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 Table of Contents  
TEACHING IMAGES
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 317-318

Recurrent aphthous stomatitis


1 Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Guntur, Andhra Pradesh, India
2 Dr. Smilez Dental Clinic, Puducherry, India

Date of Submission20-Jul-2019
Date of Decision03-Sep-2019
Date of Acceptance06-Sep-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Dr. Satvinder Singh Bakshi
House 1A, Selvam Apartments, 71 Krishna Nagar Main Road, Krishna Nagar, Puducherry - 605 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_105_19

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How to cite this article:
Bakshi SS, Bakshi S. Recurrent aphthous stomatitis. Arch Med Health Sci 2019;7:317-8

How to cite this URL:
Bakshi SS, Bakshi S. Recurrent aphthous stomatitis. Arch Med Health Sci [serial online] 2019 [cited 2020 Mar 30];7:317-8. Available from: http://www.amhsjournal.org/text.asp?2019/7/2/317/273047



A 22-year-old male presented with a 2-year history of severe oral ulcerations. The lesions were painful, recurrent, and interfered with swallowing and speaking. There was no history of trauma, genital ulcerations, ocular symptoms, or any association with food intake. Examination revealed multiple ulcers with erythematous borders ranging from 1 to 2 cm in diameter on the soft palate and anterior pillars [Figure 1]. A diagnosis of major aphthous ulcers was made, and the patient was started on oral prednisolone 30 mg, chlorhexidine mouth rinses, and topical application of lidocaine and triamcinolone gels. His symptoms reduced in 4 days, and he is currently asymptomatic at 2 months follow-up.
Figure 1: Patient with multiple large aphthous ulcers on bilateral anterior pillars and tonsillar fossa

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  Discussion Top


The term “aphthous” is derived from the Greek word “aphtha” which means ulceration. It can affect up to 25% of the general population.[1] The etiology is unclear; however, a variety of conditions may predispose the patient to develop recurrent ulcers, such as folic acid deficiency, neutropenia, iron deficiency anemia, heredity, trauma, emotional stress, hypersensitivity to certain foods, and immunoglobulin A deficiency.[2],[3] Associated systemic disorders include Behçet syndrome; inflammatory bowel disease; mouth and genital ulcers with inflamed cartilage syndrome; periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome; and sweet syndrome.[2] Based on the size, the lesions are classified into (1) minor aphthous ulcers, which are the commonest type, they are painful ulcers <1.0 cm in diameter and occur on nonkeratinized mucosa; (2) major aphthous ulcers, these are larger ulcers >1.0 cm, more painful, longer-lasting, and heal with scarring; and finally, (3) herpetiform aphthous ulcers which are more common in women, cluster on the lower lip, and heal without scarring.[3],[4] Recurrence is common and episodes usually occur about 3–6 times per year. Patients present with pain due to the ulcer which worsens on taking foods. If the lesions affect the tongue, then speaking and chewing become painful. Severe cases in which new lesions appear before the old ones heal can lead to debilitating chronic pain, malnutrition, and weight loss.[4] The therapy aims at achieving relief of pain, reduction in the duration of symptoms, restoration of normal oral functions, and reduction in the frequency and severity of recurrences. Mild cases can be managed by oral mouth rinses and topical steroids.[2],[3],[4] Systemic therapy with oral steroids, colchicine, levamisole, pentoxifylline, thalidomide, montelukast, dapsone, etc., is used for severe recurrent cases.[2]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Saikaly SK, Saikaly TS, Saikaly LE. Recurrent aphthous ulceration: A review of potential causes and novel treatments. J Dermatolog Treat 2018;29:542-52.  Back to cited text no. 1
    
2.
Akintoye SO, Greenberg MS. Recurrent aphthous stomatitis. Dent Clin North Am 2014;58:281-97.  Back to cited text no. 2
    
3.
Chiang CP, Yu-Fong Chang J, Wang YP, Wu YH, Wu YC, Sun A. Recurrent aphthous stomatitis - etiology, serum autoantibodies, anemia, hematinic deficiencies, and management. J Formos Med Assoc 2019;118:1279-89.  Back to cited text no. 3
    
4.
Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: A Review. J Clin Aesthet Dermatol 2017;10:26-36.  Back to cited text no. 4
    


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