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[Recurrent aphthous stomatitis: current etiopathogenetic and therapeutic concepts].

The authors review the literature on aetiopathogenesis and therapeutic management of recurrent aphthous stomatitis. The data regarding the role of genetic, nutritional and microbiological factors in the genesis of recurrent aphthous stomatitis has been particularly examined. Despite significant associations with some antigens HLA have been reported in Southern Europe, there is no clear genetic predisposition in recurrent aphthous stomatitis. Several studies have analyzed the importance of iron, folic acid and vitamin B12 deficiencies, gluten intolerance and sensitivity to certain foods in the triggering of recurrent aphthous stomatitis however the results have been controversial. Recently, it has been suggested that recurrent aphthous stomatitis could be caused by reactivation of varicella-zoster virus and/or cytomegalovirus but these viruses may be reactivated by the immunodysregulation known to underlie recurrent aphthous stomatitis. Moreover, antiviral drugs appear to have only an equivocal effect on recurrent aphthous stomatitis. Recurrent aphthous stomatitis is probably determined by immunological mechanisms although there actually no unifying hypothesis which attempt to integrate the results of the many immunologic studies on recurrent aphotous stomatitis. Moreover, the target antigen and the cause of recurrences of recurrent aphthous stomatitis are still unknown. As far as the management of this disease it is important to recognize recurrent aphthous stomatitis secondary to systemic diseases like Behcet's syndrome, gluten enteropathy and haematinics deficiencies. Subsequently, the symptoms can be reduced with several drugs (mainly topical corticosteroids) but there are no effective therapies preventing recurrences.

Adjuvants, Immunologic↗

Recurrent aphthous stomatitis: etiology, diagnosis, and treatment.

Recurrent aphthous stomatitis is a very common condition seen frequently by dentists in practice. Although the majority of cases are benign and resolve in less than two weeks, these ulcerations may be indicative of underlying systemic diseases ranging from vitamin deficiency to autoimmunity. Awareness of these correlations can help the dentist make or aid the diagnosis of potentially serious conditions. There are treatments of which the practitioner should be aware that may ameliorate the pain of the ulcerations or shorten their duration. The diagnosis and management of this important condition is reviewed in this article.

Administration, Topical↗

Recurrent aphthous stomatitis.

The cause of recurrent aphthous stomatitis (RAS) remains unknown despite considerable research. This article reviews the evidence for current theories regarding this disorder, including possible suspected relationships with microbial and immunologic factors, and presents medical diseases that mimic RAS lesions in certain patients. Topical management of the common form of minor RAS is described along with systemic therapy currently available to patients with severe forms of this disease.

Adolescent↗

The effects of relaxation/imagery training on recurrent aphthous stomatitis: a preliminary study.

Recurrent aphthous stomatitis (RAS) is one of the most common diseases of the oral mucosa. Although etiology remains unknown, immunological and emotional disturbances have been implicated in the pathogenesis of RAS. No consistently effective therapeutic regimen has been found. The present study investigates the voluntary modulation of RAS employing hypnosis-like relaxation/imagery training procedures. A multiple baseline design was used to evaluate change in frequency of ulcer recurrence. The role of psychological distress, ratings of perceived pain, and hypnotizability in the treatment of RAS were also examined. Results suggest that the relaxation/imagery treatment program was associated with a significant decrease in the frequency of ulcer recurrence for all subjects. Psychological distress was examined for relationship to ulcer recurrence and symptomatic changes with treatment, but no pattern was found. Finally, little support was found for the role of high hypnotic ability in the treatment of RAS.

Adolescent↗

Recurrent aphthous stomatitis: primary care management.

Recurrent aphthous stomatitis (RAS), often referred to as canker sore, is a chronic inflammatory disease. Frequently seen in the primary care setting, RAS affects over 50% of the population and may be observed in an otherwise apparently healthy individual. An unknown pathogenesis and absence of curative treatment make RAS a challenge to manage. Treating RAS should be patient specific and focus on reduction of pain and lesions. An awareness of literature suggesting etiologies, precipitating, and predisposing factors can assist the practitioner and patient in controlling RAS episodes. Contained in this review is a suggested course of management for patients with RAS, including present recommendations for pharmacological interventions.

Adult↗

Gluten-sensitive recurrent aphthous stomatitis.

Twenty selected patients with recurrent aphthous stomatitis in whom celiac disease had been specifically excluded were placed on a gluten-free diet. Five patients (25%) showed a favorable response to gluten withdrawal and a positive gluten challenge. Jejunal morphology was normal in all patients indicating gluten sensitivity without enteropathy. Gluten withdrawal provides a further method of treating some patients with recurrent aphthous stomatitis.

Adolescent↗

Food allergens and basophil histamine release in recurrent aphthous stomatitis.

The leukocytes from sixty patients with recurrent aphthous stomatitis were tested for histamine release in response to environmental and food antigens. Eighteen patients (30 percent of the population studied) were atopic, and this history of respiratory allergy was confirmed by an in vitro histamine release assay. The nonatopic patients with recurrent aphthous stomatitis had a significantly higher incidence of in vitro histamine release to foods than did control subjects. The leukocytes from twenty-three patients (38 percent) released histamine to food antigens. Patients eliminated foodstuffs in a double-blind trial to correlate the in vitro histamine release to the development of oral ulcers. Only 30 percent of the patients had a decreased incidence of ulcers after eliminating foods which had induced in vitro histamine release. On rechallenge in the double-blind trial, 30 percent of the foods which caused histamine release also correlated to increased incidence of oral lesions. In eight patients ingestion of certain foodstuffs was correlated to oral ulceration by food diaries and elimination-rechallenge in an open-trial basis. However, dietary manipulation did not completely eliminate the ulceration in any of the patients. The results suggest that food sensitivity may play a minor role in the development of recurrent aphthous stomatitis.

Adolescent↗