceration.