SummaryA series of 130 consecutive outpatients with recurrent aphthous stomatitis were screened at the oral medicine department, Glasgow Dental Hospital, for deficiencies in vitamin B12, folic acid, and iron. In 23 patients (17 7%) such deficiencies were found; five were deficient in vitamin B12, seven in folic acid, and 15 in iron. Four had more than one deficiency. Out of 130 controls matched for age and sex 11 (8 5%) were found to have deficiencies.The 23 deficient patients with recurrent aphthae were treated with specific replacement therapy, and all 130 patients were followed up for at least one year. Of the 23 patients on replacement therapy 15 showed complete remission of ulceration and eight definite improvement. Of the 107 patients with no deficiency receiving local symptomatic treatment only 33 had a remission or were improved. This difference was significant (P <0 001). Most patients with proved vitamin B12 or folic acid deficiency improved rapidly on replacement therapy; those with iron deficiency showed a less dramatic response.The 23 deficient patients were further investigated to determine the cause of their deficiencies and detect the presence of any associated conditions. Four were found to have Addisonian pernicious anaemia. Seven had a malabsorption syndrome, which in five proved to be a gluten-induced enteropathy. In addition, there were single patients with idiopathic proctocolitis, diverticular disease of the colon, regional enterocolitis, and adenocarcinoma of the caecum.We suggest that the high incidence of deficiencies found in this series and the good response to replacement therapy shows the need for haematological screening of such patients.

A series of 330 patients with recurrent aphthae was screened for deficiencies of iron, folate and vitamin B|2. In 47 patients (14.2 %) such deficiencies were found; 23 were deficient in iron, seven in folic acid, six in vitamin B|2 and in addition 11 patients had combined deficiencies.Clinical examination of the aphthae was not helpful in identifying individual patients with a nutritional deficiency although patients with an associated glossitis or angular cheilitis were more likely to suffer from such deficiencies.Screening of the patients by examination of their peripheral blood alone (estimation of haemoglobin and absolute values, and blood film examination) detected only a proportion of those with deficiencies of iron or folic acid, although in this series such screening was able to identify the small number of cases with vitamin B12 deficiency.The 39 patients with a proven nutritional deficiency who were available for follow-up showed a favourable response to corrective therapy; 23 showed a complete remission of ulcers, 11 were improved and five were not helped.The significance of these findings is discussed. It is suggested that the results indicate the need for lull haematological screening of all patients with recurrent aphthae.

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There is recent evidence to suggest that an autoimmune mechanism may be associated with the gastric mucosal changes found in pernicious anaemia. Markson and Moore (1962) and Irvine et al. (1962) found a complement-fixing antibody to gastric mucosa in the blood of 42% and 75% respectively of their patients with pernicious anaemia; and Taylor et al. (1962), using an immunofluorescent technique, demonstrated an organ-specific autoantibody in 85% of 100 patients. These last workers also showed that the antigen was localized in the cytoplasm of the parietal cells, and was recoverable in the " microsomal " fraction of homogenized gastric mucosa. The autoantibody to gastric parietal cells was shown to be quite distinct from the antibody to intrinsic factor first described by Taylor (1959

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