RECURRENT
APHTHOUS ULCER
Abdullah alsalem
401100206
SPS
OBJECTIVES
Clinical
Introduction Etiology
Features
Classification Diagnosis Management
Conclusions
INTRODUCTION
• Recurrent aphthous stomatitis (RAS) is
considered as the most common oral
mucosal lesion.
• These present as recurrent, multiple, small,
or ovoid ulcers, having yellow floors and
are surrounded by erythematous haloes,
present first in childhood or adolescence.
ETIOLOGY
Stress Trauma Genetics
Hormonal Hematinic
Drugs
changes deficiency
Tobacco
CLINICAL PRESENTATION
• RAS is characterized by recurrent bouts of solitary or
multiple shallow painful ulcers, at intervals of few months to
few days in patients who are otherwise well. It have three
different clinical variants as classified by Stanley in 1972:
• Minor RAS
• Major RAS
• Herpetiform ulceration
MINOR RAS
• It is the most common variant, constituting 80%
of RAS.
• Ulcers vary from 8 to 10 mm in size.
• Heal within 10–14 days without scarring.
MAJOR RAS
• It affects about 10–15% of patients.
• Ulcers exceed 1 cm in diameter.
• The ulcers persist for up to 6 weeks and
heal with scarring.
HERPETIFORM ULCERATION
• Multiple ulcers; may be up to 100 in number.
• These are small in size, measure 2–3 mm in
diameter.
• These ulcers last for about 10–14 days.
DIAGNOSIS
• The correct diagnosis of
RAS is dependent on a
detailed and accurate
clinical history and
examination of the
ulcers.
Tarakji, Bassel, et al. 2015, International oral health
DIAGNOSIS
• The important features include family history,
frequency of ulceration, duration of ulceration,
associated medical conditions, genital ulceration, skin
problems, gastrointestinal disturbances, drug history,
edge of ulcer, base of ulcer, and surrounding tissue.
DIAGNOSIS
• The investigation tests for patients with persistent RAS
including hemoglobin and full blood count, erythrocyte
sedimentation rate/C-reactive protein, serum B12,
serum/red cell folate, anti-gliadin, and anti-endomysial
autoantibodies .
MANAGEMENT
• There is no agreement in the treatment of RAS .
• The aim of the treatment of RAS is to decrease
symptoms; reduce ulcer number and size; increase
disease-free periods.
AMLEXANOX ORAL PASTE
• Amlexanox is an anti- inflammatory,
antiallergic immunomodulator used to treat
Recurrent Apthous Ulcers.
• It is applied on the Ulcer's directly 3-4 times a
day.
MOUTHWASHES
Tetracycline is an antibiotic mouthwash. It reduces
the ulcer size, duration, and pain.
Chlorhexidine gluconate is an antibiotic agent may
decrease the number of ulcer days.
TRIAMCINOLONE
ACETONIDE
• TRIAMCINOLONE a corticosteroid. It is
used to reduce swelling and ulcers in the
mouth. It helps treat and relieve mouth sores.
ANALGESIC'S AND ANTISEPTICS
• Analgesic's and Antiseptics such as Dologel-CT and Hexigel
which contain Choline salicylate, lignocaine hydrochloride and
chlorohexidine lips in reteing pain and help preventing
secondary infections.
SYSTEMIC MEDICATIONS
• It is indicated for severe and constantly recurring
ulcerations.
• The topical management is not effective in this
cases.
DIET SUPPLEMENTATION
• Vitamin B12, Folic Acid
• Iron
• Zinc Sulfate
REFERENCES
• Preeti L, Magesh K, Rajkumar K, Karthik R. Recurrent
aphthous stomatitis. J Oral Maxillofac Pathol. 2011
Sep;15(3):252-6.
• Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN,
Alaizari N. Guideline for the diagnosis and treatment of
recurrent aphthous stomatitis for dental practitioners. J Int
Oral Health. 2015 May;7(5):74-80.
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