Recurrent aphthous stomatitis is a frequent illness in which painful ulcers repeat on the oral mucosa in round or oval shapes. The cause is unknown. The diagnosis is made on the basis of clinical evidence. Topical corticosteroids are commonly used in symptomatic treatment.
At some point in their lives, 20 to 30 percent of adults and a higher percentage of children will develop recurrent aphthous stomatitis (RAS).
Etiology of Recurrent Aphthous Stomatitis
Although the cause is unknown, recurrent aphthous stomatitis (RAS) is known to run in families. T–cells are mostly responsible for the damage. Cytokines such IL-2, IL-10, and especially TN-alpha are involved.
Predisposing factors include the following:
Chocolate, coffee, peanuts, eggs, cereals, almonds, strawberries, cheese, and tomatoes are all stress foods.
Allergies do not appear to be a factor.
Oral contraceptives, pregnancy, and tobacco, including smokeless tobacco and nicotine-containing tablets, are all factors that may be protective for unknown reasons.
Symptoms and Signs of Recurrent Aphthous Stomatitis
Symptoms and indications typically begin in childhood (80% of patients are under 30 years old) and gradually diminish in frequency and severity as people get older. Symptoms might range from a single ulcer every 2 to 4 months to an almost constant condition with new ulcers growing as old ones heal. Ulcers are preceded by a prodrome of discomfort or burning that lasts 1 to 2 days, although there are no vesicles or bullae. Pain that is disproportionate to the size of the lesion might linger anywhere from four to seven days.
Aphthous ulcers have a necrotic center with a yellow-gray pseudomembrane, a red halo, and slightly elevated red edges and are well-demarcated, shallow, oval, or circular.
Minor aphthous ulcers account for 85% of cases.
They appear on the floor of the mouth, the lateral and ventral tongue, the buccal mucosa, and the throat are less than 8 mm in diameter (usually 2 to 3 mm), and heal without scarring in 10 days.
Major aphthous ulcers
Sutton disease, also known as periadenitis mucosa necrotic recurrens, accounts for 10% of all cases. The prodrome is more acute after puberty, and the ulcers are deeper, larger (> 1 cm), and stay longer (weeks to months) than mild aphthae. Lips, soft palate, and throat are all affected. Fever, dysphagia, malaise, and scarring are all possible side effects.
Herpetiform aphthous ulcers
Viruses that are morphologically similar to herpesvirus but are unrelated to it account for 5% of cases. They start as a series of 1- to 3-mm crops of tiny, painful ulcer clusters on an erythematous base (up to 100). They join together to develop bigger ulcers that remain for two weeks. They are more common in women and appear at a later age than other types of recurrent aphthous stomatitis.
Diagnosis of Recurrent Aphthous Stomatitis
The procedure for evaluating stomatitis is the same as stated earlier. Because there are no clear histologic characteristics or laboratory tests, the diagnosis is solely on appearance and exclusion.
Primary oral herpes simplex might seem like recurrent aphthous stomatitis (RAS), but it frequently affects younger children, always affects the gingiva, and can affect any keratinized mucosa (hard palate, connected gingiva, dorsum of tongue), as well as cause systemic symptoms. Herpes simplex can be diagnosed via viral culture. The majority of recurrent herpetic lesions are unilateral.
Behçet disease, inflammatory bowel disease, celiac disease, HIV infection, periodic fevers with aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, and nutritional deficiencies all have similar recurrent episodes, often with multiple ulcers; these conditions all have systemic symptoms and signs. Herpes infection, HIV, and, in rare cases, nutritional inadequacy can cause isolated recurrent mouth ulcers. These disorders can be detected with viral testing and serum hematologic assays.
Drug reactions may resemble RAS, but they are frequently timed to coincide with consumption. However, responses to foods or dental products can be difficult to detect, necessitating successive removal.
Treatment Recurrent Aphthous Stomatitis
- Corticosteroids and topical chlorhexidine
Patients with recurrent aphthous stomatitis may benefit from general stomatitis therapy (RAS).
The basics of therapy, chlorhexidine gluconate mouthwashes, and topical corticosteroids, should be used during the prodrome if appropriate. Dexamethasone 0.5 mg/5 mL 3 times a day as a wash and then expectorated, or clobetasol 0.05 percent or fluocinonide 0.05 percent in carboxymethylcellulose mucosal protective paste (1:1) administered 3 times a day. Candidaemia should be checked in patients using these corticosteroids. Prednisone (eg, 40 mg orally once a day) may be required if topical corticosteroids are ineffective.
RAS that is persistent or extremely severe should be treated by an oral medicine specialist. Systemic corticosteroids, azathioprine or other immunosuppressants, pentoxifylline, or thalidomide may be required for treatment. Betamethasone, dexamethasone, or triamcinolone can be injected intralesionally. In some patients, taking more B1, B2, B6, B12, folate, or iron helps to reduce RAS.