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Questions and Answers
What are two common characteristics of the ulcers in recurrent aphthous stomatitis?
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.
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?
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.
List two predisposing factors for recurrent aphthous stomatitis that are related to lifestyle or environment.
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What are two diseases that should be considered in the differential diagnosis of recurrent aphthous stomatitis?
What are two diseases that should be considered in the differential diagnosis of recurrent aphthous stomatitis?
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What specific genetic factor is associated with celiac disease?
What specific genetic factor is associated with celiac disease?
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Name two oral manifestations of celiac disease.
Name two oral manifestations of celiac disease.
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What specific antibody is tested for in the diagnosis of celiac disease?
What specific antibody is tested for in the diagnosis of celiac disease?
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What is the primary dietary treatment for celiac disease?
What is the primary dietary treatment for celiac disease?
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What two main diseases are encompassed under inflammatory bowel disease (IBD)?
What two main diseases are encompassed under inflammatory bowel disease (IBD)?
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What is the most significant difference in the location and depth of inflammation between Crohn's disease and ulcerative colitis?
What is the most significant difference in the location and depth of inflammation between Crohn's disease and ulcerative colitis?
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What does OFG stand for in the context of Crohn's disease, and what does it indicate?
What does OFG stand for in the context of Crohn's disease, and what does it indicate?
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Name one common side effect of steroid medications used to treat IBD?
Name one common side effect of steroid medications used to treat IBD?
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What is the typical age of onset for minor aphthous ulcers?
What is the typical age of onset for minor aphthous ulcers?
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How many ulcers are typically present in a minor aphthous ulcer episode?
How many ulcers are typically present in a minor aphthous ulcer episode?
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What is the typical diameter of a major aphthous ulcer?
What is the typical diameter of a major aphthous ulcer?
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True or False: Herpetiform ulcers are more common than minor aphthous ulcers.
True or False: Herpetiform ulcers are more common than minor aphthous ulcers.
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Where do minor aphthous ulcers typically occur in the mouth?
Where do minor aphthous ulcers typically occur in the mouth?
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What is the average duration of a minor aphthous ulcer?
What is the average duration of a minor aphthous ulcer?
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Do minor aphthous ulcers generally cause scarring?
Do minor aphthous ulcers generally cause scarring?
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What is the typical duration of a major aphthous ulcer?
What is the typical duration of a major aphthous ulcer?
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True or False: Major aphthous ulcers always scar after healing.
True or False: Major aphthous ulcers always scar after healing.
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How do herpetiform ulcers typically begin?
How do herpetiform ulcers typically begin?
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What type of toothpaste should be used to avoid exacerbating aphthous ulcers?
What type of toothpaste should be used to avoid exacerbating aphthous ulcers?
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What is a common covering agent used to help treat RAS?
What is a common covering agent used to help treat RAS?
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What is a common topical steroid used to treat RAS?
What is a common topical steroid used to treat RAS?
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What is a common systemic treatment to help herpetiform ulcers?
What is a common systemic treatment to help herpetiform ulcers?
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What is the definition of coeliac disease?
What is the definition of coeliac disease?
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Flashcards
What are aphthous ulcers?
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?
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?
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?
What are some of the factors that can trigger aphthous ulcers?
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What blood investigations are typically done for aphthous ulcers?
What blood investigations are typically done for aphthous ulcers?
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Celiac Disease
Celiac Disease
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Dermatitis Herpetiformis
Dermatitis Herpetiformis
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Crohn's Disease
Crohn's Disease
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Ulcerative Colitis (UC)
Ulcerative Colitis (UC)
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Oral Crohn's (OFG)
Oral Crohn's (OFG)
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Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD)
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Anti-tissue Transglutaminase (anti-tTG) Antibody
Anti-tissue Transglutaminase (anti-tTG) Antibody
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Recurrent Aphtous Ulcers
Recurrent Aphtous Ulcers
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Minor Aphthous Ulcer
Minor Aphthous Ulcer
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Major Aphthous Ulcer
Major Aphthous Ulcer
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Herpetiform Aphthous Ulcers
Herpetiform Aphthous Ulcers
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Recurrent Aphthous Stomatitis (RAS)
Recurrent Aphthous Stomatitis (RAS)
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Symptomatic and Antiseptic Mouth Ulcer Treatment
Symptomatic and Antiseptic Mouth Ulcer Treatment
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Topical Steroids
Topical Steroids
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Systemic Steroids
Systemic Steroids
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Vitamin B12 Deficiency
Vitamin B12 Deficiency
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Covering Agents for Mouth Ulcers
Covering Agents for Mouth Ulcers
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Mouthwashes for Mouth Ulcers
Mouthwashes for Mouth Ulcers
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Red Flags for Reccurent Aphthous Stomatitis (RAS)
Red Flags for Reccurent Aphthous Stomatitis (RAS)
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History Questions for RAS
History Questions for RAS
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Management of Reccurent Aphthous Stomatitis (RAS)
Management of Reccurent Aphthous Stomatitis (RAS)
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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
- Symptomatic and Antiseptic:
- 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.