Aphthous Stomatitis
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
- Minor (< 7mm in diameter), most common
- Appears as rounded, well-demarcated, single or multiple ulcers that usually heal in 10–14 days without scarring
- Major(>7 mm in diameter)
- Usually take longer than 14 days to heal and may result in scarring
- Herpetiform
Symptoms
- 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)
Canker Sores
Preventive Measures & Treatment
- Â Most mild aphthae require no treatment.
- Application of benzocaine paste or gel (Orabase (R)), 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 of 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.
References
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.