Figure 2 - uploaded by César Rivera
Content may be subject to copyright.
Small ulcers of recurrent aphthous stomatitis minor-type (Mikulicz ulcer). These ulcers are painful.
Source publication
Recurrent aphthous stomatitis (RAS), also known as canker sores, is the most common disease of the oral mucosa. Unlike caries and periodontal disease, patients with RAS are unable to prevent it. The clinical picture of RAS is characterized by recurrent episodes of solitary or multiple painful ulcerations without association with systemic diseases....
Contexts in source publication
Context 1
... daily functions, including nutrition, speech and oral hygiene (23), and affect quality of life (24). This is important, considering that the lesions can last >2 weeks, with recurrent episodes in a period of 1-4 months (8). RAS occurs in three morphological presentations: Minor-type (Mikulicz ulcers, 2-10 mm in diameter), which is the most common (Fig. 2); major aphthous, also termed Sutton ulcers or periadenitis necrotic mucosa (>10 mm in diameter); and herpetiform ulceration, which consists of multiple small ulcers (25). Some patients have continuous oral ulcerations; in these cases, some ulcers heal as others develop, with occasional genital ulcers. This corresponds to a clinical ...
Context 2
... daily functions, including nutrition, speech and oral hygiene (26), and affect quality of life (27). This is important, considering that the lesions can last >2 weeks, with recurrent episodes in a period of 1-4 months (11). RAS occurs in three morphological presentations: Minor-type (Mikulicz ulcers, 2-10 mm in diameter), which is the most common (Fig. 2); major aphthous, also termed Sutton ulcers or periadenitis necrotic mucosa (>10 mm in diameter); and herpetiform ulceration, which consists of multiple small ulcers (28). Some patients have continuous oral ulcerations; in these cases, some ulcers heal as others develop, with occasional genital ulcers. This corresponds to a clinical ...
Similar publications
The word “Aphthous” originated from the Greek word “aphtha”, the meaning of which is ulcer Aphthous Stomatitis
is one of most common ulcerative disease associated mainly with the oral mucosa characterized by the extremely
painful, recurring solitary, multiple ulcers in the upper throat and oral cavity. The disease is known by lay public and
profess...
Citations
... Conditions such as oral herpes simplex virus infection, oral lichen planus, Behcet's disease, inflammatory bowel disease, systemic lupus erythematosus (SLE), and nutritional deficiencies (e.g., vitamin B12, iron, folate) should be included in the differential diagnosis. 9 Clinical features, medical history, and, if necessary, biopsy findings aid in distinguishing RAUs from other similar conditions. ...
Recurrent aphthous ulcers (RAUs) represent a common yet burdensome oral mucosal condition affecting individuals worldwide. This review article comprehensively examines the current understanding of RAUs, including epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, and management strategies. Epidemiological studies indicate a prevalence ranging from 5% to 25% globally, with variations across demographics and geographic regions. Etiological factors such as genetic predisposition, immune dysregulation, microbial influences, local trauma, and systemic conditions contribute to the development and recurrence of RAUs. The pathogenesis involves a complex interplay of inflammatory cascades, involving cytokines, immune cells, and genetic factors. Clinically, RAUs present as painful, round or oval-shaped ulcers with characteristic features, predominantly located in the oral mucosa. Diagnosis is primarily clinical, based on history and examination findings, while biopsy and laboratory investigations may be warranted in certain cases. Management approaches encompass symptomatic relief, preventive measures, and targeted therapies, including topical agents, systemic medications, and lifestyle modifications. Emerging treatments such as immunomodulators, laser therapy, and biologic agents offer promising avenues for future research and clinical practice. Overall, a multidisciplinary approach involving healthcare professionals, including dentists, dermatologists, and immunologists, is essential for the comprehensive management of RAUs and improving patient outcomes.
... The etiology and pathogenesis of RAS remain unclear. Multiple factors are associated with the development of this disease, including positive family history, food hypersensitivity, smoking, psychological stress and immune disturbance (Rivera, 2019). ...
Recurrent aphthous stomatitis is the most common inflammatory ulcerative condition of the oral mucosa. Interleukin-10 (IL-10) also known as cytokine synthesis inhibitory factor, IL-10 was demonstrated to be an important cytokine-suppressing autoimmunity and inflammatory response. The study aimed to investigate the association between the Interleukin-10 (IL-10) gene polymorphism and its salivary level with recurrent aphthous stomatitis in Babylon province. The total subjects of the present study is 94, divided into 2 groups; 45subjects with recurrent aphthous stomatitis and 49 subjects healthy controls, Un-stimulated salivary sample was taken from each subject and genotyped for interleukin-10 polymorphism (rs 1518111) by sequencing after SSCP technique. On the other hand, the level of interleukin-10 (IL-10) in saliva was estimated by the ELISA technique. In this study, the result show that the allele T had a significant association with recurrent aphthous stomatitis (OR.1.8, PV.0.3) and inherited as a recessive allele in which TT genotype has OR of 3 compared to other genotypes. On the other hand, the salivary interleukin-10 level did not record any significant difference between the case and control group. The results suggest that Interleukin-10 (IL-10) rs1518111 gene polymorphism was a putative risk factor for recurrent aphthous stomatitis.
... Since the underlying cause triggering RAS remains to be elucidated, at present the emergence of new lesions cannot be prevented, and therapy focuses mainly on pain reduction, through corticosteroids and topical analgesics plus antiseptics. 33 A trial involving patients with minor RAS and comparing the effectiveness of 0.15% benzydamine HCl, 0.2% aqueous chlorhexidine and placebo mouthwashes administered consecutively for 3 months/each, for a total of 9 months, did not reveal any difference between the treatments tested. However, a subgroup of patients preferred the benzydamine HCl preparation because of the temporary topical anesthetic effect, which gave some pain relief. ...
Pain and inflammation are the consequences of sore throat, dental and oral procedures, infections, ulcers and head and neck chemotherapy/radiotherapy, and their management is of fundamental importance to avoid distress in patients. Benzydamine hydrochloride (HCl) is a topical indolic nonsteroidal anti-inflammatory drug, endowed with analgesic and anesthetic activity, and with antimicrobial (including both gram-positive and gram-negative bacteria) and antifungal properties (targeting Candida albicans and non-albicans strains), used in odontostomatology, otorhinolaryngology, and gynecology for its properties. This molecule has a lipophilic nature, showing high affinity with cell membranes and exhibiting membrane stabilization properties, resulting in local anesthesia, an effect related also to the interaction of the drug with cationic channels. In addition, benzydamine HCl is able to inhibit the production of pro-inflammatory cytokines, with consequent analgesia. Moreover, benzydamine HCl is able to inhibit leukocyte-endothelial interactions and platelet aggregation. Unlike other non-steroidal anti-inflammatory drugs, benzydamine HCl does not inhibit cyclooxygenase or lipoxygenase. Here we review the most updated clinical data available on benzydamine HCl local application as spray, mouthwash or gargling and evidence of its effectiveness in inflammatory and/or septic conditions in the otorhinolaryngology and odontostomatology settings, with particular reference to sore throat, oral inflammation, dental plaque, tonsillitis/tonsillectomy and chemo- or radiotherapy-induced oral mucositis. Novel formulations for oral administration of benzydamine HCl are also reviewed, including in situ gelling formulations to be sprayed onto the damaged oral mucosa. Finally, novel data on the potential role of benzydamine HCl in nociceptor excitability are introduced.
... 7 The etiology of RAS is still uncertain; however, several factors have been linked to the RAS occurrence, including genetic factors, local injury, bacteria and viruses, food hypersensitivity, vitamin and micronutrient deficiencies, systemic diseases, hormonal factors, smoking cessation, psychological stress, immune disorders, and drugs. 8,9 Several studies reported that psychological stress is significantly correlated with the occurrence of RAS. 10,11 Psychological stress, both acute and chronic, can result in increased cortisol levels which have a bad influence on reduced immunity and have a negative impact on individual health. ...
Background: The etiology of recurrent aphthous stomatitis (RAS) is still unclear, but psychological stress is thought to contribute to the occurrence of RAS. One of the biomarkers for evaluating psychological stress levels is through measuring salivary cortisol levels. This scoping review aims to review and evaluate the correlation between salivary cortisol levels in individuals with psychological stress and an increased incidence of RAS. Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through databases on PubMed, ScienceDirect, Scopus, ProQuest, and Google Scholar until November 2023. All included studies discussed salivary cortisol levels in RAS patients and controls. Results: Eleven of the twelve studies showed an increase in salivary cortisol levels in RAS patients compared with the control group, with eight of them having a statistically significant increase. In addition, eight studies evaluated the level of psychological stress in respondents, seven of which concluded that there was an increase in stress levels in RAS patients with five of them showing a statistically significant increase. Conclusion: In conclusion, the present study concludes that there is a correlation between increased salivary cortisol levels in individuals with psychological stress and an increased incidence of RAS.
... Recurrent aphthous stomatitis can affect up to 7 out of 10 persons at some point in their lives. The most typical ulcerative lesions of the oral mucosa are recurrent cases of aphthous stomatitis [15]. Although the specific cause of recurrent aphthous stomatitis is unknown, it is thought that a number of potential variables may contribute to its occurrence. ...
... Recurrent aphthous stomatitis (RAS), also known as recurrent aphthous ulcers or canker sores, is one of the most prevalent ulcerative diseases of the oral mucosa (Giannetti et al., 2018;Rivera, 2019). RAS affects approximately 5%-25% of the global population and predominantly women from higher socioeconomic groups (Nalbantoglu and Nalbantoglu, 2020). ...
Background: Cod liver oil has anti-inflammatory properties and could help regulate recurrent aphthous stomatitis (RAS). An orthogonal experiment was used to evaluate and improve the dosage form of compound cod liver oil, which has replaced the previously used liniment preparation based on film method.
Methods: An orthogonal experiment was adopted, and the appearance and film-forming time of the film coating agents were used as indicators. The optimal ratio in the preparation process for the compound cod liver oil film agent was then optimized. A method for determination of compound cod liver oil film was established using High-Performance Liquid Chromatography (HPLC).
Results: The results indicate that the blank films prepared using 55 mg polyvinyl alcohol (PVA) (PVA low), 45 mg of PVA (PVA medium), and 10 mg glycerol had the optimal performance, which was defined as PVAa. The drug-carrying film prepared from 3 mL PVAa (i.e., film-forming material with the optimal proportion), 30 mg dexamethasone acetate, and 30 mg metronidazole had the optimal performance. The verified sample has a complete and smooth appearance, uniform thickness and color, and no evident bubbles, which meets the requirements for a film agent defined in the Chinese Pharmacopoeia, 2020 edition. HPLC was used to determine the major components: dexamethasone acetate, metronidazole, and dyclonine hydrochloride, and the optimal separation effect was obtained. The method has advantages of good specificity, good linear results, high recovery rate, and good repeatability.
Conclusion: This study proposes an optimized compound cod liver oil film former agent and preparation method. The results indicate that the compound cod liver oil film former agent had good performance, reflecting the high feasibility of this research method. The detection method of compound cod liver oil film was established by HPLC. The method was feasible, and the validity and stability of the formulation and preparation technology were guaranteed. The role of the newly developed agent in patients with RAS should be investigated further.
... The etiology of RAS is not fully understood, despite numerous clinical observations and research efforts. Several factors are believed to contribute to the development of RAS, including genetic predisposition, mechanical trauma, deficiencies in micronutrients and vitamin B 12 , increased oxidative stress, food allergies, microbial factors or infections, anxiety, internal disorders, hormonal imbalances, and systemic disorders that are associated with lesions clinically similar to RAS like anemias, HIV infection, and reactive arthritis (Tarakji et al., 2015;Sharma and R, 2018;Rivera, 2019). ...
Background: Recurrent Aphthous Stomatitis (RAS) is a common ulcerative disease of the oral mucosa which is characterized by pain, and recurrent lesions in the oral cavity. This condition is quite painful, causing difficulty in eating, speaking and swallowing. Topical medications have been used for this condition, but the obstacle in using topical medications is the difficulty of achieving drug effects due to saliva wash out. This problem can be overcome by film hydrogel formulation which can protect the ulcer and reduce the pain to some extent. α-mangostin is a xanthone isolated from the rind of the mangosteen fruit. One of the activities of α-mangostin is anti-inflammatory effects, which operate through the characteristic mechanism of inhibiting the inflammatory response. This protocol study aims to investigate the efficacy of an α-mangostin hydrogel film with a chitosan alginate base for recurrent aphthous stomatitis (RAS) in comparison with a placebo over a period of 7 days.
Study design: This is a two-arm, double blinding, randomized controlled trial enrolling patients with RAS. The efficacy test of α-mangostin Hydrogel Film will be tested against the placebo. Patients with RAS will be allocated randomly into the two arms and the hydrogel film will be administered for 7 days. The diameter of ulcer and visual analog scale (VAS) score will be used as the primary efficacy endpoint. The outcome measure will be compared between the two arms at the baseline, day 3, day 5, and at the end of 7 days.
Discussion: The purpose of this clinical research is to provide scientific evidence on the efficacy of α-mangostin hydrogel film with a chitosan alginate basis in treating recurrent aphthous stomatitis. The trial is expected to improve our capacity to scientifically confirm the anti-inflammatory effectiveness of α-mangostin compounds in a final formulation that is ready to use.
Trial registration: NCT06039774 (14 September 2023).
... trailed by the gatherings 7 and 8 years (24.5% and 23.9%, individually). The pervasiveness then, at that point, consistently diminished through the age layers, with a recurrence as low as 6.8% in ages 12 years and that's only the tip of the iceberg (Rivera, 2019;Scully, 2006). There was a little power between females (P < 0.05). ...
... The prevalence of RAS varies globally and between different age groups, with estimates ranging from 0.9 to 78% of the population [7]. Such variations may be attributed to differences in study design, investigative methods, and diagnostic criteria [8]. ...
The systematic review assessed the efficacy and safety of propolis for treating recurrent aphthous stomatitis (RAS). The review adopted the PICO framework to examine the effects of topical and systemic propolis on RAS while also comparing it to established treatments, placebos, or no treatment. The main focus was on the healing time, pain levels, adverse effects, the likelihood of ulcer recurrence, and accompanying symptoms such as redness. The team included randomised controlled trials (RCTs) and quasi-randomised trials, excluding case reports and studies on oral ulcers other than RAS. In May 2022, the review team comprehensively searched nine databases and trial registries following the PRISMA guidelines. The protocol was registered in the PROSPERO database under the registration number CRD42022327123. Two review authors conducted a comprehensive and autonomous search for pertinent papers and extracted essential data. Where data permitted, the team utilised Review Manager 5 to conduct a random-effects meta-analysis, assessing the risk of bias and heterogeneity of the included studies. Where possible, the GRADE Pro programme was used to assess the certainty of the evidence for all the outcomes. This review included 10 RCTs, comprising 825 participants aged between 18 and 69 years. Seven studies evaluated the efficacy and safety of propolis when applied topically, all of which used different formulations, concentrations, and carriers. The remaining three studies assessed systemic administration in tablet form. The duration of investigations ranged from 5 days to 3 years. The review team classified two studies as having an overall ‘high risk’ of bias, while the remaining studies were categorised as having an overall ‘uncertain risk’. The overall certainty of the evidence was ‘very low’. The results indicate that topical and systemic propolis may decrease the duration of healing, alleviate pain, and reduce redness in patients with RAS compared to a placebo. However, the certainty of the evidence is very low. These may be due to the high risk of bias, substantial heterogeneity, and limited sample sizes in the included studies. For these reasons, the results of this review should be interpreted with caution. Nevertheless, the limited number of adverse effects observed suggests that propolis may have a favourable safety profile when used for a short period in treating RAS.
... Thrush or recurrent aphthous stomatitis (RAS) is the most common type of ulceration in the oral cavity [1]. It is often referred to as canker sores by patients and healthcare providers [2]. RAS is reported to affect up to 25% of the population which characterized by painful, round, or oval shaped ulcers with an inflammatory halo [3]. ...
Introduction
Recurrent Aphthous Stomatitis (RAS) is the most common type of ulceration in the oral cavity which can occur due to several factors.
Aims
To determine the factors related to the incidence of RAS and examine the social class inequality in RAS among the Indonesian population using data from the fifth wave of the Indonesian Family Life Survey (IFLS5) in 2014.
Methods
This study is a descriptive study with a cross-sectional design using secondary data from IFLS5 data in 2014 (n = 28,410). Socio-economic position (SEP) was calculated by Adult Equivalent Scale and categorized into 4 classes. Outcome is RAS. Mediating factors were psychosocial (stress), eating behavioral (food consumption), and systemic diseases. Descriptive analysis, chi-square and a series of logistic regressions were performed to analyze the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results.
Results
Only 18.39% of IFLS5 respondents experienced the incidence of recurrent aphthous stomatitis in 2014. The bivariate (chi-square) results showed that there was a relationship between the incidence of RAS and the related independent variables. Logistic regression showed the highest possibility of RAS in respondents aged 18–34 years, female, unmarried, high school education level, living in the city, having frequent stress levels, having food habits that frequently drinking soda, sweet foods, chili sauce, fried food and has systemic diseases such as, asthma, cancer, rheumatism, and digestion. The lowest SEP group had the highest probability of occurrence of RAS over the other groups among the different models.
Conclusions
There are several factors that determine the incidence of RAS. There was a monotonic gradient of inequality in RAS according to SEP group. This study might be useful to provide information regarding the relationship of determinants factors with the incidence of RAS to prevent it and promote oral health in the future.
