Recurrent Apthous Stomatitis

Definition of Recurrent Aphthous Stomatitis: A common oral disease characterized by the development of painful, recurring solitary or multiple ulcerations of the oral mucosa.

Synonyms:

1. Aphthous ulcers
2. Aphthae
3. Canker sores

Etiology of Recurrent Aphthous Stomatitis:

1. Bacterial infection – L form of streptococci – streptococcus sanguis – immunologic hypersensitivity reaction to L form of streptococci
2. Immunologic abnormalities – altered immune response against non pathogenic oral flora & host oral tissue
3. Iron, Vitamin B12 or folic acid deficiency
4. Emotional stress and lack of sleep
5. Mechanical trauma, for example self-inflicted bite
6. Nutritional deficiencies
7. Certain foods including chocolate
8. Certain toothpastes
9. Menstrual cycle

Precipitating Factors:

1. Trauma
2. Endocrine conditions
3. Pshychic factors
4. Allergic factors

Classification:

1. Recurrent aphthous minor
2. Recurrent aphthous major
3. Recurrent herpetiform ulcerations
4. Recurrent ulcers associated with Behcets syndrome

Recurrent Aphthous Minor:

Clinical Features:

Minor Aphthous Ulcer

Number: Single / multiple
Size – 2-3mm to 10mm
Site – labile mucosa not bound to periosteum – buccal & labial mucosa, buccal & lingual sulci, tongue, soft palate, pharynx & gingiva

Presents as well circumscribed superficial erosions covered by a gray membrane & surrounded by an erythematous halo

Recurrent Aphthous Major:

Age: no predilection
Sex: F > M

Clinical Features:

• 1-10 in number
• More than 5mm in diameter
• Large Ulcers which are mostly Painful

major aphthous ulcer

Site:  lips, cheeks, tongue, soft palate & fauces

Lesions occur at frequent intervals & persist upto 6 weeks; healing occurs with scarring.

Treatment of Aphthous Ulcers:

There is no medical treatment for aphthous ulcers.
Main concern for the Treatment is to decrease the discomfort of the patient and to promote the healing of Ulcers on their own.
Most recurrent minor aphthous ulcers heal within 1-2 weeks without any treatment and Major Aphthous Ulcers heal within 6 weeks.

General measures for Aphthous Ulcers Treatment:

• Antiseptic Gels should be used which as well act as a barrier from external irritation.
• Local anaesthetics benzocaine and lignocaine (lidocaine)
• Medicated toothpaste without sodium laureth sulfate
• Regular Mouth Wash usage which decrese the bacterial colonization
• Help the patient get out of Stress. (most common cause of aphthous ulcers is “Stress”)

Medication:

Topical Treatment:

• Lotions, creams and paste containing Topical corticosteroids
• Triamcinolone in dental paste
• Mouthwash containing Tetracycline

Systemic Medication – (Used only in Severe Cases)
Medications used are

• Anti-inflammatory
• Systemic steroids
• Immunosuppressive agents
• Tumour necrosis factor (TNF) antagonists (adalimumab, etanercept, infliximab)