Aphthous Stomatitis

Description:
- This is one of the most common oral diseases.
- It's a painful lesion that size from less than 1 mm to 2 cm, single or multiple.
- There is three types: The small lesions are less than 0.5 cm and called the "Minor Aphthae", The large lesions are more than 0.5 cm and called the "Major Aphthae", while they may be Multiple and pinpoint seldom exceeding 1 mm and are called "Herpetiform Aphthae".
- The exact incidence is unknown, but estimates range from 20% to 60% of the population.
- The Lesion begins as a red macule, less often papule, but not blisted. Then it ulcerates and the ulcer become covered by pyogenic membrane producing the characteristic yellow-white center with surrounding erythematous flare.
- It's usually round to oval but may be elongated in natural folds such as the vestibule.
- The lips, cheeks, soft palate, floor of mouth, ventral and lateral tongue are often involved but attached gingival, hard palate and dorsal tongue are seldom affected.
(Occurs on freely movable mucosa that does not overlie bone).
- Aphthous lesions affect all age groups from young to old but young adults and females are more affected.
- Also Known as: Canker sores, recurrent aphthous stomatitis, RAS.

Etiology:
- The cause is unknown.
- There are too many theories for them all to be correct. Aphthous stomatitis may not be a single disease with a single cause but instead a variety of diseases all manifested by painful mouth sores.
- The concept that canker sores are caused by a microbiologic agent has been superceded by theories revolving around an immunopathogenesis. The deposition of antibodies and complement within epithelium and basement membrane during the early stages of the disease suggests a humoral immune response, and the influx of lymphocytes rather than neutrophils in early lesions points to a cellular immune reaction as well. It is yet to be learned if the immune response is directed against self (autoimmunity) or against an extrinsic antigen such as bacteria or viruses. To further cloud the issue, a variety of other factors have been implicated. Withdrawal of certain foods such as cheese, tomato products and gluten, as well as sodium lauryl sulfate-containing toothpastes, has been claimed to help some patients whereas in others, correction of iron, B12 and folate deficiencies have brought about a cure. Improvement of aphthous lesions during the last stages of pregnancy with exacerbation after delivery suggests that gonadal hormones may lay a role. The occurrence of canker sores during menstruation also suggests a hormonal basis. To add a final element of mystery, aphthous stomatitis has been reported to worsen when cigarette smoking is discontinued.

Treatment:
- To reduce pain, patients with few lesions may be treated with topical medications such as Orabase® with Benzocaine, Zilactin®, or Soothe-N-Seal®.
- Anti-inflammatory agents such as topical steroids or Aphthasol® have also been shown to be effective.
- For severe or widespread disease, systemic prednisone such as a Medrol 4 mg Dosepak® is helpful.
- Long-term systemic steroid therapy may be associated with numerous adverse effects, including osteoporosis, asceptic necrosis, cataracts, depression, fluid retention and exacerbation of diabetes.

Prognosis:
- Cure is seldom achieved but palliation and long-term remission may be achieved by above mentioned treatment.
- Without treatment, healing time varies from 4 days for a small lesion to a month or more for major aphthae.
- Major aphthae may also cause scarring.

Differential Diagnosis:
- Aphthous stomatitis must be differentiated from herpetic stomatitis, the disease with which it is most often confused.
- Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone. The hard palate is the most common site.
- Lesions indistinguishable from aphthous stomatitis have been reported in Behcet’s syndrome, Reiter’s syndrome, Crohn’s disease and celiac disease.

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:: World Of Dentistry :: TEAM