RECURRENT

APHTHOUS
STOMATITIS
MUSKAN GUPTA
Definition

 RAS is a common disease characterized by

development of painful, recurrent solitary or
multiple ulcerations of oral mucosa.
 Also known as APHTHOUS ULCERS, CANKER
SORES.
ETIOLOGY

 BACTERIAL INFECTION
Streptococcus sanguis: - a pleomorphic L –form of an
alpha haemolytic streptococcous was strongly implicated
as causative agent of the disease
 Genetic history
There is a positive family history and occourence of RAS associated
with HLA –B 51
 Iron,vit B12 or folic acid deficency
ETIOLOGY

 Immunologic abnormalities
Autoimmune response of oral epithelium was considered as an
etiologic factors as both IgG and IgM bind by epithelial cells of spinous
layer of oral mucosa in patients with RAS.
 Precipitating factors
 Trauma
 Endocrine conditions
 Allergic factors
 Systemic disease
 Recurrent aphthous minor

Recurrent aphthous major

CLASSIFICATION
Recurrent herpetiform ulcerations
CLINICAL
FEATURES
 RECURRENT APTHOUS MINOR
 More frequently seen in
women than in men
 Age between 10-30 yrs
 Unfortunately,the disease
typically persists with
recurring attacks over a
period of many years
 It has remarkable familial
tendency for occurrence of
the disease
CLINICAL
FEATURES
 RECURRENT APTHOUS MINOR
 Frequency of outbreaks
varies between
patients.occasional patients
have continiual, repeated
outbreak and are never free
of lesions for extended
intervals
 They occour as one or more
small nodule
CLINICAL
FEATURES
 RECURRENT APTHOUS MINOR
 Burning
sensations,erythrema,general
ized edema of oral
cavity,specially the
tongue,paraesthesia,malaise
and low grade
fever,localized
lymphadenopathy and
vesicle like lesions
coaintaining mucous
CLINICAL
FEATURES
 RECURRENT APTHOUS MINOR
They begin as single or multiple
superficial erosions covered by
a grey membrane and has a
necrotic center with a clearly
defined raised margins
surrounded by an
erythrematous halo
They are very painful,1-100 in
number and size 2-3mm to
10mm in diameter.
 CLINICAL
FEATURESRAS MAJOR
RAS MINOR

2-3mm <10cm >10cms

1-100 in number 1-10 in number

10-30 yrs age No age prediliction

No scar on healing Scars on healing

Similar lesions on
vagina or
penis,rectum and
larynx
Associated with
Rheumatoid arthritis
or conjuctivitis
More in patients with
CLINICAL
FEATURES
 RECURRENT HERPETIFORM
ULCERS
 Crops of multiple small
shallow ulcers
 Upto 100 in number
 Female>males
 Not associated with herpes
virus
Differential diagnosis

 Herpetic stomatitis
 Erythrema multiforme
 Erosive lichen planus
 Pemphigus
 Pemphigoid
 herpangina
Labaratory
diagnosis
 Biopsy
 hematologic abnormalities,
such as reduced levels of serum
iron, folate, vitamin
B12, and ferritin. Patients with
abnormalities in these values
should be referred to an internist
to rule out malabsorption
syndromes and to initiate
proper replacement therapy
Management

 Tetracycline mouthrinse : Dosage 250mg per

5ml. It is usually taken by diluting the tetracycline
capsules in 5 ml of water and is gargled in the
mouth four times a day for 5 to 7 days. This
treatment produced a good response in nearly
70 % of the Patients tested, by reliving the pain,
reducing the size of the lesions and reducing the
healing time.
Management

 • 5%Amlexanox is an anti-
inflammatory, antiallergic
used to treat Recurrent
Apthous Ulcers during
prodromal phases. • It is
applied on the Ulcer’s
directly 3-4 times a day.
Management

 Analgesic’s and Antiseptics such as

Deltagel and Quadragel which
contain lignocaine hydrochloride
,metronidazole benzoate,menthol
and chlorohexidine gluconanate
helps in reliving pain and help
preventing secondary infections.
Management

• Vitamin B12, Folic Acid Iron

• Not much of positive
results are found with
administration of vitamin B12
in patients with Recurrent
Apthous Ulcer’s.
Management

Intralesional injection of
steroid – Triamcinolone
acetonide (0.1-0.5 ml/l) or –
Betamethasone propionate
and sodium phosphate •
Placing of gauze sponge
containing topical steroids
on ulcers in cases of larger
ulcers.
References

Shafer’s textbook of Oral pathology -7th edition

• Burkets oral medicine-11th edition
• Textbook of Oral medicine Oral diagnosis and Oral
radiology-Ravikiran Ongole 2nd edition
• Textbook of oral medicine -Anil Govindarao Ghom 3rd
edition