2. Introduction
The term aphthous is defined as a breach
in the oral epithelium which typically
exposes nerve endings in the underlying
lamina propria resulting in pain and
soreness.
3. Introduction
• RAS is characterised by spontaneous,
self-limiting ulcerations of the mucosa of
oral cavity, recurring at intervals of
approx 3-4 weeks.
• Lesions can be single or multiple.
• Generally affect the non-keratinized
mucosa of the cheeks, the soft palate, the
fauces, the mouth floor, the tongue, and
the gums.
5. Aetiology
It can also occur as widespread lesions in
association with systemic diseases
including Behçet’s syndrome,
gastrointestinal malabsorption disorders
like Crohn’s and celiac diseases and
immunodeficiency syndromes such as
infection with the human
immunodeficiency virus (HIV) or cyclic
neutropenia.
6. Clinical Features
Onset – Frequently in childhood but peak
in adolescence and early adult life
Attacks at relatively regular intervals
Most patients are otherwise healthy
Few patients have haematological defects
Most patients are non-smokers
Usually self-limiting eventually
7. RAS ─ Classification
Minor Aphthae (most common type)
Major Aphthae
Herpetiform Aphthae
8. Minor Aphthae
Non-keratinized mocosa affected e.g.
buccal mucosa, lateral borders of the
tongue, sulci
Persist upto 7-10 days
Ulcers are shallow, 5-7mm across, with an
erythematous margin and yellowish floor
One or several ulcers may be present
9.
10. Major Aphthae
Uncommon
Persist upto 6 weeks
Ulcers frequently several centimeters
across
Sometimes mimic a malignant ulcer
Masticatory mucosa (dorsum of the
tongue, gingivae) may be involved
Scarring may follow healing
11.
12. Herpetiform Aphthae
Uncommon,
Non-keratinised mucosa affected
Ulcers are 1-2 mm across
Dozens or hundreds may be present
May coalesce to form irregular ulcers
Widespread bright erythema round the
ulcer
Healing generally occurs in 1-2 weeks
13.
14. Diagnosis
History Examination Special
Investigations
o Recurrences?
o Pattern?
o Onset?
o Family History
o Distribution only
on non-
keratinised
mucosa
o Signs/symptoms
of Behcet’s
Disease?
o Discreet well-
defined ulcers
o Scarring or
soft palate
involvement
suggesting
major
aphthae
o Anemia, iron, red
cell folate and
vitamin B12
status
o H/O diarrhea,
constipation, or
blood in stools
suggesting celiac
disease/
malabsorption
15. Management
General Measures Medication
o Reduce the painful
symptoms through
antiseptic gels
o L/A benzocaine & lidocaine
o Help the patient get out of
stress
Topical Systemic
o Steroids
o Azathioprine
o Colchicine
o Thalidomide
o Intralesional
Steroid Inj
(Maj Ras)
16. Topical Medication
Covering agents e.g. Carboxy
methylcellulose (Orabase)
Topical gels e.g. choline salicylate
(Bonjela)
Benzydamine and Chlorhexidine mouth
washes.
Tetracycline mouth rinses – the contents
of a tetracycline capsule 250mg stirred in
a little water and held in mouth for 2-3
mins TDS 5 days.
17. Topical Medication
Corlan (hydrocortisone hemisuccinate) -
2.5mg pellets allowed to dissolve in the
mouth QDS.
Triamcinolone dental paste 0.1% –
corticosteroid in a vehicle – apply QDS
with moist finger.
Steroid aerosols – 1 puff per ulcer QDS
Steroid m/w (Betamethasone) – Dissolve
0.5mg in 5ml water & rinse for 2-3 mins
QDS
18. Miscellaneous Treatments
Laser can be an alternative treatment for
aphthous ulcers.
Low Level Lasers Therapy (LLLT) -
Dosimetry depends upon the size of the
lesion.
Photobanding - The technique consists of
the formation of a protective layer on
exposed connective tissue using lasers.
These treatments reduce healing time and
inflammatory reaction and provides
immediate pain relief.
19. Miscellaneous Treatments
One study has demonstrated the efficacy and
the rapidity of response of the Lactobacillus
brevis CD2 lozenges (at least 1 billion live
bacteria per lozenge) in resolving the clinical
signs and symptoms of aphthous stomatitis,
with a significantly rapid improvement of pain.
The Lactobacillus brevis CD2 strain is endowed
with high levels of arginine deiminase, an
enzyme that plays a fundamental role in the
metabolism of arginine thus preventing the
growth of arginine-dependent inflammatory
microorganisms.
20. Nano gum gel, antioxidant therapy
Royal Jelly (Propillus) is one of the
contents.
21.
22.
23.
24. References
Chireen Chamas, Dolly Roukoz, Nadia Skandri.
Pain Relief of Aphthous Ulcers by Lasers: A
Literature Review. Dental News.
http://www.dentalnews.com/2014/12/20/pain-
relief-of-aphthous-ulcers-by-lasers-a-literature-
review/
V Trinchieri, SD Carlo, M Bossu’, A Polimeni. Use
of Lozenges Containing Lactobacillus brevisCD2 in
Recurrent Aphthous Stomatitis: A Double-Blind
Placebo-Controlled Trial.Ulcers;
Volume 2011 (2011); Article ID 439425, 6 pages.
http://dx.doi.org/10.1155/2011/439425