Guidelines for Diagnosis and Management of Aphthous Stomatitis

Abstract

Aphthous ulcers are the most common oral mucosal lesions in the general population. These often are recurrent and periodic lesions that cause clinically significant morbidity. Many suggestions have been proposed but the etiology of recurrent aphthous stomatitis (RAS) is unknown. Several precipitating factors for aphthous ulcers appear to operate in subjects with genetic predisposition. An autoimmune or hypersensitivity mechanism is widely considered possible. Sometimes aphthous ulcers can be the sign of systemic diseases, so it is essential to establish a correct diagnosis to determine suitable therapy. Before initiating medications for aphthous lesions, clinicians should determine whether well-recognized causes are contributing to the disease and these factors should be corrected. Various treatment modalities are used, but no therapy is definitive. Topical medications, such as antimicrobial mouth-washes and topical corticosteroids (dexamethasone, triamcinolone, fluocinonide, or clobetasol), can achieve the primary goal to reduce pain and to improve healing time but do not improve recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective.

Recurrent aphthous stomatitis: An overview

“…If these clinical features arise, other diseases such as IBD, HIV or any other autoimmune diseases should be taken in consideration. 29,30 Immunopathogenesis: It's still unclear about the documentation of immunological connection in pathogenesis of RAS. But it was reported earlier that both cell-mediated and humoral immune response is involved.…”

Recurrent Aphthous Stomatitis: Diagnosis and Management in Primary Care

“…They occur on the labial or buccal mucosa, soft palate, tongue or floor of the mouth. [1][2][3][4] There may be a prodromal burning or stinging sensation prior to appearance of the lesions. Scar formation does not occur with healing of minor aphthae.…”

“…Major aphthae may form a scar with healing. [1][2][3][4] Major aphthae can be seen with human immunodeficiency virus (HIV) infection, and HIV testing should be considered when major aphthae are present. 3 The herpetiform presentation is also rare, representing 10% or less of all RAS cases, and is defined by outbreaks of numerous, small, vesicular lesions.…”

“…Minor aphthae are by far the most common presentation of RAS, representing 80-85% of cases. [1][2][3][4] Ulcers are up to 1 cm in size, shallow and generally last 10-14 days. They occur on the labial or buccal mucosa, soft palate, tongue or floor of the mouth.…”

“…Scar formation does not occur with healing of minor aphthae. [1][2][3][4] Major aphthae are rare, representing approximately 10-15% of RAS cases. They are defined by ulcers larger than 1 cm, are generally deeper and have a longer duration than minor aphthae.…”