Recurrent Apthous Stomatitis
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Recurrent Apthous Stomatitis

Oral Aspects Of Metabolic Diseases

Oral Pathology And Medicine

RECURRENT APTHOUS STOMATITIS

Contributed By: Dr. Himani

DEFINITION

It is a common disease characterized by development of painful, recurrent, solitary or multiple ulcerations of oral mucosa where the ulcers heal spontaneously and there are no signs of any other disease.



ETIOLOGY

Immunological abnormalities:

Mucosal destruction occurs due to T cell mediated immunological reaction.

Genetic predisposition:

Increased susceptibility is seen in recurrent apthous stomatitis positive parents.

Microbial oraganism:

L form of alpha -hemolytic streptococcus & streptoccocus sanguis has been implicated as the causative agent of the disease.

Systemic factors:

Some patients have nutritional deficiency such as vitamin B12, folic acid and iron.

Endocrine condition:

There is remission of ulcers during pregnancy.Incidence of apthous ulcers are greatest during menstruation.

Stress:

More apthous ulceration is seen during exam period and less ulceration in vacation.

Cessation of smoking:

It increase the frequency and severity of recurrent Apthous stomatitis.



CLASSIFICATION OF APTHOUS ULCERS:

ACCORDING TO MORPHOLGY:-

1. Minor aphthae:-

  • Also called as "canker sores"
  • Less than 1cm in diameter

2. Major aphthae

  • Also called "sutton’s disease"
  • Ulcers are over 1cm in diameter.

3. Herpetiform ulcers:

  • Ulcers are less than 0.5 cm in diameter.

ACCORDING TO SEVERITY:-

1. Simple aphthosis:

  • Recurrent attacks of any morphology of aphthae with distinct ulcer free period.

2. Complex aphthosis:

  • Presence of three or more than three oral ulcers or recurrent orogenital aphthosis


CLINICAL FEATURES

  • Age :- Usually occurs between second and third decades of life.
  • Sex:- More common in women than men.
  • Site:- Occurs most commonly on non keratinized mucosa.
  • Prodormal symptoms:- It begins with burning, itching, or stinging for 24 to 48 hours, before the ulcer appears.
  • Symptoms:- Lesion is typically painful, so commonly interferes with eating for several days.
  • Signs:- It begins as a single or multiple superficial erosion covered by grey membrane.It is surrounded by localized area of erythema and developed within hours.
  • Shape:- Lesions are round, symmetric and shallow.
  • Course of disease:- Ulcers persist for 7 to 14 days, may recur after 1-4 months with no evidence of scarring.


DIAGNOSIS

  •  Clinical diagnosis : It is made from clinical presentation and exclusion of other systemic disease.

Image - recurrent aphthous stomatitis



DIFFERENTIAL DIAGNOSIS

  • Recurrent herpes simplex infection
  • Bednar’s aphthae
  • Cyclic neutropenia
  • Lupus erythematosus
  • Erosive lichen planus
  • Primary syphilitic lesion
  • Herpangia
  • Squamous cell carcinoma
  • Hand, foot and mouth disease


MANAGEMENT

Three types of treatment can be done:-

  • TOPICAL TREATMENT
  • SYSTEMIC TREATMENT
  • SURGICAL TREATMENT

TOPICAL TREATMENT

Topical corticosteriod:-

  • 0.1% triamcinolone acetonide 3- 4 times daily
  • 0.05% betamethasone diproprionate
  • 0.05 % clobetasol propionate gel can be used

Topical anesthetics:-

  • 2% viscous lidocaine , benzocaine and bezydamine hydrochloride may reduce pain

Sucaralfate:-

  • Topical application 4 times a day shows soothing effect

Tetracycline mouth wash:-

  • 250 mg per 30 ml, 4 times daily for 5 to 7 days

Intralesional injection of steriod:-

  • Triamcenalone acetonide (0.1- 0.5ml/ lesion)
  • Betamethasone propionate may retard major aphthous ulcer

Beclomethasone dipropionate spray:-  It is recommended in severe cases of aphthous ulcer


SYSTEMIC TREATMENT

Systemic steriods:

  • Prednisolone tab 20-30 mg/day for 4 to 8 days
  • Betamethasone 2-3 mg/day for 4 to 8 days
  • Intravenous pulse therapy at 100mg/day for 3 days

Other medications:

  • Dapsone 100mg/day
  • Azelastine hydrochloride
  • Cyclosporine
  • Gamma globulin

SURGICAL TREATMENT

Laser surgery:

  • ND:YAG laser
  • CO2 laser

Local cauterization:

  • Applications of hydrogen peroxide 0.5% solution, silver nitrate 1-2 % solution can reduce duration of solitary aphthae


REFERENCES

  • Textbook of Oral Medicine 3rd edition by Anil Ghom, pg no -359 to 364.
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