Recurrent aphthous stomatitis: Clinical characteristics and associated systemic disorders

Abstract

Recurrent aphthous stomatitis (RAS), commonly known as canker sores, has been reported as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. One of its variants is the most painful condition of the oral mucosa. Recurrent aphthous stomatitis has been the subject of active investigation along multiple lines of research, including epidemiology, immunology, clinical correlations, and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MiAU, MjAU, HU) and severity (simple versus complex). The natural history of individual lesions of RAS is important, because it is the bench mark against which treatment benefits are measured. The lesions of RAS are not caused by a single factor but occur in an environment that is permissive for development of lesions. These factors include trauma, smoking, stress, hormonal state, family history, food hypersensitivity and infectious or immunologic factors. The clinician should consider these elements of a multifactorial process leading to the development of lesions of RAS. To properly diagnose and treat a patient with lesions of RAS, the clinician must identify or exclude associated systemic disorders or "correctable causes." Behçet's disease and complex aphthosis variants, such as ulcus vulvae acutum, mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome, fever, aphthosis, pharyngitis, and adenitis (FAPA) syndrome, and cyclic neutropenia, should be considered. The aphthous-like oral ulcerations of patients with human immunodeficiency virus (HIV) disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause," which, with appropriate treatment, can result in a remission or substantial lessening of disease activity.

Relationship of Recurrent Aphthous Stomatitis with Nutritional Habits

“…None declared herpetiform type. The previous studies reported that oral ulcers occured more frequently on non-osseous sides of oral cavity [13]. In our study the most frequent localizations of oral ulcers were buccal mucosa and labial mucosa followed by tongue , gingival mucosa, palatal mucosa and tonsilla palatina.…”

“…4% of the subjects declared that they had no subjective symptome caused by the oral ulcer. Fever, exhaustion, musculoskeletal pain, lymphadenopathy, nausea and vomitting are other reported symptomes declared by subjects with RAS in the literature [13,14]. 20% of the subjects in RAS group,12.7% of the subjects in control group had a family history for recurrent oral ulcers.…”

Increased Anxiety Level and High Salivary and Serum Cortisol Concentrations in Patients with Recurrent Aphthous Stomatitis

“…The aetiopathogenesis of RAS appears to be complex, interactions with genetic, nutritional, and hematologic factors are reported (Rogers 1997;Saral et al 2005). Much has now been clarified about the mechanisms involved, and interesting new associations such as the involvement of a T cell mediated immunologic reaction have emerged (Natah et al 2000).…”

Recurrent aphthous stomatitis: An overview

“…7 In pregnancy period especially in first trimester, RAS tend to be increased. 8 24 Females are affected mostly and it occurs in late age. 27 b. Herpetiform ulcers are small, grey in color, have no marked border, usually 1-2 mm in diameter, appear in clusters and multiple ulcers (5 to 100 in numbers) can be present at the same time ( Fig.…”