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Aphthous Stomatitis

Clinical case examples of canker sores
Joanna Douglass, BDS, DDS

Recurrent aphthous stomatitis (RAS)—also known as "canker sores"—is an oral ulcerative condition. Although a variety of host and environmental factors have been implicated, including trauma, nutritional deficiencies, and autoimmunity, the precise etiology remains unknown. 

Three Clinical Forms
1. Minor (< 7mm in diameter), most common
Appears as rounded, well-demarcated, single or multiple ulcers that usually heal in 10–14 days without scarring
2. Major(>7 mm in diameter)
Usually take longer than 14 days to heal and may result in scarring
3. Herpetiform

Recurring, painful, solitary, or multiple ulcers
Typically covered by a white to yellow pseudomembrane surrounded by an erythematous halo
Usually involves nonkeratinizing mucosa (e.g., labial mucosa, buccal mucosa, and ventral tongue)

Preventive Measures & Treatment

Most mild aphthae require no treatment.
Application of Orabase, with or without topical steriods can be used for symptomatic relief.
Topical treatment with corticosteroids, such as fluocinonide gel or dexamethasone elixir, can promote healing and lessen severity.
Steroid injection of ulcers or systemic therapy with thalidomide, colchicine, pentoxifylline, or azathioprine may be necessary in severe cases, especially with major aphthae.
Avoiding trigger foods or sodium lauryl sulfate in toothpaste can help reduce recurrences.
Celiac disease should be considered in patients with recurrent aphthous ulcers or stomatitis.

Neville BW, Damm DD, Allen CM, Bouqout JE. Recurrent aphthous stomatitis (recurrent aphthous ulcerations; canker sores). In: Oral & Maxillofacial Pathology. Philadelphia: W.B. Saunders Company; 2002. p. 285-90.

Eisenberg E. Diagnosis and treatment of recurrent apthous stomatitis. Oral Maxillofacial Surgery Clinics of North America 2003;15:111-22.

Chahine L, Sempson N, Wagoner C. The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study. Compend Contin Educ Dent. 1997 Dec;18(12):1238-40.

Liu C, Zhou Z, Liu G, et al. Efficacy & Safety of dexamethasone ointment on RAU. Am J. Med. 2012; 125(3): 292-301.
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