Mouth ulcers that comes very often (RECURRING ULCERS)

RECURRENT APTHOUS STOMATITIS / APTHOUS ULCER/MOUTH ULCERS

This is one of the most commonly seen recurrent ulcer. 

It's a disorder characterized by recurring ulcers confined to oral mucosa with NO OTHER SIGNS OF DISEASE. 

This is no longer considered as a separate

 disease. 

Causes

1. Immunological disorders
2.Hematological deficiencies
3.Allergic abnormalities
4.Pshycological abnormalities
5.Hereditary 
6.Stress
7.Trauma

Initially RAS was thought as a form of recurrent HSV infection but NOOOOO. 

"Herpes" is anxiety producing term. 

This distinction is important at the time where there is specific, effective antiviral therapy for HSV which is USELESS for RAS. 

Most documented causative factor  - HERIDITY

A study showed patients with RAS positive parents had a 90% chance of developing RAS. They had an increase in HLA D77 antigens. 

HEMATOLOGICAL DEFICIENCIES, particularly serum iron ,folate,or vit - B12 appears to be etiological factor. 

IMMUNOGICAL DISORDERS - Autoimmune disorders or hypersensitivity to oral organisms 

( Streptococcus sanguis) , antibody dependent cell mediated cytotoxicity

 

It is also documented that cessation of SMOKING increases the frequency and severity of  RAS. 

CLINICAL MANIFESTATION:

Usually begins in second decade of life. 

Confined to ORAL MUCOSA . 

Begins with prodromal burning any time 2- 48hrs before ulcer appears. 

                  Erythema develops

                                  | 

                                  |  (within hrs) 

                                  |

                        White papule 

                       |

                                  | (WITHIN 48 HRS)

                                  |

                  Ulcerates & enlarges

Individual lesions : round, symmetric, shallow (similar to viral ulcers), no tissue tags

Multiple lesions : number, size and frequency vary considerably. 

                                 Buccal ( inner cheek) and labial mucosa ( inner lip) commonly involved. 

                              Most people have 2-6 lesions per episode. 

Minor ulcers - less than 1 cm in diameter

Major ulcers - more than 1 cm in diameter

                        - leaves scar on healing

Herpetiform ulcers - distinct clinical entity manifests as recurrent crops of dozens of small virus throughout oral mucosa

Treatment:

1.Rule out malabsorption syndromes. 

2.In mild cases topical emollients are given. 

3.For severe cases topical corticosteroids are given. (Triamcinalone, fluocinolone) 

4.Intralesional steroid injections. 

5.Chlorotetracycline mouthwashes given as rinses or placed at the lesion with gauze to reduce the pain

6.If they don't respond to steroid sometimes DAPSONE or THALIDOMIDE are given understanding the RISK OF POTENTIAL SIDE EFFECTS. 

Thalidomide is not approved in some countries  due to teratogenic properties and other side effects. 

There are also other recurring ulcers. Will mention about them too.