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Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease of the oral mucosa.
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Several proposed etiologic theories are reviewed.
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Topical and systemic therapies that are used to manage RAS are presented.
Recurrent Aphthous Stomatitis
Section snippets
Key points
Epidemiology
Approximately 20% of the general population is affected by RAS, but incidence varies from 5% to 50% depending on the ethnic and socioeconomic groups studied.2, 3 The prevalence of RAS is influenced by the population studied, diagnostic criteria, and environmental factors.1 In children, prevalence of RAS may be as high as 39%, and is influenced by the presence of RAS in one or both parents.4 Children with RAS-positive parents have a 90% chance of developing RAS, compared with 20% of those with
Predisposing etiologic factors
The etiology of RAS lesions is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors have been proposed as causative agents. Moreover, some medications including immunosuppressive drugs such calcineurin and mammalian target of rapamycin (mTOR) inhibitors have been associated with severe aphthous-like stomatitis (Table 2).8, 9
Clinical manifestation and pathogenesis
RAS patients usually experience prodromal burning sensations that last from 2 to 48 hours before an ulcer appears. Ulcers are round with well-defined erythematous margins and a shallow ulcerated center, covered with yellowish-gray fibrinous pseudomembrane. RAS ulcers usually develop on nonkeratinized oral mucosa, with the buccal and labial mucosa being the most common sites, and last approximately 10 to 14 days without scar formation (see Table 1). The oral ulcers seen in Behçet disease are
Management
The proper treatment of RAS depends on the severity of symptoms and the frequency, size, and number of ulcers. Patients who experience occasional episodes of minor aphthous ulcers experience significant relief with appropriate topical therapy. Symptoms resulting from occasional small lesions are often adequately controlled with the use of a protective emollient such as Zilactin (Zila Pharmaceuticals, Phoenix, AZ) or Orabase (Bristol Myers Squibb, Princeton, NJ), either alone or mixed with a
Summary
RAS is the most common ulcerative disease affecting the oral mucosa, whose etiology remains unknown. RAS occurs mostly in healthy individuals and has a more severe clinical presentation in immunocompromised persons. Several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS is aimed at improving the function and quality of life of patients using topical and
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A version of this article appeared as Akintoye SO, Greenberg MS. Recurrent aphthous stomatitis. Dent Clin N Am 2005;49:31–47.