Recurrent aphthous stomatitis is a common disorder characterized by recurring oral ulcers with no signs of systemic disease. It is caused by various factors like bacterial infection, immunologic abnormalities, nutritional deficiencies, trauma, and hormonal changes. Clinically, it presents as painful round or oval ulcers that heal within 2 weeks. It is classified into minor, major, and herpetiform types based on size, number, and site of ulcers. Treatment involves topical steroids, antimicrobial mouthwashes, analgesics, or intralesional steroid injections to reduce pain and promote healing.

1. RECURRENT APHTHOUS
STOMATITIS

2. CONTENTS
1. Definition
2. Etiology
3. Types
4. Clinical features
5. Presentation
6. Clinical types
7. Histopathology
8. Syndromes associated with aphthous ulcers
9. Differential diagnosis
10. Treatment
11. Conclusion

4. DEFINITION OF ULCER
•ANY BREACH IN THE CONTINUITY OF
THE EPITHELIUM OF THE SKIN OR
MUCOUS MEMBRANE TO INVOLVE THE
UNDERLYING CONNECTIVE TISSUE AS
A RESULT OF MICROMOLECULAR CELL
DEATH OF SURFACE EPITHELIUM OR
ITS TRAUMATIC REMOVAL.

5. DEFINITION
It is a common disorder
characterized by recurring
ulcers confined to oral mucosa
with no other signs of
systemic diseases.

6. ETIOLOGY
BACTERIAL INFECTION- an α-hemolytic streptococci, and
streptococcus sanguis play a significant role.
IMMUNOLOGIC ABNORMALITIES
Iron, vitamin B12, folic acid deficiency
p
TRAUMA- due to self –inflicted bites,oral surgical
rocedures,tooth brushing,dental procedures,needle
injections,dental trauma
ENDOCRINE CONDITION-during premenstrual period and
at postovulation period.

7. ETIOLOGY
 Cessation of smoking increases the
frequency and
severity of
RAS.
Increased prevalence seen among children of RAS
positive parents (HLA – B 51)
Acute psychological problems appear to precipitate the
attacks of RAS.(more in examination; less in vacation)

8. CLINICAL FEATURES
•Age: second, third and fourth decades.
•Sex: Females>Males
•A higher prevalence has been found in the
higher socioeconomic groups and among
individuals with stress, such as students at
the time of examinations.

9. PRESENTATION
Ulcer begins as a
round or oval
area of erythema
Pin-point central
area of white
ulceration
Next 3-7 days
The ulcer enlarges
laterally
Becomes
saucerized or
cupped out.
As healing
commences
The erythematous
area diminishes
Small punctate red
areas dot thewhite
ulcer bed

10. CLASSIFICATION
Simple aphthous is described when
1. Ulcer recurrences are few
2. Not associated with systemic factors
3. Occur only 2–4 times each year.
Complex aphthous is described when
1. Develop recurrent oral and genital aphthous ulcers
2.When there is a continuous disease activity with new lesions
developing as older lesions heal
3. When ulcers are associated with systemic diseases.

11. CLINICAL TYPES:
RECURRENTAPHTHOUS
MINOR
RECURRENTAPHTHOUS
MAJOR
RECURRENT
HERPETIFORM
ULCERATIONS

12. AGE- 10-30yr
GENDER- women>men
SITE- common on non-keratinized mucosa e.g –
buccal & labial mucosa, buccal & lingual sulci,
tongue, soft palate, pharynx,gingiva.
APPEARANCE- begins as a single or multiple
superficial erosions covered by greyish – white
removable fibrinopurulent membrane encircled by
erythematous halo.

13. Number-1-6
SIZE- 2-3 mm to 10 mm in diameter.
Persist for 7-14 days & heal without scarring.

15. Previously it represent a separate disease entity k/n as
periadenitis mucosa necrotica recurrens (mikulicz’s
scarring aphthae or sutton’s disease)
It is now regarded as severe expression of aphthous
stomatitis.
COMMON SITE- lips, cheeks, tongue, soft palate,
fauces, cause severe pain & dysphagia.
Also involve keratinized mucosa
INCIDENCE – common in HIV patient.
SIZE – Larger than the minor apthous ulcer diameter
more than 10mm.

16. NO.-1-10 in no.
Takes 4-6 weeks to heal.
Heal with scarring
Recurrs in less than a month time.
APPEARANCE- extend deeper and may present as
crater-like ulcers with rolled margins which are
indurated on palpation because of underlying fibrosis.

18. consist of clusters
resemble herpetic lesions.
HERPETIFORM
crops of ulcer
present
ULCERATIONS
• First described by Cooke in 1960 later by Lehner , Brooke
& Sapp
due to tendency to
reccur
RECURRENT

19. SITE- any intra oral site
SIZE-1-3 mm in diameter
APPEARANCE – characterized by crop of small, shallow
ulcers ,that may be joined together and form large
ulcer.
No. – 10 – 100
Healing occur in 1 to 2 weeks.
Heal with scarring.
Lesions persist for 1 to 3 year with short remissions

21. HISTOPATHOLOGY

22. DIFFERENTIAL DIAGNOSIS
• Recurrent herpes simplex infection
• Bednar’s aphthae
• Cyclic neutropenia
• Erosive lichen planus
• Stomatitis medicamentosa
• Squamous cell carcinoma

23. TREATMENT
• Tetracycline mouthrinse : Dosage 250mg per 5ml. It is
usually taken by diluting the tetracycline capsules in 5 ml
of water and is gargled in the mouth four times a day for
5 to 7 days.
This treatment produced a good response in nearly 70 %
of the Patients tested, by reliving the pain, reducing the
size of the lesions and reducing the healing time.

24. TREATMENT
• 5%Amlexanox is an anti- inflammatory, antiallergic used
to treat Recurrent Apthous Ulcers during prodromal
phases.
• It is applied on the Ulcer’s directly 3-4 times a day.

25. TREATMENT
• TRIAMCINOLONE a corticosteroid.
It is used to reduce swelling and ulcers in the mouth.
Applied 3-4 times a day on the ulcer.

26. TREATMENT
• Analgesic’s and Antiseptics such as Deltagel and
Quadragel which contain lignocaine hydrochloride
,metronidazole benzoate,menthol and chlorohexidine
gluconanate helps in reliving pain and help preventing
secondary infections.

27. TREATMENT
• Vitamin B12, Folic Acid Iron
• Not much of positive results are found with administration
of vitamin B12 in patients with Recurrent Apthous Ulcer’s.

28. TREATMENT
• Intralesional injection of steroid
– Triamcinolone acetonide (0.1-0.5 ml/l) or
– Betamethasone propionate and sodium phosphate
• Placing of gauze sponge containing topical steroids on ulcers in
cases of larger ulcers.

29. TREATMENT
• Surgical
– Laser surgery