From the Guidelines
Recurrent aphthous stomatitis (RAS) should be worked up and managed through a combination of detailed clinical medical history inquiry, histopathological examination, and screening for ulceration-related systemic diseases.
Diagnostic Approach
- The diagnosis of RAS is primarily based on clinical presentation, with characteristic well-demarcated, oval or round ulcers with a white or yellow pseudomembrane and a halo of surrounding erythema 1.
- A thorough medical history is essential to identify potential local and systemic causes of oral ulcers, including traumatic, infectious, allergic factors, and associations with skin disease, autoimmune disease, tumor, inflammatory bowel disease, and other conditions.
- Histopathological examination may be necessary to confirm the diagnosis and rule out other conditions, especially in cases with atypical clinical features or uncertain diagnosis.
Management
- The management of RAS typically involves topical treatments, such as anesthetics, anti-inflammatory agents, and protective barriers, to reduce pain and promote healing.
- In some cases, systemic treatments, such as corticosteroids or immunomodulators, may be necessary to control symptoms and prevent recurrence.
- Identifying and addressing underlying causes, such as nutrient deficiencies, oral trauma, anxiety, or stress, is also crucial in managing RAS.
Challenges and Considerations
- The complexity and diversity of oral ulcerations, including RAS, pose significant diagnostic and therapeutic challenges to oral specialists.
- A comprehensive assessment, including detailed clinical medical history inquiry, histopathological examination, and screening for ulceration-related systemic diseases, is necessary to improve diagnostic accuracy and timeliness, and to reduce unnecessary financial burden 1.
From the Research
Diagnosis and Clinical Characteristics
- Recurrent aphthous stomatitis (RAS) is characterized by recurrent episodes of solitary or multiple painful ulcerations without association with systemic diseases 2
- The clinical picture of RAS is often accompanied by pain, and the main complaint of patients with RAS is typically pain 3
- RAS may have a genetic basis, with more than 42 percent of patients having first-degree relatives with RAS 3
Management and Treatment
- The primary goals of therapy for RAS are relief of pain, reduction of ulcer duration, and restoration of normal oral function 3
- Topical applications of corticosteroids, antibiotics, and analgesics are highly recommended as a first aid in relieving the pain 4
- Systemic therapy of RAS should be used in the case of multiple painful ulcerations compromising the quality of life of the patient 4
- Natural anti-inflammatory substances from medicinal herbs, in the form of essential oils and extracts, are promising agents in the management of RAS 4
- Preventive treatment is a consideration for patients with RAS caused by food allergy, focusing on dietary modifications and the use of topical immunosuppressant and particularly corticosteroids 3
Differential Diagnosis
- RAS can pose a diagnostic challenge, as similar oral ulcers can appear secondary to a variety of well-defined pathological conditions 4
- A comprehensive differential diagnosis is necessary to rule out other conditions that may cause similar oral ulcers 4
- Behcet's syndrome is a multisystem disease complex that can feature RAS as a central symptom, and therapeutic considerations and strategies are essential to management of patients suffering from recurrent mouth ulcers 5