RECURRENT APHTHOUS ULCER

By

Asma Qasm Rahman

B.D.S, M.Sc
Oral Medicine Department
College of Dentistry
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OUTLINE
• Introduction

• Clinical Presentation

• Classification

• Etiology

• Underlying medical disease

• Diagnosis

• Diffrential diagnosis

• Management 2
 Learning outcome

• To know recurrent aphthous ulcer.

• To diagnose different types.
• Prescribe appropriate treatment.

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INTRODUCTION
Recurrent aphthous ulcer (RAU) is a
very common and poorly understood
painful oral mucosal inflammatory
ulcerative condition that affects the
quality of life.

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• Hippocrates (460-370 BC) was the first to
use the term aphthai.
• The prevalence of RAU in general
population is of the order of 5 to 25%
• More common among females than males.
• Higher prevalence in younger adults,
decreasing with age

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CLINICAL PRESENTATION
• Characterized by multiple, recurrent,
round or ovoid ulcers.
• Have yellow-grayish membrane at
the base and are surrounded by raised
margins and erythematous haloes.

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CLINICAL PRESENTATION (CONT..)
• Typically seen on the buccal and labial
mucosa, floor of the mouth and tongue.

• A prodrome of localized burning or pain

usually precedes the ulcers for 24 to 48
hours. The lesions are painful.

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CLINICAL PRESENTATION (CONT..)

• The pain is severe and gets aggravated on

eating, swallowing and speaking. The pain
usually persists for three to four days.

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CLASSIFICATION

Minor RAU

Major RAU

Herpetiform RAU
1. Minor RAU
• Most common

• No: 1-5, Size: <10mm

• Duration: 7-14 days

• Site: Non-keratinized mucosa :buccal/labial

mucosa, dorsum and lateral border of tongue.

• Scar formation: No scar 10

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2. Major RAU
• No: 1-3

• Size: >10mm

• Duration: 2weeks -3months

• Site: Keratinized and non-keratinized

mucosa (soft palate).

• Scar formation: Heal with scar.

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3. Herpetiform RAU
• No: 5-20 (up to 100)

• Size: 1-2 mm

• Duration: 7-14 days

• Site: Non-keratinized mucosa (floor of mouth,

ventral surface of tongue)

• Scar formation: No scar

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ETIOLOGY
Local factors
Genetic factors
Hematinic deficiency
Nutritional deficiency
Hormonal disturbances
Food hypersensitivities
medications 16
UNDERLYING MEDICAL DISEASE
• Behcets syndrome: Most prominent,

characterized by recurring oral and genital

ulcers, and eye lesions.

• Inflammatory Bowel disease: Such as

Crohn’s disease and ulcerative colitis,

associated with RAU

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UNDERLYING MEDICAL DISEASE

• Celiac disease: An autoimmune sensitivity

to gluten often associated with RAU.

• HIV positive: RAU occurs more frequently,

lasts longer, and causes more painful
symptoms.

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 UNDERLYING MEDICAL DISEASE
• Cyclic neutropenia: A rare disorder

presents at childhood, associated with RAU

when the neutrophil count is decreased.

• PFAPA: Recurrent episodes of fever, AU,

pharyngitis and cervical adenitis.

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 DIFFRENTIAL DIAGNOSIS
• Traumatic ulcers
• Viral stomatitis.
• Chronic multiple lesions such as
pemphigus or pemphigoid.
• Drug reactions, and dermatologic disorders.
• Connective tissue disease such as lupus.
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 Diagnosis of RAU
Based on the history and clinical features.

To exclude a number of systemic disorders, it

is often useful to undertake investigations on:

CBP, ESR, CRP

Ferritin levels

Vitamin B 12 measurements 21
 MANAGEMENT
Correction of predisposing factors

I. Trauma: Avoid hard or sharp foods and

brush teeth atraumatically.

II.Consider SLS and food hypersensitivity,

Iron and vitamins deficiency.
III. Good oral hygiene.
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 MANAGEMENT (cont..)
• Topical anesthetics,
Topical anti-inflammatory
Treatment agents, corticosteroids
and laser therapy

Systemic • Systemic corticosteroids

(prednisolone),
Treatment Multivitamins.

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 SUMMARY
• RAU is the most common oral mucosal
disease of Unknown etiology.
• Characterized by multiple, round or ovoid
ulcers.

• Three types: minor, major and herpetiform.

• Diagnosis is clinical.

• Topical or systemic treatment. 24

 References

– Scully C (2013). Oral and maxillofacial

medicine; the basis of diagnosis and treatment.
3rded. London, UK: Elsevier Ltd. P. 228-229.

– Lewis MAO, Jordan RCK (2012). A color

handbook of oral medicine. 2nd ed. London UK:
Manson Publishing Ltd. P.25

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