Aphthous stomatitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* Regular, round/oval ulcers | * Regular, round/oval ulcers |
Revision as of 21:45, 25 December 2020
- Common condition characterised by the repeated formation of benign and non-contagious aphthae (mouth ulcers)
- Also known as "canker sores" (especially in North America)
- Classification:
- Simple aphthosis
- Most common form of the disease
- This is also called Mikulicz ulcers
- Individual usually experiences several episodes per year
- Usually one to several ulcers lasting up to 14 days
- Ulcers limited to oral mucosa
- Complex aphthosis
- Ulcers can involve oral and genital mucosa
- Usually ulcers are larger (>1cm) and can take several weeks to resolve
- Some experience such frequent episodes that they are rarely without ulcers
- Must exclude diagnosis of Behçet's syndrome before diagnosis is made
- Simple aphthosis
Epidemiology
- Common worldwide - highest prevalence in Middle East, Mediterranean and South Asia [1]
- Most individuals start developing recurrent aphthae during adolescence
- May decrease in later years and may spontaneously resolve for some
- More common in higher socioeconomic group
- ♀ > ♂
Clinical Features
- Regular, round/oval ulcers
- Painful
- Erythematous border
- Recur on regular basis
- Three different ulcer morphologies exist:
Minor | <1cm ∅ (usually 3-5mm)
Classically grey ulcer base that becomes yellow with an erythematous halo as it heals Usually solitary but can occur in clusters of up to ~6 Occur predominantly on non-keratinised mucosa 7-10 days to heal Heal without scarring Recur at intervals of 1-4 months |
---|---|
Major | >1cm ∅
More painful than minor morphology Keratinised and non-keratinised mucosa equally involved Recur more regularly than minor Can take up to 1 month to heal Can heal with scarring Recur frequently |
Herpetiform | Clusters of small ulcers (1-2mm) ← initially present as crops of vesicles that quickly develop into ulcers
Can coalesce to form larger ulcers Keratinised and non-keratinised mucosa equally involved Heal in ~10 days Can recur very frequently |
Differential Diagnosis
Aetiology and Pathogenesis
- Aetiology and pathogenesis are largely unknown (likely multifactorial)
- Theories suggest altered immune regulation involving oral mucosa → exaggerated pro-inflammatory process and/or weak anti-inflammatory response [2]
- Genetic predisposition possible (common for patients to have family history of RAS)
- Certain foods as well as vitamin/mineral deficiencies have been implicated but no strong evidence
- Sodium lauryl sulfate (found in toothpastes) can make RAS worse/more frequent for some patients [3]
- Some observational evidence suggesting smoking confers some protection
- Stress and hormonal disturbances can also be predisposing factors
Management
- Rule out differentials (if differentials suspected/identified these need to be addressed)
- Correct any underlying deficiencies
- Good oral hygiene and avoidance of precipitating factors
- Chlorhexidine mouthwash can help prevent superinfection
- Alleviate symptoms (analgesia)
- Benzydamina mouthwash (Difflam)
- Lidocaine barrier gels
- Oral analgesia (paracetamol)
- Topical corticosteroids
- No evidence that adrenal suppression occurs with long-term/repeated application
- Examples:
- Hydrocortisone
- Betamethasone phosphate - 0.5mg tablets, every 6 hours, use as mouthwash
- Triamcinolone
- Beclometasone - metered dose inhaler applied topically - 1 puff [200mg] to lesion every 6 hours
- Topical tetracycline mouthwash
- Rarely used
- Reduces severity but not course
- Avoid in <12yrs old due to tetracycline staining of developing teeth
Prognosis and Complications
- Symptoms tend to decrease with age (especially in edentulous)
- Patients should be reassured that these are common and whilst no cure exists, they can be controlled
- No long-term consequences are known
Images
References
- ↑ Chattopadhyay, Amit, and Kishore V Shetty. “Recurrent aphthous stomatitis.” Otolaryngologic clinics of North America vol. 44,1 (2011): 79-88, v. doi:10.1016/j.otc.2010.09.003
- ↑ Slebioda, Zuzanna et al. “Etiopathogenesis of recurrent aphthous stomatitis and the role of immunologic aspects: literature review.” Archivum immunologiae et therapiae experimentalis vol. 62,3 (2014): 205-15. doi:10.1007/s00005-013-0261-y
- ↑ Herlofson, B B, and P Barkvoll. “Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study.” Acta odontologica Scandinavica vol. 52,5 (1994): 257-9. doi:10.3109/00016359409029036