Recurrent Aphthous Stomatitis Overview
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Questions and Answers

What are two common characteristics of the ulcers in recurrent aphthous stomatitis?

The ulcers are typically round or oval with a yellow-white fibrinous center and an erythematous halo.

Besides genetic predisposition, name two categories of factors that may contribute to recurrent aphthous stomatitis.

Nutritional/haematinic deficiencies and gastrointestinal disorders.

Name two common blood tests that would be used to investigate potential causes of recurrent aphthous stomatitis?

FBC (full blood count) and haematinics (iron, folate, serum vit b12).

List two predisposing factors for recurrent aphthous stomatitis that are related to lifestyle or environment.

<p>Stress and sodium lauryl sulfate (SLS).</p> Signup and view all the answers

What are two diseases that should be considered in the differential diagnosis of recurrent aphthous stomatitis?

<p>Bechet’s disease and coeliac disease.</p> Signup and view all the answers

What specific genetic factor is associated with celiac disease?

<p>HLA DQ2</p> Signup and view all the answers

Name two oral manifestations of celiac disease.

<p>Recurrent apthous ulcers and angular cheilitis.</p> Signup and view all the answers

What specific antibody is tested for in the diagnosis of celiac disease?

<p>Anti-tissue transglutaminase (anti-tTG) antibodies</p> Signup and view all the answers

What is the primary dietary treatment for celiac disease?

<p>A gluten-free diet</p> Signup and view all the answers

What two main diseases are encompassed under inflammatory bowel disease (IBD)?

<p>Ulcerative colitis and Crohn's disease</p> Signup and view all the answers

What is the most significant difference in the location and depth of inflammation between Crohn's disease and ulcerative colitis?

<p>Crohn's disease can affect the entire GI tract and is transmural, while ulcerative colitis is limited to the colon and rectum and is intramural.</p> Signup and view all the answers

What does OFG stand for in the context of Crohn's disease, and what does it indicate?

<p>Orofacial Granulomatosis. It represents Crohn's disease affecting the mouth without gastrointestinal involvement.</p> Signup and view all the answers

Name one common side effect of steroid medications used to treat IBD?

<p>Candidiasis</p> Signup and view all the answers

What is the typical age of onset for minor aphthous ulcers?

<p>10-40 years old.</p> Signup and view all the answers

How many ulcers are typically present in a minor aphthous ulcer episode?

<p>1-6 ulcers.</p> Signup and view all the answers

What is the typical diameter of a major aphthous ulcer?

<p>1 cm or greater.</p> Signup and view all the answers

True or False: Herpetiform ulcers are more common than minor aphthous ulcers.

<p>False.</p> Signup and view all the answers

Where do minor aphthous ulcers typically occur in the mouth?

<p>Non-keratinized mucosa, such as the lips and cheeks.</p> Signup and view all the answers

What is the average duration of a minor aphthous ulcer?

<p>4-14 days.</p> Signup and view all the answers

Do minor aphthous ulcers generally cause scarring?

<p>No, they do not.</p> Signup and view all the answers

What is the typical duration of a major aphthous ulcer?

<p>More than 30 days.</p> Signup and view all the answers

True or False: Major aphthous ulcers always scar after healing.

<p>True.</p> Signup and view all the answers

How do herpetiform ulcers typically begin?

<p>Multiple pinhead aphthae.</p> Signup and view all the answers

What type of toothpaste should be used to avoid exacerbating aphthous ulcers?

<p>SLS-free toothpaste.</p> Signup and view all the answers

What is a common covering agent used to help treat RAS?

<p>Sodium Carboxymethylcellulose or Carmellose sodium.</p> Signup and view all the answers

What is a common topical steroid used to treat RAS?

<p>Hydrocortisone Oromucosal Tablets.</p> Signup and view all the answers

What is a common systemic treatment to help herpetiform ulcers?

<p>Doxycycline.</p> Signup and view all the answers

What is the definition of coeliac disease?

<p>An autoimmune condition characterized by gluten hypersensitivity that attacks the villi of the small intestine causing malabsorption.</p> Signup and view all the answers

Flashcards

What are aphthous ulcers?

Painful, round or oval sores with a yellow-white center and red ring that recur throughout life.

When do aphthous ulcers typically start?

They tend to appear in childhood and recur throughout life, usually in otherwise healthy individuals.

What nutritional factors can contribute to aphthous ulcers?

Iron, folate, and vitamin B12 deficiencies can be a cause.

What are some of the factors that can trigger aphthous ulcers?

It's often difficult to pinpoint the exact cause, but genetics, stress, and certain foods seem to play a role.

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What blood investigations are typically done for aphthous ulcers?

Blood tests to check for iron, folate, and vitamin B12 levels are important.

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Celiac Disease

An autoimmune disorder that affects the small intestine and is triggered by gluten.

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Dermatitis Herpetiformis

A type of dermatitis associated with celiac disease, characterized by itchy, blistering skin rash.

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Crohn's Disease

An inflammatory bowel disease that affects the entire GI tract, from mouth to anus, and is characterized by 'skip lesions'.

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Ulcerative Colitis (UC)

An inflammatory bowel disease that affects only the colon and rectum, leading to continuous inflammation.

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Oral Crohn's (OFG)

Oral manifestations of Crohn's disease without any GI symptoms.

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Inflammatory Bowel Disease (IBD)

Chronic inflammatory bowel disease characterized by inflammation of the GI tract walls, leading to periods of remission and exacerbation.

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Anti-tissue Transglutaminase (anti-tTG) Antibody

An antibody used in the diagnosis of celiac disease.

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Recurrent Aphtous Ulcers

A common oral manifestation of celiac disease, often occurring in the mouth.

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Minor Aphthous Ulcer

A small, shallow sore in the mouth, usually less than 1 cm in diameter. They are typically found on the inside of the cheeks, lips, and tongue. They are usually painful and can last for a few days to a few weeks.

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Major Aphthous Ulcer

A large, painful mouth ulcer, bigger than 1cm. It can be found on both keratinized and non-keratinized tissues. They can be single or multiple and often last for longer than a month.

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Herpetiform Aphthous Ulcers

A rare type of mouth ulcer characterized by numerous tiny, pinhead-sized ulcers that appear in clusters. They can be very painful and last for a month or more.

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Recurrent Aphthous Stomatitis (RAS)

An inflammatory condition affecting the mouth characterized by recurrent mouth ulcers.

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Symptomatic and Antiseptic Mouth Ulcer Treatment

Pain relief for mouth ulcers that eases discomfort. Common examples include lidocaine ointment and spray

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Topical Steroids

Topical steroids, such as hydrocortisone, are applied directly onto the mouth ulcer to reduce inflammation and pain.

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Systemic Steroids

Systemic steroids, such as prednisolone, are taken orally to reduce inflammation and pain. This treatment is usually reserved for severe cases of RAS.

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Vitamin B12 Deficiency

A condition where the body does not absorb enough vitamin B12. Low B12 can be linked to oral ulceration.

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Covering Agents for Mouth Ulcers

Sodium Carboxymethylcellulose and Carmellose Sodium. These agents create a protective barrier over the ulcer, helping to alleviate pain and promote healing.

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Mouthwashes for Mouth Ulcers

These mouthwashes are used to reduce bacteria in the mouth and help to prevent infection.

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Red Flags for Reccurent Aphthous Stomatitis (RAS)

A history of mouth ulcers that started in childhood or adolescence, recurrent episodes, and triggers like new medications, toothpaste, or smoking cessation.

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History Questions for RAS

Questions asked to confirm RAS and investigate underlying causes. These can include questions about past medical history, recent changes in medication, and potential deficiencies.

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Management of Reccurent Aphthous Stomatitis (RAS)

A range of treatments for RAS, starting from simple pain relief and antiseptic measures to more complex treatments such as topical and systemic steroids.

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Study Notes

Recurrent Aphthous Stomatitis (RAS)

  • Definition: Chronic, painful, recurrent ulcers (aphthous ulcers), typically round or oval with a yellow-white fibrinous center and an erythematous halo. Begins in childhood, recurring with age.
  • Demographics: Affects 10-25% of the population, most patients are otherwise healthy and non-smokers. Onset frequently occurs in childhood/adolescence and young adulthood.
  • Etiology: Unknown (multifactorial), possibly involving genetic predisposition (HLA), nutritional/haematinic deficiencies (iron, folate, B12), and/or gastrointestinal disorders (celiac disease, inflammatory bowel disease).
  • Predisposing Factors: Often found in genetically predisposed individuals who are otherwise healthy, and may be triggered by stress, exaggerated trauma response, sodium lauryl sulphate (SLS), cessation of smoking, food allergies, hormonal changes (progesterone phase, pregnancy), or immunocompromised states.
  • Investigations: Complete blood count (FBC), haematinic levels (iron, folate, vitamin B12), screening for celiac disease (anti-tissue transglutaminase antibodies) and inflammatory bowel disease.
  • Diagnosis: Clinical (history and exam) – recurring, childhood-onset, painful ulcers with characteristic appearance; lab tests to rule out deficiencies and GI disorders.
  • Differentials: Behçet's disease, MAGIC syndrome, inflammatory bowel disease, celiac disease, and immunocompromised states like HIV.
  • Types: Classified differently (minor, major, herpetiform) based on appearance, size, location, healing time, and intensity of symptoms. Distinct characteristics are presented in table below.

RAS Typology

  • Minor aphthae: Small (2-4mm), non-keratinized mucosa (buccal, labial), mild pain, single or multiple (max 6). Heals without scarring in 7-10 days.
  • Major aphthae: Larger (1cm+), keratinized and non-keratinized mucosa (often in areas with keratinized tissue, such as palate or dorsum of tongue), more severe pain than minor, multiple ulcers (max 6), and lasting over a month, potentially with scarring.
  • Herpetiform aphthae: Extremely painful, extremely small (1-2mm ulcers), numerous (10-100), initially in clusters like vesicles, and possibly recurring for months; some scarring possible.

RAS History and Questions

  • Useful for confirming RAS diagnosis involves inquiries about childhood/adolescent onset, reccurence, recent changes to medication, cessation or change of smoking habits, or the presence of any underlying gastrointestinal disease or nutritional deficiencies.

RAS Management

  • Initial Investigation: Determine if a secondary cause like a nutritional deficiency or GI disorder exists. This includes assessing factors like triggers, assessing levels of haematinics & relevant lab tests, evaluating celiac, and IBD. Consider B12 supplementation irrespective of serum levels. Refer if investigation suggests underlying cause for oral lesions.
  • Local Measures: Saline mouthwashes.
  • Pharmacological Management: (In increasing order of intervention need):
    • Symptomatic and Antiseptic:
      • protective agents (ex. Sodium Carboxymethylcellulose, Carmellose sodium).
      • pain relief (ex. Lidocaine ointment/spray, Benzydamine spray/mouthwash)
      • Antiseptic mouthwash (ex. Chlorohexidine, Benzydamine hydrochloride mouthwash).
    • Topical Steroids: (for more severe cases) - Hydrocortisone, Beclometasone inhaler, Betamethasone tablets - used cautiously.
    • Systemic Steroids: (For severe or resistant cases), usually managed by specialists
  • Referral: Specialist consultation for non-responding cases or suspected underlying conditions.

RAS Secondary to GI Disease

Coelic Disease

  • Definition: Autoimmune condition due to gluten hypersensitivity leading to small intestine villi damage and nutrient malabsorption.
  • Cause: Genetic predisposition (HLA DQ2).
  • Oral Manifestations: Recurrent aphthous ulcers, xerostomia, angular cheilitis, glossitis, and enamel defects.
  • Diagnosis: Anti-tissue transglutaminase (anti-tTG) antibody testing.
  • Associated condition: Dermatitis herpetiformis

Inflammatory Bowel Disease (IBD)

  • Definition: Chronic inflammation of the gastrointestinal tract, with periods of remission and exacerbation. Includes Crohn's disease and ulcerative colitis.
  • Etiology: Multifactorial (impacts of infections, genetics, diet/environment).
  • Oral Manifestations: Aphthous ulcers, cobblestone mucosa, lip swelling and cracking, hyperplastic gingivitis, angular cheilitis, glossitis.
  • Crohn's Disease: Affects any part of the GI tract, often with "skip lesions," transmural inflammation (full thickness). More prevalent in the ileum, and smoking is a risk factor.
  • Ulcerative Colitis: Limited to the colon and rectum, superficial (intramural) inflammation, and blood/mucus discharge. Smoking is protective.
  • Treatment: IBD treatment often includes steroids (Prednisolone, Hydrocortisone), immunosuppressants (Ciclosporin, Azathioprine), and antineoplastic drugs (Methotrexate). Side effects should be carefully monitored.

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Description

This quiz covers the essential aspects of Recurrent Aphthous Stomatitis (RAS), including its definition, demographics, etiology, and predisposing factors. Ideal for students and professionals looking to deepen their understanding of this common oral condition.

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