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PubMed2003

Etiology and Management of Recurrent Aphthous Stomatitis.

Recurrent aphthous stomatitis (RAS) is an ulcerative condition that affects the oral mucosa without evidence of an underlying medical disorder. RAS is characterized by the appearance of round, shallow ulcerations surrounded by inflammation that chiefly involves the nonkeratinized mucosa. The etiology of RAS is unknown, but has a strong hereditary component and appears to be related to an immune reaction against the oral mucosa. RAS must be distinguished from other diseases that cause recurring oral ulcers such as Behçet's syndrome, systemic lupus erythematosus, and Crohn's disease. This paper reviews the current theories regarding the etiology of RAS, the clinical evaluation of patients with recurring aphthous ulcers, and describes current treatment options for this condition.

Journal Article↗
PubMed2006

Investigation of functional gene polymorphisms IL-1beta, IL-6, IL-10 and TNF-alpha in individuals with recurrent aphthous stomatitis.

UNLABELLED: Recurrent aphthous stomatitis (RAS) is characterized by recurrent episodes of oral ulceration in an otherwise healthy individual. Some reports in the literature indicate that RAS may have immunological, psychological, genetic and microbiological bases. OBJECTIVE: The purpose of the present study was to investigate, using binary logistic regression analyses, a possible association between the functional IL-1beta +3954 (C/T), IL-6 -174 (G/C), IL-10 -1082 (G/A) and TNF-alpha -308 (G/A) genetic polymorphism and RAS in a sample of Brazilian patients, using a multivariate statistical analysis. DESIGN: Sixty-four consecutive subjects affected by minor and major forms of RAS and 64 healthy volunteers were genotyped. To investigate the association between the single nucleotide polymorphisms and risk of RAS, binary logistic regression models were fitted. The associations were expressed by odd ratios (ORs) and adjusted for age and gender, with the corresponding 95% CIs. P-values less than 0.05 were considered significant. RESULTS: A significant increase in the IL-1beta and TNF-alpha heterozygous genotypes were associated with an increased risk of RAS development (OR 2.40 and 3.07, respectively), in the multivariate model. CONCLUSION: Our findings demonstrate that polymorphisms of high IL-1beta and TNF-alpha production were associated with an increased risk of RAS development. Our findings also give additional support to a genetic basis for RAS pathogenesis.

Adolescent↗
PubMed2003

Polymorphisms in the IL-10 and IL-12 gene cluster and risk of developing recurrent aphthous stomatitis.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common, painful, ulcerative condition of the mouth. Although there is no clear genetic mode of inheritance, there is evidence that inheritance of specific gene polymorphisms may predispose individuals to RAS. AlsoTh1 cell mediated immune responses under the control of IL-10/IL-12 are thought to play an important role in its pathogenesis. OBJECTIVE: The objective of this study was to investigate the possibility that susceptibility to RAS is associated with the inheritance of specific gene polymorphisms for the T cell regulatory cytokines interleukin-10 (IL-10) and interleukin-12 (IL-12). PATIENTS AND METHODS: One hundred RAS patients and 91 ethnically matched controls were genotyped for the IL-10-592, and -1082 polymorphisms, and the IL-12 1188 polymorphism. Chi-square analysis was used to compare the allele frequencies and genotypes of cases and controls. RESULTS: No significant association was identified between inheritance of specific alleles or genotypes of the IL-10-592 and -1082 polymorphisms or IL-12 1188 polymorphism and susceptibility to RAS. CONCLUSIONS: We were unable to demonstrate an association between the inheritance of specific IL-10 or IL-12 gene polymorphisms and RAS susceptibility.

Adult↗
PubMed2002

IL-1B and IL-6 gene polymorphisms encode significant risk for the development of recurrent aphthous stomatitis (RAS).

Recurrent aphthous stomatitis (RAS) is an, ulcerative condition of the mouth, with a polygenic mode of inheritance in which cytokines are thought to play an important role. Ninety-one RAS patients and 91 controls were genotyped for known IL-1A, IL-1B, IL-1RN and IL-6 gene polymorphisms. Inheritance of the G allele of the IL-1B -511 polymorphism was strongly associated with RAS (OR = 2.5, P < 0.00002), with increased numbers of G/G homozygotes (OR = 4.5, P < 0.0005). The G allele of IL-6 -174 also occurred more frequently in RAS (OR = 2.6, P < 0.0001) with greatest risk associated with G/G homozygosity (OR = 3.4, P < 0.0001). IL-1RN VNTR 1/1 homozygotes also occurred more frequently in RAS (OR = 2.0, P < 0.02). Inheritance of the G/G genotype of both IL-1B and IL-6 was a particularly strong predictor for RAS (OR = 8.5).

Adolescent↗
PubMed1975

[General factors in the pathogenesis of parodontosis and chronic recurring aphthous stomatitis].

Parodontosis and aphthous stomatitis form a nosological entity which may be considered to be due to a pathological condition of exchange functions within the matrix of the connective tissue. As final products of the catabolism of collagen, there may be found peptid fragments containing both oxyproline and free amino acids. A large number of series of tests were made on a total of 164 patients in order to determine the various products of decomposition of collagen in the urine and their accumulation in the plasma.

Adult↗
PubMed1996

Recurrent aphthous stomatitis. An update.

Recurrent aphthous ulceration or recurrent aphthous stomatitis is the most common oral mucosal disease known to human beings. Despite much clinical and research attention, the causes remain poorly understood, the ulcers are not preventable, and treatment is symptomatic. The most common presentation is minor recurrent aphthous stomatitis: recurrent, round, clearly defined, small, painful ulcers that heal in 10 to 14 days without scarring. Major recurrent aphthous stomatitis lesions are larger (greater than 5 mm), can last for 6 weeks or longer, and frequently scar. The third variety of recurrent aphthous stomatitis is herpetiform ulcers, which present as multiple small clusters of pinpoint lesions that can coalesce to form large irregular ulcers and last 7 to 10 days. Diagnosis of all varieties is usually made after clinical examination. Many local and systemic factors have been associated with these conditions, and there is evidence that there may be a genetic and immunopathogenic basis for recurrent aphthous ulceration. Management of this condition depends on the clinical presentation and symptoms and includes analgesic, antimicrobial, and immunomodulatory drugs. As dental clinicians and researchers become better trained in oral medicine and stomatology, it is anticipated that the pathophysiology, prevention, and treatment of recurrent aphthous ulceration will improve in the future.

Adjuvants, Immunologic↗
PubMed1996

Recurrent aphthous stomatitis and thiamine deficiency.

Recurrent aphthous stomatitis is a disease of unknown cause. To examine whether thiamine (vitamin B1) deficiency is associated with recurrent aphthous stomatitis, we studied vitamin B1 levels in 70 patients with recurrent aphthous stomatitis and in 50 members of a control group. The vitamin B1 level was determined as thiamine pyrophosphate effect on transketolase activity in red blood cell lysates. Low levels of vitamin B1 were detected in 49 patients but in only two members of the control group (p < 0.0001). These low levels were not associated with patient age, sex, or underlying disease causing recurrent aphthous stomatitis. Our finding suggests an association between thiamine deficiency and recurrent aphthous stomatitis.

Adolescent↗
PubMed2005

Helicobacter pylori infection in oral lesions of patients with recurrent aphthous stomatitis.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a disorder distinguished by ulcers restricted to the oral mucosa. Because of the histological similarities between peptic ulcers and RAS and the identified role of Helicobacter pylori (H. pylori) in peptic ulcer, the possibility of bacterial involvement in the progression of aphthae has been suggested. Our aim was to find H. Pylori in brushed samples of oral aphthous ulcers by the polymerase chain reaction (PCR) method. MATERIAL/METHODS: The evaluated patients were referred to the laboratory with the diagnosis of RAS from the beginning of 2001 throughout 2002 in Rasht city. We collected oral aphthous specimens by toothbrush from these patients. PCR was used to isolate H. Pylori in the samples of RAS lesions and other parts of the oral cavity. Enzyme-linked immunosorbant assay (ELISA) was also done in all patients to determine IgG antibody RESULTS: We studied 50 patients with ages between 18 to 60 years (mean+/-SD: 32.38+/-11.30). Twenty-six patients (52%) had positive ELISA test and we obtained H. Pylori DNA in only one patient (2%). CONCLUSIONS: According to the results of this study, H. Pylori DNA could not be found in the aphthous ulcers of these patients, even in those with positive anti-H. Pylori antibody (IgG), and it is probable that these bacteria are not involved in recurrent oral aphthous ulcers.

Adolescent↗
PubMed1998

An evaluation of a chemical cautery agent and an anti-inflammatory ointment for the treatment of recurrent aphthous stomatitis: a pilot study.

OBJECTIVE: Recurrent aphthous stomatitis is a very common condition, currently treated with anti-inflammatory agents, which palliate the symptoms. The purpose of this clinical trial was to compare a medication commonly used to treat recurrent aphthous stomatitis, Kenalog-in-Orabase, and a newer agent, Debacterol. METHOD AND MATERIALS: Sixty patients diagnosed with recurrent aphthous stomatitis were enrolled in the study. Twenty patients were assigned to each of the two treatment groups, and 20 age- and sex-matched patients were assigned to the control group, which received no treatment. After the diagnosis was made, clinical examinations and ulcer measurements were performed, and a subjective evaluation of symptoms (100-mm visual analog scale) was completed by each subject. The subjects did not use any other medications. Both agents were applied topically (the frequency varied depending on the group of subjects) at specified intervals. Ulcer measurements and subjective evaluations were made at days 0, 3, 6, and 10 for all subjects. RESULTS: In both treatment groups, by day 10, 100% of the ulcers had clinically healed and were no longer causing pain. Patients in the Debacterol group reported a significantly greater decrease in pain at 3 days (> 70%) than did subjects in the other groups (< 20%), although the size of the ulcer did not differ significantly in any of the groups. After day 6, 80% of the ulcers in the Debacterol group had clinically disappeared and no longer caused symptoms, as compared to about 30% in the other groups. CONCLUSION: Patients subjectively reported significantly greater relief from symptoms with Debacterol than with Kenalog-in-Orabase or no treatment. The relief of symptoms associated with recurrent aphthous stomatitis may or may not correspond to clinical improvement, and these two topical medications may affect signs and symptoms of the lesions differently.

Administration, Topical↗
PubMed1988

Treatment of severe recurrent aphthous stomatitis with colchicine.

Recurrent aphthous stomatitis (RAS) is characterized by necrotizing ulcers of the oral mucosa that persist, remit, and recur for variable periods of time. Despite the benign nature of the disease, persistent pain and ulceration may disable patients from performing their daily activities. We describe three patients with long-standing active RAS treated with oral colchicine. All patients experienced a marked decrease in symptoms and a remission of the disease. Recurrences, however, occurred within three days of discontinuation of the therapy. In one patient, colchicine therapy was discontinued because of persistent diarrhea. In another, a second remission was more difficult to achieve on the same regimen. The literature on the subject is reviewed, and the beneficial effects of colchicine therapy are discussed in relation to the immunopathogenesis of this disease. We conclude that colchicine therapy should be considered as an alternative in the treatment of the major or persistent form of RAS.

Adult↗
PubMed1975

Aspects of the fine anatomy of aphthous stomatitis.

Samples of human aphthous stomatitis were studied under the electron microscope. The epithelial cells bordering the ulcer present multivesicular bodies, pinocytotic vesicles, primary lysosomes, digestive vacuoles, and autophagic vacuoles. The golgicomplex is noticeably increased; free ribosomes and rough endoplasmic reticulum are abundant. Crystalline structures are close to the nucleus. One or two paranuclear bodies are in most of the nuclei. A frank cell injury is evident, causing a major activity of the digestive cell system; the origin and formation of lysosomes through r.e.r. and the Golgi system are discussed.

Cell Membrane↗
PubMed1994

Oral findings, treatment and follow-up of a case with major aphthous stomatitis (Sutton's disease).

Major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis, which is noted for its high morbidity. Since the etiology of the disease is not clear, many therapies have been attempted. However, the controversial results hinder the adoption of a single mode of management. We present a 13-year-old boy with Sutton's disease, who was successfully treated with a combination of burst systemic prednisone (1 mg/kg/day for five days, thereafter half dose on alternate days for one week) and topical triamcinolone (four rinses a day). He continued the mouth rinses with the same interval. At the end of the first month, significant healing was observed and gradual tapering was recommended on the condition that the ulcers were well-controlled. The maintenance of steroid rinse once a day provided a symptom-free period of one year. Neither any withdrawal signs nor side affects were observed. Therefore, we think that this regimen should be considered as the treatment of choice in Sutton's disease along with a close follow-up even in childhood.

Adolescent↗