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PubMed2006

Association of interleukin-1beta polymorphism with recurrent aphthous stomatitis in Brazilian individuals.

BACKGROUND: 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. The purpose of the present study was to investigate the possible association between interleukin-1beta (IL-1beta) +3954 (C/T) genetic polymorphism and RAS in a sample of Brazilian patients. SUBJECTS AND METHODS: Sixty-two consecutive subjects affected by minor and major forms of RAS and 62 healthy volunteers were genotyped at IL-1beta (+3954). The chi-squared test was used for statistical analysis. RESULTS: A significant increase in the high production of IL-1beta genotype CT was observed in the group with RAS (P = 0.01). After stratifying RAS patients according to the mean number of lesions per episode, a significant difference was only observed between patients with >or=3 lesions in each episode and control. CONCLUSION: There is an increased frequency of polymorphism associated with high IL-1beta production in RAS patients.

Adolescent↗
PubMed2003

Results of double-blind placebo-controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis.

BACKGROUND: The aetiology of recurrent aphthous stomatitis (RAS) has so far not been completely clarified. Recently, several studies reported that patients affected by cutaneous diseases (i.e. dermatitis, eczema and urticaria) with positive patch test to nickel have a positive oral nickel challenge. OBJECTIVE: A retrospective data analysis of patch test and oral nickel challenge in 380 patients (204 women and 176 men) affected by RAS was performed. PATIENTS AND METHODS: We examined 380 consecutive patients affected by RAS during the period 1990-1999. In 28/380 patients the appearance of their oral symptoms coincided with the fitting of orthodontic appliance, while 352/380 reported that their oral symptoms worsened after the fitting of orthodontic appliance. All patients were studied with the series (European standard series and series for dental materials) for patch tests. RESULTS: Seventy out of 380 patients (18.4%) presented a contact sensitization to nickel sulphate (positive patch test). In all of these, the orthodontic appliance was replaced with one made of nickel-free materials. All patients were re-examined by the dentist 6 months after the removal of the orthodontic appliance. The symptoms had completely remitted in 28/70 patients, partially had improved in 31/70 patients and had remained unchanged in 11/70 patients. In all patients (n = 70) with a positive patch test to nickel we performed an oral double-blind placebo-controlled challenge (DBPC) test with nickel sulphate. The DBPC was positive in 32/70 patients, 21 of whom had partially improved and 11 had not, even after the replacement of the orthodontic appliance with material not containing nickel. None of the 28 patients in complete remission showed an adverse reaction to oral nickel challenge. CONCLUSION: The results of this study demonstrate that, in some patients with a positive patch test to nickel sulphate, the perpetuation of RAS can be related to a hypersensitivity to ingested nickel salts, independently of local contact to nickel.

Adult↗
PubMed2003

The diagnosis and management of recurrent aphthous stomatitis: a consensus approach.

BACKGROUND: Recurrent aphthous stomatitis, or RAS, is a common oral disorder of uncertain etiopathogenesis for which symptomatic therapy only is available. This article reviews the current data on the etiopathogenesis, diagnosis and management of RAS in a primary care setting. METHODS: The authors reviewed publications on Medline from 1995 through 2000, the period since the last major reviews were published. RESULTS: RAS may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein. Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies and HIV infection. While topical corticosteroids remain the mainstay for therapy, a number of other immunomodulatory modalities now are available. CONCLUSIONS: There is still no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore therapy can attempt only to suppress symptoms rather than to address the basic issues of susceptibility and prevention. CLINICAL IMPLICATIONS: In the majority of patients, symptomatic relief of RAS can be achieved with topical corticosteroids alone, with other immunomodulatory topical agents or by combination therapy.

Adjuvants, Immunologic↗
PubMed2004

Low frequency of anti-endomysial antibodies in recurrent aphthous stomatitis.

INTRODUCTION: The aetiology of recurrent aphthous stomatitis (RAS) remains unknown. An association between RAS and coeliac diseases (CD) has previously been suggested, but the supporting evidence remains equivocal. The aim of the present study was to determine the likely frequency of CD in a large cohort of patients with well-defined RAS, by detailed haematological and serological analysis, including the detection of anti-endomysium and anti-reticulin antibodies. MATERIALS AND METHODS: The study comprised 87 patients with minor RAS. Full blood counts and the presence of IgA anti-endomysial and IgA anti-reticulin antibodies were estimated in all patients. RESULTS: The frequency of anti-endomysium and anti-reticulin antibodies was not elevated in patients with RAS and no patients with RAS had other serological features of CD. CONCLUSIONS: It is concluded that there is little significant aetiological link between RAS and CD, and that screening RAS patients for key serological markers of CD is of little clinical value.

Adolescent↗
PubMedDate not supplied

Anxiety in recurrent aphthous stomatitis patients.

The relationship of recurrent aphthous stomatitis (RAS) to psychological factors has been reported. The purpose of this study was to determine anxiety in RAS patients. All new patients seen during May 1988-November 1988 at the Oral Diagnosis Clinic, Department of Oral Medicine, Faculty of Dentistry, Mahidol University, completed a questionnaire regarding their history of RAS. For the measurement of anxiety, patients were given the Self-rating Anxiety Scale (SAS). Of the 3,106 patients studied, 46.7% reported a positive history of RAS. In this population, females were significantly (P less than 0.001) more anxious than males. The mean SAS score obtained from patients with RAS was significantly (P less than 0.001) higher than that of patients without RAS in each sex. It is concluded that patients with RAS are more anxious than patients without RAS.

Adult↗
PubMed1995

[The clinico-immunological characteristics of the course of recurrent aphthous stomatitis].

Clinical and laboratory examinations of 86 patients with relapsing aphthous stomatitis making use of a complex of clinical, immunological, cytochemical, and microbiological methods, helped specify the clinico-anamnestic features in the course of this disease. An immunobacterial concept of the pathogenesis of relapsing aphthous stomatitis has been formulated; according to this concept, the disease is initiated by disorders of T and B immunity system and nonspecific defense factors, leading to increase of the content and virulence of oral microflora, and thus stimulating the bacterial sensitization of the organism of patients with relapsing aphthous stomatitis.

Adolescent↗
PubMed1991

Aphthous stomatitis and its management.

The clinical features and etiology of recurrent aphthous stomatitis are reviewed briefly. Because etiology and pathogenesis are not yet well established, recurrent aphthous stomatitis continues to be a difficult disease to treat. Several therapy modalities are discussed, including corticosteroids (both topical and systemic), antibiotics, mouth rinses, levamisole, and thalidomide. The recent literature contains several discussions of the treatment of recurrent aphthous stomatitis with thalidomide.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Recurrent aphthous stomatitis: which role for viruses, food, and dental materials?].

Recurrent aphthous stomatitis is a frequently occurring disorder which may be a clinical feature of systemic disease. For many other patients, it is a tedious problem often having no known cause. The aim of this study was to verify if immune responses to common foods and/or viruses are involved in the etiopathogenesis of recurrent aphthous stomatitis. Sixteen patients with this disorder were studied by measurement of immunoglobulin classes (IgG, IgA, IgM), blood lymphocyte subpopulations, blood circulating immune complexes, and complement fractions (C3 and C4). Intradermal skin tests for common food and inhalant allergens were performed in all cases. In 5 patients with positive skin tests, serum specific IgE were tested for the same allergens by radioallergosorbent test. Skin patch tests for dental material were performed in all cases. Oral mucosal biopsies and/or cytology samples were taken in 10 cases for histopathological evaluation and in situ hybridization for Papillomavirus, Cytomegalovirus, Herpes simplex virus I and II, Epstein Barr virus. In 13 patients, lymphocyte subpopulations were altered, with a reduced CD4/CD8 ratio. No other alterations of serum immunological parameters were observed. Skin patch tests for dental material were negative in all cases, while skin tests for food allergens were positive in 5 cases (not confirmed by radioallergosorbent test or food challenge tests). Virus antigen and DNA were not found in mucosal specimens, although one patient was positive for Epstein Barr virus DNA by in situ hybridization. An alteration of the CD4/CD8 ratio was demonstrated in most of the patients with recurrent aphthous stomatitis, although immune responses to food and/or dental material and/or common viruses did not seem to be involved in the etiopathogenesis of this disorder.

Adult↗
PubMed1997

Topical and systemic therapy for recurrent aphthous stomatitis.

The cause of recurrent aphthous ulcers (RAU), the lesions of recurrent aphthous stomatitis, is incompletely understood but appears to involve immune system dysfunction. Treatment options include no treatment, treatment of associated systemic diseases or conditions (eg, celiac sprue, vitamin deficiencies), systemic medications, topical medications, conversion of the aphthous ulcer to a wound, and palliative treatments. The most effective treatments (systemic or topical corticosteroids, thalidomide) involve agents that suppress or modulate immune system function. In general, topical agents are preferred because they have fewer associated side effects; however, inability to obtain adequate contact time may limit their effectiveness. Adjunct pain control is sometimes necessary, either with pain medications or with adherent agents that coat the ulcers.

Adjuvants, Immunologic↗
PubMed2006

Hematologic status in patients with recurrent aphthous stomatitis in Jordan.

OBJECTIVE: To determine the prevalence of hematinic deficiencies in patients with recurrent aphthous stomatitis. METHODS: The study took place in the Oral Medicine Clinic of the Jordan University Hospital in Amman, Jordan, between January 1993 and December 2000. We studied the hemoglobin, serum ferritin, vitamin B12 and folate levels in 143 patients with recurrent aphthous stomatitis. We compared the results with a control group of 143 age- and gender-matched patients with a range of other oral diseases. RESULTS: In recurrent aphthous stomatitis patients, 14% were anemic and 37.8% showed hematinic deficiencies; 16.8% showed low serum ferritin; 26.6% showed low serum vitamin B12 and 4.9% showed low serum folate. In the control group, 10.5% were anemic and 18.2% showed hematinic deficiencies; 9.8% showed low serum ferritin; 12.6% showed low serum vitamin B12 and none showed serum folate deficiency. CONCLUSION: Patients with recurrent aphthous stomatitis have more hematinic deficiencies, particularly vitamin B12 deficiency, compared with controls. Correction of these hematinic deficiencies could help in the management of the disease.

Adolescent↗
PubMed2004

Celiac disease in patients having recurrent aphthous stomatitis.

BACKGROUND/AIMS: Celiac disease is a condition related to the small intestine's intolerance to gluten. In epidemiologic studies the prevalence is highly variable. The diagnosis can be difficult due to the wide spectrum of signs and symptoms. As the risk for intestinal lymphoma is higher in these patients, early diagnosis has its privileges. The higher prevalence of recurrent aphthous stomatitis in celiac disease led us to investigate the celiac disease prevalence in patients with recurrent aphthous stomatitis, which might assist in diagnosis of asymptomatic celiac disease patients. The aim of this study was to determine the prevalence of celiac disease in patients presenting with recurrent aphthous stomatitis. METHODS: The study group consisted of patients having a history of recurrent aphthous stomatitis. The control group included patients not having aphthous stomatitis. Antibodies to gliadin IgG and IgA and antibodies to endomysium were determined from the serum samples of all patients. Biopsies were obtained from the distal part of the duodenum. RESULTS: Biopsies of two patients (4.8%) out of 41 belonging to the study group were diagnosed as celiac disease. In serum samples of both, antibodies to gliadin IgA and antibodies to endomysium were found to be positive. Antibodies to gliadin IgG antibody were positive in only one of these two patients. None of the 49 patients in the control group was diagnosed as celiac disease. CONCLUSION: Further evaluation of recurrent aphthous stomatitis patients for celiac disease must be performed. As the endoscopic procedures are invasive and costly, evaluation of recurrent aphthous stomatitis patients for celiac disease must include serologic markers at the beginning. If any positivity is determined in markers, then endoscopic procedures including biopsies of the duodenum must be considered as the second-step intervention.

Adult↗
PubMed1997

Recurrent aphthous stomatitis: clinical characteristics and associated systemic disorders.

Recurrent aphthous stomatitis (RAS), commonly known as canker sores, has been reported as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. One of its variants is the most painful condition of the oral mucosa. Recurrent aphthous stomatitis has been the subject of active investigation along multiple lines of research, including epidemiology, immunology, clinical correlations, and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MiAU, MjAU, HU) and severity (simple versus complex). The natural history of individual lesions of RAS is important, because it is the bench mark against which treatment benefits are measured. The lesions of RAS are not caused by a single factor but occur in an environment that is permissive for development of lesions. These factors include trauma, smoking, stress, hormonal state, family history, food hypersensitivity and infectious or immunologic factors. The clinician should consider these elements of a multifactorial process leading to the development of lesions of RAS. To properly diagnose and treat a patient with lesions of RAS, the clinician must identify or exclude associated systemic disorders or "correctable causes." Behçet's disease and complex aphthosis variants, such as ulcus vulvae acutum, mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome, fever, aphthosis, pharyngitis, and adenitis (FAPA) syndrome, and cyclic neutropenia, should be considered. The aphthous-like oral ulcerations of patients with human immunodeficiency virus (HIV) disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause," which, with appropriate treatment, can result in a remission or substantial lessening of disease activity.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Major aphthous stomatitis (Sutton's disease): etiopathogenesis, histological and clinical aspects].

Major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis differentiated by its high level of morbidity. It is generally found in areas of non-keratinized mucosa and is characterised by the presence of necrotic giant ulcers accompanied by intense pain. While this pathology has been the subject of molecular studies, its etiopathogenesis is still unknown. The most widely accredited hypothesis is that it represents an immune mechanism, namely the immunological response of mucosa with antigenic anomalies, modulated by altered local reactivity and influenced by triggering factors. After an extensive review of the various etiopathogenetic hypotheses, clinical and pathological aspects, the authors outline a number of therapeutic protocols including the use of topical and systemic cortisone, immunomodulators and alternative therapies like laser and ultrasound, or medications to protect the ulcers. They stress that the lack of etiopathogenetic uniformity precludes any specific treatment.

Adjuvants, Immunologic↗
PubMed1978

Double-blind study of levamisole in aphthous stomatitis.

Sixty-five patients with recurrent aphthous stomatitis participated in a double-blind study to evaluate levamisole. Nineteen of 34 patients improved on levamisole and only five of 31 patients improved on placebo (P less than 0.004, chi-square with two degrees of freedom). After breaking the code and switching placebo patients to levamisole and non-responders to an alternate dosage schedule, 46 of 60 patients noted clinical improvement.

Adolescent↗
PubMed1994

Specific lymphocytotoxic destruction of autologous epithelial cell targets in recurrent aphthous stomatitis.

Concepts of the immunopathogenesis of recurrent aphthous stomatitis (RAS) based on lesion histology suggest an early role for CD4+ T cells. Other in vitro studies show enhanced destruction of epithelial targets by peripheral blood mononuclear cells (PBMC) from RAS subjects. The present project aimed to extend these studies under conditions simulating the in vivo situation. Epithelial cells were cultured and induced to express class I and class II major histocompatibility complex (MHC) antigens with gamma interferon (gamma-IFN). Co-cultures with autologous PBMC showed evidence of specific destruction of epithelial targets in RAS patients when compared with a control group. Co-culture with CD4+ enriched cells also showed specific epithelial cell lysis. Effector cells pre-incubated with interleukin-2 (IL-2) did not produce increased destruction of epithelial cells. This study has supported previous work and identified an early role of CD4+ cells.

Adult↗
PubMed1978

Management of recurrent aphthous stomatitis. A review.

The management of recurrent aphthous ulceration is discussed. It appears that the treatment of choice in mild to moderately severe aphthous stomatitis is repeated application of topical tetracycline hydrochloride. Viscous lidocaine (2 percent) provides symptomatic relief and is therefore a useful adjunct to therapy. Cyclical estrogens appear to be helpful in recurrent premenstrual aphthosis. Immune-regulating agents such as levamisole hold promise for the future.

Administration, Topical↗
PubMed1981

Role of mucosal injury in initiating recurrent aphthous stomatitis.

The buccal mucosa of 30 patients with recurrent aphthous stomatitis and 15 healthy controls was injured by suture and penetration with a tenaculum and a hypodermic needle and each of the six puncture wounds produced monitored for up to seven days for the development of ulcers. Altogether 26 lesions were induced in 13 patients, whereas none occurred in the controls (p less than 0.001). Sutures caused most of the lesions (15), and those so induced had a mean maximum diameter of 2.3 mm and lasted for an average of four days. Ulcers induced mechanically were clinically indistinguishable from those usually seen in the patients, except that they were generally smaller and healed more quickly. These findings confirm that mechanically induced injury of the oral mucosa may cause ulceration in people susceptible to aphthous stomatitis. Such a procedure may therefore be helpful in identifying subsets of patients.

Adult↗