Recurrent aphthous stomatitis (episodic mouth ulcers)

Clinically, three forms of recurrent aphthous ulceration exist: major, minor, and herpetiform.

Recurrent aphthous stomatitis is distinguished from aphthous-like ulceration by exclusion of underlying systemic conditions (e.g., inflammatory bowel disease, Behcet syndrome, HIV/AIDS, or cyclic neutropenia).

Diagnosis is based on the history and clinical examination with exclusion of a systemic aetiology; there are no specific laboratory findings.

Topical corticosteroids and anti-inflammatory agents are the mainstay of treatment. Severe or refractory cases may require systemic therapy.

Recurrent aphthous stomatitis (RAS) is a common condition of the oral mucosa that presents in patients who are otherwise healthy. It is characterised by recurrent episodes of round or ovoid ulcers with circumscribed erythematous margins and a greyish-yellow base. These typically present in childhood or adolescence.[1]Scully C. Clinical practice. Aphthous ulceration. N Engl J Med. 2006 Jul 13;355(2):165-72. http://www.ncbi.nlm.nih.gov/pubmed/16837680?tool=bestpractice.com [2]Scully C, Shotts R. ABC of oral health: mouth ulcers and other causes of orofacial soreness and pain. BMJ. 2000 Jul 15;321(7254):162-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118165 http://www.ncbi.nlm.nih.gov/pubmed/10894697?tool=bestpractice.com Similar presentations of recurrent oral ulceration (aphthous-like ulceration) may occur associated with systemic disease, including autoinflammatory syndromes (e.g., periodic fever with adenitis, pharyngitis, and aphthae [PFAPA syndrome], Behcet syndrome, Crohn's disease), and immunodeficiency states (e.g., nutritional defects such as in coeliac disease and other gastrointestinal disorders, immune defects such as HIV/AIDS, or neutrophil defects such as cyclic neutropenia); therefore, to avoid confusion, the term RAS should be reserved for ulceration seen in the absence of systemic disease.[1]Scully C. Clinical practice. Aphthous ulceration. N Engl J Med. 2006 Jul 13;355(2):165-72. http://www.ncbi.nlm.nih.gov/pubmed/16837680?tool=bestpractice.com [2]Scully C, Shotts R. ABC of oral health: mouth ulcers and other causes of orofacial soreness and pain. BMJ. 2000 Jul 15;321(7254):162-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118165 http://www.ncbi.nlm.nih.gov/pubmed/10894697?tool=bestpractice.com

Other causes of oral ulceration include trauma, inflammatory conditions such as oral lichen planus or graft versus host disease, medications (e.g., non-steroidal anti-inflammatory drugs [NSAIDs], nicorandil), infections (herpes simplex virus infection, syphilis), and malignancy (i.e. oral squamous cell carcinoma).