Urban legends: recurrent aphthous stomatitis

Abstract

Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet’s disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases (e.g., celiac disease and B12 deficiency)? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested that: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with celiac disease; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, though potential for bias was high.

Oral cancer: A new therapeutic agent

“…Aphthous ulceration is common but generally poorly responsive to antibiotics and antipyretics, and the range of agents trialled is testimony to their low efficacy. 1 Some ulceration that clinically mimics aphthae is serious and the differential diagnosis in a patient with oral ulceration and systemic lesions, such as genital ulceration, accompanied by fever, skin rashes and arthritis includes the possibility of aphthous-like ulceration 2 such as seen in Behcet syndrome 3 or other auto-inflammatory diseases. 2 These are disorders of innate immunity characterised by an exaggerated inflammatory response in the absence of autoantibodies or any identifiable infection which manifest as recurring ulcers but closer scrutiny will reveal episodes of fever and systemic inflammation affecting other mucosae, skin and joints -and with raised inflammatory markers such as the erythrocyte sedimentation rate.…”

Coeliac disease in children – an update for general dental practitioners

“…RAU in association with CD is predominantly of the minor variant with the average ulcer size being 5 mm with a non-keratinised mucosal distribution 5 . Clinically indistinguishable ulceration can be associated with conditions other than CD such as immunodeficiency states and Crohn's disease.…”

“…While the exact cause of RAU in CD remains unknown; it may be potentially related to nutrient deficiencies associated with low serum iron, folic acid and vitamin B12. 5,12,29 RAU often regresses with the implementation of a GFD 29 .…”

“…Appropriate referral may allow interception of CD in its subclinical form 4 . It is important to remember that children with undiagnosed CD may have no other symptoms than the oral and dental abnormalities 5 . Early referral and diagnosis of CD is important to prevent associated complications.…”

Treatment of Recurrent Aphthous Stomatitis by 100% Topical Pumpkin Seed Oil

“…There are many therapeutic agents that have been used in treatment of RAS aiming to reduce the frequency of ulceration and to minimize the discomfort that associated with disease activity but the doctors and patients aims are to have full recovery and even cure, these agents include: chlorhexidine [4]; topical honey [25]; 5% lactic acid mouth wash [26]; Nigella sativa oil [27]; tetracyclin and their derivative (doxycycline and minocycline) [28]; BCG vaccine [29]; oral dapson and zinc sulfate [30]; oral steroid [31]- [34]; oral colchicine [35]; and oral clofazimine [31]. Recently, an Iraq study showed that oral isotretinoin had an effective therapeutic and prophylactic role in management of RAS [36].…”