Recurrent Aphthous Stomatitis Overview
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Questions and Answers

What are the three main types of Recurrent Aphthous Stomatitis (RAS)?

The three main types of RAS are Minor Aphthous Ulcers, Major Aphthous Ulcers, and Herpetiform Ulcers.

What is a possible trigger for RAS that can be found in toothpaste?

Sodium lauryl sulfate (SLS) is a common toothpaste ingredient that can trigger RAS in some individuals.

What are two common local treatments for minor RAS?

Saltwater rinses and lidocaine gel are two common local treatments for minor RAS, providing soothing and numbing effects.

What type of medication is often prescribed for moderate to severe RAS?

<p>Topical steroids, such as hydrocortisone lozenges, betamethasone mouthwash, or beclometasone inhalers are often prescribed for moderate to severe RAS.</p> Signup and view all the answers

Besides blood count and haematinic levels, what type of tests might be done to investigate the cause of RAS?

<p>Blood tests for GI disorders such as celiac and Crohn's disease may be helpful in diagnosing potential causes of RAS.</p> Signup and view all the answers

What is a key characteristic of Herpetiform Ulcers that distinguishes them from other types of RAS?

<p>Herpetiform Ulcers present as clusters of tiny ulcers, typically 1-2 mm in size.</p> Signup and view all the answers

What systemic medication might be prescribed for severe or non-responsive RAS?

<p>Systemic steroids, such as Prednisolone, may be prescribed for severe or non-responsive RAS.</p> Signup and view all the answers

Explain the difference between Major Aphthous Ulcers and Minor Aphthous Ulcers.

<p>Major Aphthous Ulcers are larger than 1 cm in size, more painful, last longer than a month, and can lead to scarring, while Minor Aphthous Ulcers are smaller, heal quickly without scarring, and are less painful.</p> Signup and view all the answers

What is the difference between treating minor RAS versus moderate to severe RAS?

<p>Treating minor RAS focuses on local symptomatic relief with measures like saltwater rinses and lidocaine gel. Moderate to severe cases often require topical steroids or, in some cases, systemic steroids.</p> Signup and view all the answers

What are two important things to remember about RAS?

<p>RAS is common but not contagious, and its causes are multifactorial, involving genetic factors, nutritional deficiencies, and other underlying conditions.</p> Signup and view all the answers

What characterizes Recurrent Aphthous Stomatitis (RAS)?

<p>RAS is characterized by painful, round or oval ulcers with a yellow-white fibrinous center and a red inflammatory halo.</p> Signup and view all the answers

What is the estimated prevalence of RAS in the general population?

<p>RAS affects approximately 10-25% of the population.</p> Signup and view all the answers

List at least two potential nutritional deficiencies that may trigger RAS.

<p>Low iron, folic acid, or vitamin B12 can trigger RAS.</p> Signup and view all the answers

What type of factors are believed to contribute to the occurrence of RAS?

<p>RAS is believed to be multifactorial, involving genetics, nutritional deficiencies, and gastrointestinal disorders.</p> Signup and view all the answers

What common trigger related to oral hygiene may lead to RAS outbreaks?

<p>Sodium Lauryl Sulfate (SLS) in toothpaste can trigger RAS outbreaks.</p> Signup and view all the answers

How is RAS primarily diagnosed?

<p>RAS is primarily diagnosed based on clinical history and examination.</p> Signup and view all the answers

Why might smoking cessation be considered a trigger for RAS?

<p>Cessation of smoking can lead to changes in the oral environment, triggering RAS outbreaks.</p> Signup and view all the answers

What demographic is most likely to be affected by RAS?

<p>RAS most commonly affects non-smokers and otherwise healthy individuals.</p> Signup and view all the answers

Flashcards

Recurrent Aphthous Stomatitis (RAS)

A type of mouth ulcer that recurs frequently, typically affecting young adults.

Causes of RAS

Can be caused by a variety of factors such as genetics, stress, nutritional deficiencies, and certain foods.

Saltwater Rinses

Commonly used to help soothe minor RAS ulcers.

Sodium Lauryl Sulfate (SLS)

A type of toothpaste ingredient often found to trigger RAS, consider switching to SLS-free.

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Minor Aphthous Ulcers

A common type of RAS that is small and heals quickly without scarring.

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Major Aphthous Ulcers

A severe form of RAS, lasting over a month and potentially causing scarring.

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Herpetiform Ulcers

A type of RAS characterized by a cluster of tiny, extremely painful ulcers.

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RAS Management Options

Treatment options for RAS range from local symptomatic relief to systemic steroids, depending on severity.

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Doxycycline

A common treatment for herpetiform RAS, often taken as a rinse.

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RAS is not contagious

Although RAS can be bothersome, it is not contagious and should not be spread through contact.

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What is Recurrent Aphthous Stomatitis (RAS)?

A chronic condition characterized by recurrent, painful, round or oval ulcers in the mouth. These ulcers have a distinctive appearance with a yellow-white center and a red inflammatory ring around it.

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When does RAS typically start and how common is it?

RAS typically begins in childhood and persists with recurring episodes throughout life. It affects a significant portion of the population, with non-smokers being more prone.

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What are the main causes of RAS?

While the exact cause remains elusive, it's believed to be a combination of factors.

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What are some genetic and nutritional factors that influence RAS?

Genetic predisposition is a key factor, with specific genes increasing susceptibility to RAS. Nutritional deficiencies, particularly in iron, folic acid, and vitamin B12, can also trigger episodes.

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How do certain gastrointestinal disorders relate to RAS?

Conditions like celiac disease and inflammatory bowel disease (IBD) are linked to RAS, suggesting a potential connection to gut health.

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What are some common triggers for RAS?

Stressful situations and emotional distress can trigger RAS outbreaks. Physical trauma, such as biting your cheek or dental procedures, can also lead to ulcer formation.

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What are some surprising triggers for RAS?

SLS (Sodium Lauryl Sulfate), a common ingredient found in toothpaste, can irritate the mouth and potentially trigger RAS. Interestingly, quitting smoking can also lead to a temporary increase in ulcers.

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How do hormonal changes and food allergies relate to RAS?

Hormonal fluctuations during menstruation or pregnancy can also trigger RAS episodes. Some individuals have food allergies to citrus, nuts, or spicy foods, which might cause ulcers.

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Study Notes

Recurrent Aphthous Stomatitis (RAS)

  • Definition: Chronic condition causing painful, round or oval mouth ulcers with a yellow-white center and red halo.
  • Prevalence: Affects 10–25% of the population, predominantly healthy non-smokers.
  • Onset: Often begins in childhood, recurring throughout life.

Causes of RAS

  • Multifactorial: The precise cause is unknown.
  • Genetics: HLA types may increase susceptibility.
  • Nutritional Deficiencies: Low iron, folic acid, or vitamin B12 may be contributing factors.
  • Gastrointestinal Disorders: Conditions like celiac disease and inflammatory bowel disease (IBD) are linked to RAS.

Triggers of RAS

  • Stress and Emotional Strain
  • Minor Trauma (e.g., chewing, dental procedures).
  • Sodium Lauryl Sulfate (SLS) Toothpaste: Especially changes in toothpaste.
  • Smoking Cessation: Surprisingly, quitting smoking can be a trigger.
  • Hormonal Changes: Occurring during menstruation or pregnancy.
  • Food Allergens: Certain foods (e.g., citrus, nuts) can trigger outbreaks.
  • Immune Deficiencies: Can increase the likelihood of an outbreak (though less common).

Diagnosis of RAS

  • Clinical: Based primarily on patient history and physical examination. Questions asked include:
    • Ulcer onset timing (childhood/adolescence)
    • Frequency of recurrences
    • Recent changes in medications or diet(especially toothpaste).
    • Symptoms suggesting GI disorders.
  • Testing (severe/persistent): Full Blood Count (FBC), haematins levels, and tests for GI diseases.

Differentiating RAS from Other Conditions

  • Behçet's Disease: Includes mouth ulcers and systemic symptoms.
  • Inflammatory Bowel Disease (IBD): May involve GI symptoms alongside oral ulcers.
  • HIV-related Ulcers: Common in immunocompromised patients.
  • MAGIC Syndrome: A rare autoimmune disorder.

Types of RAS

  • Minor (most common): Small ulcers (2–7 mm), healing in 7–10 days without scarring.
  • Major: Larger than 1 cm, more painful, and lasting longer (> 1 month). Can lead to scarring.
  • Herpetiform: Clusters of tiny ulcers (1–2 mm), extremely painful, and may consolidate to form larger, irregular lesions.

Management of RAS

Addressing the Cause:

  • Identify and address any triggers (stress, diet, underlying GI issues).
  • Consider SLS-free toothpaste.
  • Supplement deficiencies of iron, B12, or folate.

Local Symptomatic Relief:

  • Saltwater rinses.
  • Lidocaine gel (5%).
  • Chlorhexidine mouthwash (0.2%).
  • Difflam Spray (Benzydamine 0.15%).

Medical Treatment (Severity Dependent):

  • Mild: Orabase (protective barrier)
  • Moderate-Severe: Topical steroids (e.g., hydrocortisone, betamethasone), or beclometasone inhalers for targeted ulcer treatment.
  • Doxycycline (100mg dispersible tablet) for herpetiform ulcers (as a rinse)
  • Severe/Non-Responsive: Systemic steroids (e.g., Prednisone). Specialist referral.

Key Takeaways

  • RAS is common but not contagious.
  • Causes are diverse (genetics, diet, GI issues, lifestyle).
  • Stress, trauma, and certain dietary adjustments (like the elimination of SLS toothpaste) can be triggers.
  • Diagnosis involves a clinical evaluation and potentially blood tests.
  • Treatments vary depending on severity, from home remedies to more extensive medical management.

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Description

Explore the chronic condition known as Recurrent Aphthous Stomatitis (RAS), characterized by painful mouth ulcers. This quiz delves into its prevalence, causes, triggers, and the impact on individuals, particularly focusing on nutritional deficiencies and stress factors. Test your knowledge about this common yet often misunderstood condition.

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