Re: Effectiveness of Vitamin B₁₂ in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

To the Editor: I read with interest the original research article, “Effectiveness of Vitamin B₁₂ in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial” by Volkov et al.¹ As noted, this study suggests that daily 1000 mcg cyanocobalamin placed under the tongue may be preventive for recurrent aphthous stomatitis (RAS) after 5 months of use. Cyanocobalamin is not bioactive and must first be converted in the body to a bioactive form before it can be of benefit.

I would like to draw your attention to another study published by myself and Jeff Haley titled “Effect of Bioactive B₁₂ in Adhering Discs on Aphthous Ulcers.” This study, published October 2008 in Inside Dentistry with commentary by Howard E. Strassler, DMD,² suggests that 500 mcg bioactive methylcobalamin, when delivered daily into saliva via adherent discs that are adhered to the buccal side of a tooth and allow for a time release over 20 to 40 minutes (Avamin Melts, OraHealth, Bellevue, WA), may also be effective with respect to perceived improvement (reduced pain and duration) but with this occurring in as little as 4 weeks. This pilot study included a double-blinded, placebo-controlled trial (n = 15) and a nonblinded A-B-A assessment (n = 16).

It seems from these 2 studies that daily use of methylcobalamin time-released into saliva to allow for mucosal absorption may be an effective strategy for reducing the number, duration, and pain of recurrent aphthous ulcers, regardless of the level of underlying serum vitamin B₁₂ levels.