|
 |
|
REVIEW ARTICLE |
|
|
|
|
| Year : 2011 | Volume
: 15
| Issue : 3 | Page : 252-256 |
| |
Recurrent aphthous stomatitis
L Preeti1, KT Magesh2, K Rajkumar1, Raghavendhar Karthik1
1 Department of Oral Pathology, SRM Dental College, Ramapuram, India
2 Department of Oral Pathology, SRM Dental College and Hospital, Kattankulathur, India
| Date of Web Publication | 25-Oct-2011 |
Correspondence Address:
L Preeti
15/9 Venkatraman Street, R.A. Puram, Chennai 600 028
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0973-029X.86669
 Abstract | | |
Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence, etiopathogenesis remains unclear. This review article summarizes the clinical presentation, diagnostic criteria, and recent trends in the management of recurrent apthous stomatitis.
Keywords: Diagnostic criteria, recurrent aphthous stomatitis, stress ulcers, ulcer activity index immunomodulation
How to cite this article:
Preeti L, Magesh K T, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac Pathol 2011;15:252-6 |
| Introduction | |  |
The term "aphthous" is derived from a Greek word "aphtha" which means ulceration. Recurrent aphthous stomatitis (RAS) is one of the most common painful oral mucosal conditions seen among patients. These present as recurrent, multiple, small, round, or ovoid ulcers, with circumscribed margins, having yellow or gray floors and are surrounded by erythematous haloes, present first in childhood or adolescence. [1]
| Clinical Presentation | | |
RAS is characterized by recurrent bouts of solitary or multiple shallow painful ulcers, at intervals of few months to few days in patients who are otherwise well. [2] RAS has been described under three different clinical variants as classified by Stanley in 1972. [3]
- Minor RAS is also known as Miculiz's aphthae or mild aphthous ulcers. It is the most common variant, constituting 80% of RAS. Ulcers vary from 8 to 10 mm in size. It is most commonly seen in the nonkeratinized mucosal surfaces like labial mucosa, buccal mucosa, and floor of the mouth. Ulcers heal within 10-14 days without scarring.
- Major RAS is also known as periadenitis mucosa necrotica recurrens or Sutton's disease. It affects about 10-15% of patients. Ulcers exceed 1 cm in diameter. Most common sites of involvement are lips, soft palate, and fauces. Masticatory mucosa like dorsum of tongue or gingiva may be occasionally involved. [4] The ulcers persist for up to 6 weeks and heal with scarring.
- Herpetiform ulceration is characterized by recurrent crops of multiple ulcers; may be up to 100 in number. These are small in size, measure 2-3 mm in diameter. Lesions may coalesce to form large irregular ulcers. These ulcers last for about 10-14 days. Unlike herpetic ulcers, these are not preceded by vesicles and do not contain viral infected cells. These are more common in women and have a later age of onset than other clinical variants of RAS. [5]
Predisposing factors
Genetics
A genetic predisposition for the development of apthous ulcer is strongly suggested as about 40% of patients have a family history and these individuals develop ulcers earlier and are of more severe nature. [2] Various associations with HLA antigens and RAS have been reported. These associations vary with specific racial and ethnic origins.
Trauma
Trauma to the oral mucosa due to local anesthetic injections, sharp tooth, dental treatments, and tooth brush injury may predispose to the development of recurrent aphthous ulceration (RAU). [1] Wray et al. [6] in 1981 proposed that mechanical injury may aid in identifying and studying patients prone to aphthous stomatitis.
Tobacco
Several studies reveal negative association between cigarette smoking, smokeless tobacco and RAS. Possible explanations given include increased mucosal keratinization; which serves as a mechanical and protective barrier against trauma and microbes. [7],[8],[9] Nicotine is considered to be the protective factor as it stimulates the production of adrenal steroids by its action on the hypothalamic adrenal axis and reduces production of tumor necrosis factor alpha (TNF-α) and interleukins 1 and 6 (IL-1 andIL-6). [10] Nicotine replacement therapy has been suggested as treatment for patients who develop RAU on cessation of smoking. [11]
Drugs
Certain drugs have been associated with development of RAU; these include angiotensin converting enzyme inhibitor captopril, gold salts, nicorandil, phenindione, phenobarbital, and sodium hypochloride. NSAIDS such as propionic acid, diclofenac, and piroxicam may also cause oral ulceration similar to RAS. [12]
Hematinic deficiency
Deficiencies of iron, vitamin B12, and folic acid predispose development of RAS. Deficiencies of these hematinics are twice more common in these individuals than controls. Contrary findings in various studies relating the association of hematinic deficiency and RAS have been explained as due to varying genetic backgrounds and dietary habits of the study population. [2],[12]
Gluten sensitive enteropathy/celiac disease, inflammatory bowel disease
Gluten sensitive enteropathy (GSE) is an autoimmune inflammatory disease of small intestine that is precipitated by the ingestion of gluten, a wheat protein in susceptible individuals. It is characterized by severe malnutrition, anemia, abdominal pain, diarrhea, aphthous oral ulcers, glossitis, and stomatitis. RAS may be the sole manifestation of the disease. The use of gluten-free diet in the improvement of RAS is considered uncertain. It has been suggested that evaluation for celiac disease may be appropriate for RAS patients. [13] Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis may present with apthous-like ulceration. [1]
Sodium lauryl sulfate - containing toothpaste
An increased frequency in the occurrence of RAS has been reported on using sodium lauryl sulfate (SLS)-containing tooth paste with some reduction in ulceration on use of SLS-free tooth paste. However, because of the widespread use of SLS-containing dentifrice, it has been proposed that this may not truly predispose to RAS. [1]
Hormonal changes
Conflicting reports exist regarding association of hormonal changes in women and RAU. Studies state association of oral ulceration with onset of menstruation or in the luteal phase of the menstrual cycle. Mc Cartan et al. [14] in 1992 established no association between apthous stomatitis and premenstrual period, pregnancy, or menopause.
Stress
Stress has been emphasized as a causative factor in RAU. It has been proposed that stress may induce trauma to oral soft tissues by parafunctional habits such as lip or cheek biting and this trauma may predispose to ulceration. A more recent study shows lack of direct correlation between levels of stress and severity of RAS episodes and suggests that psychological stress may act as a triggering or modifying factor rather than etiological factor in susceptible RAS patients. [15]
Micro organisms implicated in apthous ulcers
Several micro organisms have been implicated in the pathogenesis of RAS. Several contrary findings have been reported in the various studies published.
RAS and oral streptococci
Oral streptococci have been considered as microbial agents in the pathogenesis of RAS. They have been implicated as microorganisms directly involved in the pathogenesis of these lesions or as agents which serve as antigenic stimuli, which in turn provoke antibody production that cross-react with oral mucosa. It has been suggested that L form of α-hemolytic streptococci, Streptococcus sanguis; later identified as Streptococcus mitis was the causative agent of this disease. Hoover et al. [16] in 1986 demonstrated low levels of cross-reactivity of oral Streptococci and oral mucosal antigens and considered the reactivity to be non-specific and clinically insignificant.
RAS and Helicobacter pylori
H. pylori has been implicated as one of the organisms in the etiopathogenesis of RAS. H. pylori is a gram-negative, S-shaped bacterium that has been associated with gastritis and in chronically infected duodenal ulcers. H. pylori has been reported to be present in high density in dental plaque. [17] Porter et al. [18] in 1997 measured the levels of IgG antibodies against H. pylori in patients with RAS and showed that no the frequency of anti-H. pylori seropositivity was not significantly elevated in patients with RAS and other ulcerative and non-ulcerative oral mucosal disorders.
Viruses as etiologic agents in RAS
Various viruses have been implicated in the etiopathogenesis of recurrent apthous stomatitis. There have been several suggestive, but as yet there exists inconclusive evidence toward a viral etiology. Characteristics of aphthous ulcers which are indicative of infectious etiology include recurrent ulceration, lymphocytic infiltration, perivascular cuffing, presence of auto-antibodies, inclusion bodies in case of herpetiform ulcers and similarity of RAU to viral ulcerative diseases in animals. [19] Virtanen et al. [17] in 1995 demonstrated the presence of human cytomegalovirus DNA (HCMV) in biopsies of oral mucosal ulcers, but they were unable to rule out the presence of this virus which may have existed as a super infection or co infection from existing HCMV in saliva. Sun et al. [20] in 1996 demonstrated the presence of HCMV genomes by polymerase chain reaction in pre-ulcerative oral apthous tissues. They postulated that when viral infection occurs in oral epithelial cells expressing major histocompatibility complex class II molecules (MHC-II), an intense T-cell response is elicited against virus containing oral epithelial cells. They concluded that HCMV may play role in perpetuating local immune response in genetically predisposed individuals.
Sun et al. [21] in 1998 demonstrated the presence of Epstein-barr virus (EBV) genomes by polymerase chain reaction in pre-ulcerative oral apthous tissues in RAU patients. They postulated a possible role of association of EBV in pre-ulcerative oral lesions in patients of RAU.
Role of tumor necrosis factor alpha in RAS
Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine and is one of the most important cytokine implied in the development of new apthous ulcers in patients. The association of TNF-α in the development of RAS gains credence due to the fact that immunomodulatory drugs such as thalidomide and pentoxifylline have been found effective in the treatment of RAS. Thalidomide reduces activity of TNF-α by degrading its messenger RNA and pentoxifylline inhibits TNF-α production. [22],[23] Antigenic stimulation of oral mucosal keratinocytes results in the production of pro-inflammatory cytokines such as IL-2 and TNF-α. TNF-α also causes expression of class I major histocompatability complex, subsequently these cells are targeted for attack by cytotoxic T cells. [1]
| Index for Determining Impact of Oral Ulcer Activity in Patients of RAS | | |
Mumucu et al. [24] in 2009 proposed a composite index to monitor the clinical manifestations associated with oral ulcers in patients of RAS and Behcet's disease. They proposed that such indices serve to provide important information regarding prognosis of disease and therapeutic effect of medication.
The index evaluated the oral ulcer activity, ulcer-related pain, and functional disability. Oral ulcer activity was recorded as number of ulcers in the past 1 month. This was scored zero if there were no ulcers and as one, if the number of ulcer was greater or equal to than one. The pain status was evaluated on a visual analogue scale (VAS). This is a 100-mm line with extreme values at either end. The patients have to mark the intensity of pain on the line.
Functional status evaluation
This involved the evaluation of effects of oral ulcers on tasting, speaking, and eating/chewing/swallowing. This was evaluated by both Likert-type scale and VAS scale. Scoring is done as 0, when none of the time; 1, little of the time; 2, some of the time; 3, most of the time; 4, all of the time and VAS (0-100 mm).
Use of visual analog scale to evaluate the pain caused by ulcers is highly subjective and is ridden with interpersonal variation. This is a continuous scale with no discrete levels as would be suggested by grades such as none, mild, moderate, or severe. Further studies in different population and ethnic groups need to be carried out using this criteria to validate this index.
| Histopathology of RAS | | |
The microscopic picture of aphthous ulcer is non-specific, and diagnosis must be based on history and careful clinical examination. The mucous membrane of aphthous ulcer shows superficial tissue necrosis with a fibrinopurulent membrane covering the ulcerated area. The necrosis is covered by tissue debris and neutrophils. Epithelium is infiltrated by lymphocytes and few neutrophils. Intense inflammatory cell infiltration, predominantly neutrophils present immediately below the ulcer, mononuclear lymphocytes are seen in adjacent areas. Minor salivary glands commonly present in areas of aphthae exhibit focal periductal and perialveolar fibrosis and chronic inflammation. [12],[25]
| Diagnosis | | |
Diagnosis of RAS is based on history, clinical manifestations, and histopathology. Other causes of recurrent oral ulceration must be ruled out. Systemic diseases which present with recurrent oral ulcerations are summarized in [Table 1]. Diagnostic criteria for minor RAU were proposed by Natah et al. [12] in 2004. They proposed that a diagnosis of idiopathic RAU and secondary RAU (associated with systemic disease) is established when four major and one minor criteria are fulfilled. The major and minor criteria for diagnosis of minor RAU are illustrated in [Table 2] and [Table 3]. | Table 1: Systemic diseases with recurrent oral ulceration (modified from reference 1)
Click here to view |
 | Table 2: Major criteria for diagnosis of RAU minor (Natah et al.[12] 2004)
Click here to view |
Management
There is no definitive curative treatment for RAS. Possible systemic association with RAS must be ruled out, especially in cases where there is sudden development of ulceration in adulthood. [2] Laboratory investigations such as complete blood counts, red cell folate, serum ferritin levels, and vitamin B12 recommended. Screening for GSE must be done in cases where associated systemic manifestations of GSE are present. Various topical and systemic agents used in treatment of RAS are summarized in [Table 4].
| Conclusion | | |
Recurrent apthous stomatitis is a very common, recurrent painful ulceration occurring in the oral cavity. The etiopathogenesis of this disease is yet unclear. Treatment strategies must be directed toward providing symptomatic relief by reducing pain, increasing the duration of ulcer-free periods, and accelerating ulcer healing.[27]
| References | | |
| 1. | Jurge S, Kuffer R, Scully C, Porter SR. Recurrent aphthous stomatitis. Oral Dis 2006;12:1-21. 
|
| 2. | Scully C, Porter S. Oral mucosal disease: Recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 2008;46:198-206.
|
| 3. | Stanley HR. Aphthous lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1972;30:407-16.
|
| 4. | Cawson RA, Odell EW. Cawson's Essentials of Oral Pathology and Oral Medicine. 8 th ed. Philadelphia: Elseivier; 2008.
|
| 5. | Scully C, Porter S. Recurrent aphthous stomatitis: Current concepts of etiology, pathogenesis and management. J Oral Pathol Med 1989;18:21-7.
|
| 6. | Wray D, Graykowski EA, Notkins AL. Role of mucosal injury in initiating recurrent aphthous stomatitis. Br Med J (Clin Res Ed) 1981;283:1569-70.
|
| 7. | Bookman R. Relief of Canker Sores on Resumption of Cigarette Smoking. Calif Med 1960;93:235-6.
|
| 8. | Shapiro S, Olson DL Chellemi SJ. The association between smoking and aphthous ulcers. Oral Surg Oral Med Oral Pathol 1970;30:624-30.
|
| 9. | Grady D, Ernster VL, Stillman L, Greenspan J. Smokeless tobacco use prevents aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1992;74:463-65.
|
| 10. | Floto RA, Smith KG. The vagus nerve, macrophages and nicotine. Lancet 2003;361:1069-70.
|
| 11. | Scheid P, Bohadana A, Martinet Y. Nicotine patches for aphthous ulcers due to Behcet's syndrome. N Engl J Med 2000;343:1816-17.
|
| 12. | Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Häyrinen-Immonen R. Recurrent aphthous ulcers today: A review of growing knowledge. Int J Oral Maxillofac Surg 2004;33:221-34.
|
| 13. | Shakeri R, Zamani F, Sotoudehmanesh R, Amiri A, Mohamadnejad M, Davatchi F, et al. Gluten sensitive enteropathy in patients with recurrent aphthous stomatitis. BMC Gastroenterol 2009;9:44.
|
| 14. | McCartan BE, Sullivan A. The association of menstrual cycle, pregnancy and menopause with recurrent oral aphthous stomatitis: A review and critique. Obstet Gynecol 1992;80:455-8.
|
| 15. | Gallo Cde B, Mimura MA, Sugaya NN. Pschological stress and recurrent aphthous stomatitis. Clinics (Sao Paulo) 2009;64:645-8.
|
| 16. | Hoover CI, Olson JA, Greenspan JS. Humoral responses and cross reactivity to viridians streptococci in recurrent aphthous ulceration. J Dent Res 1986;65:1101-4.
|
| 17. | Leimola-Virtanen R, Happonen RP, Syrjänen S. Cytomegalovirus (CMV) and Helicobacter pyroli (HP) found in oral mucosal ulcers. J Oral Pathol Med 1995;24:14-7.
|
| 18. | Porter SR, Barker GR, Scully C, Macfarlane G, Bain L. Serum IgG antibodies to Helicobacter pyroli in patients with recurrent aphthous stomatitis and other oral disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:325-8.
|
| 19. | Hooks JJ. Possibility of a viral etiology in recurrent aphthous ulcers and Behcet's syndrome. J Oral Pathol 1978;7:353-64.
|
| 20. | Sun A, Chang JG, Kao CL, Liu BY, Wang JT, Chu CT, et al. Human cytomegalovirus as a potential etiologic agent in recurrent aphthous ulcers and Behcet, s disease. J Oral Pathol Med 1996;25:212-8.
|
| 21. | Sun A, Chang JG, Chu CT, Liu BY, Yuan JH, Chiang CP. Preliminary evidence for an association of Epstein - Barr virus with pre-ulcerative oral lesions in patients with recurrent aphthous ulcers or Behcet's disease. J Oral Pathol Med 1998;27:168-75.
|
| 22. | Jacobson JM, Greenspan JS, Spritzler J, Ketter N, Fahey JL, Jackson JB, et al. Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med 1997;336:1487-93.
|
| 23. | Zabel P, Schade FU, Schlaak M. Inhibition of endogeneous TNF-α formation by pentoxifylline. Immunobiology 1993;187:447-63.
|
| 24. | Mumcu G, Sur H, Inanc N, Karacayli U, Cimilli H, Sisman N, et al. A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis. J Oral Pathol Med 2009;38:785-91.
|
| 25. | Shafer, Hine, Levy. A Textbook of Oral Pathology. 4 th ed. New Delhi: Saunders; 1997.
|
| 26. | Zhou Y, Chen Q, Meng W, Jiang L, Wang Z, Liu J, et al. Evaluation of penicillin G potassium troches in the treatment of minor recurrent aphthous ulceration in a Chinese cohort: A randomized, double-blinded, placebo and no- treatment- controlled, multicenter clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:561-6.
|
| 27. | Nolan A, Baillie C, Badminton J, Rudralingam M, Seymonr RA. Efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration J Oral Pathol Med 2006;35:461-5.
|
[Table 1], [Table 2], [Table 3], [Table 4]
| This article has been cited by | | 1 |
Pharmacological Management of Common Soft Tissue Lesions of the Oral Cavity |
|
| Guillermo Puig Arroyo, Ashley Lofters, Earl Clarkson | | Oral and Maxillofacial Surgery Clinics of North America. 2022; 34(1): 99 | | [Pubmed] | [DOI] | | | 2 |
Silver nitrate in the management of recurrent aphthous stomatitis: A systematic review and meta-analysis |
|
| Nasir Zeeshan Bashir, Nabeela Caratela | | Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2021; 33(2): 196 | | [Pubmed] | [DOI] | | | 3 |
The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials |
|
| Mojgan Shavakhi, Amirhossein Sahebkar, Farinaz Shirban, Mohammad Bagherniya | | Phytotherapy Research. 2021; | | [Pubmed] | [DOI] | | | 4 |
Association between serum zinc levels and recurrent aphthous stomatitis: a meta-analysis with trial sequential analysis |
|
| Sadeq A. Al-Maweri, Esam Halboub, Hesham Mohammed Al-Sharani, Anas Shamala, Ahlam Al-Kamel, Mohammed Al-Wesabi, Abdullkhaleg Albashari, Amani Al-Sharani, Saleem Abdulrab | | Clinical Oral Investigations. 2021; 25(2): 407 | | [Pubmed] | [DOI] | | | 5 |
Applications of Novel and Nanostructured Drug Delivery Systems for the Treatment of Oral Cavity Diseases |
|
| Reza Hosseinpour-Moghadam, Fatemeh Mehryab, Maryam Torshabi, Azadeh Haeri | | Clinical Therapeutics. 2021; | | [Pubmed] | [DOI] | | | 6 |
Occurrence of Recurrent Aphthous Stomatitis (RAS) as a Rare Oral Manifestation in a Patient with Gilbert’s Syndrome |
|
| Artak Heboyan, Anna Avetisyan, Hans Erling Skallevold, Dinesh Rokaya, Vinay Marla, Anna Vardanyan, Alberto Delbem | | Case Reports in Dentistry. 2021; 2021: 1 | | [Pubmed] | [DOI] | | | 7 |
The Anti-Inflammatory Effect of Zhibaidihuang Decoction on Recurrent Oral Ulcer with Sirt1 as the Key Regulatory Target |
|
| Yajie Shao, Bin Ding, Jinjun Ji, Shanshan Lei, Yu Dong, Yongsheng Fan, Weihong Ge, Li Xu, Jing Zhao | | Evidence-Based Complementary and Alternative Medicine. 2021; 2021: 1 | | [Pubmed] | [DOI] | | | 8 |
Eating disorders and the orthodontist: Diagnosis, considerations and referral |
|
| Kelly Smorthit, David Sawbridge, Rhian Fitzgerald | | Journal of Orthodontics. 2021; 48(3): 313 | | [Pubmed] | [DOI] | | | 9 |
Risk of autoimmune diseases in recurrent aphthous ulcer patients: A nationwide population study |
|
| Young Chan Lee, Su Jin Jeong, Young-Gyu Eun, Ran Song, In-Hwan Oh | | Oral Diseases. 2021; 27(6): 1443 | | [Pubmed] | [DOI] | | | 10 |
TRADITIONAL METHODS OF CHRONIC RECURRENT AFTHOUS STOMATITIS THERAPY |
|
| Elena Nikitina, Eleonora Borisova | | Actual problems in dentistry. 2021; 17(1): 26 | | [Pubmed] | [DOI] | | | 11 |
Academic Stress on the Incidence of Recurrent Aphthous Stomatitis: A Cross Sectional Study |
|
| Tedi Purnama, Rizki Sofian, Bimo Gigih Sasongko, Muhammad Fiqih Sabilillah, Hadiyat Miko, Yonan Heriyanto | | Journal of Drug Delivery and Therapeutics. 2021; 11(3): 61 | | [Pubmed] | [DOI] | | | 12 |
Bee Venom, Honey, and Royal Jelly in the Treatment of Bacterial Infections of the Oral Cavity: A Review |
|
| Michal Otreba, Lukasz Marek, Natalia Tyczynska, Jerzy Stojko, Anna Rzepecka-Stojko | | Life. 2021; 11(12): 1311 | | [Pubmed] | [DOI] | | | 13 |
Comparative assessment of low-level laser therapy (LLLT) vs. topical application of amlexanox + lidocaine to treat recurrent aphthous ulcers (RAUs): A randomized controlled trial |
|
| Charu Mohan Marya, Jiksha Mehlawat, Ruchi Nagpal, Sakshi Kataria, Pratibha Taneja | | Journal of Dental Research, Dental Clinics, Dental Prospects. 2021; 15(1): 11 | | [Pubmed] | [DOI] | | | 14 |
Assessment of prevalence of recurrent aphthous stomatitis in the North Indian population: A cross-sectional study |
|
| Ramneet Kaur, AshimaBali Behl, RamandeepSingh Punia, Kumar Nirav, KhundongbamBikramjit Singh, Sukhpreet Kaur | | Journal of Pharmacy And Bioallied Sciences. 2021; 13(5): 363 | | [Pubmed] | [DOI] | | | 15 |
Evaluation of Stress in Concurrence with Level of Oral Hygiene among Dental Undergraduates in Malaysia |
|
| Rajeev Arunachalam, Sarath B Kurra, Vini Rajeev, Soh P Chin, Stephanie H Chait Wei, Taatcaaayini A/P Shanmugavelu | | World Journal of Dentistry. 2021; 12(1): 78 | | [Pubmed] | [DOI] | | | 16 |
Recurrent Aphthous Stomatitis and Related Factors Among 12-17-Year-Old Students in Zahedan, Iran |
|
| M shirzaiy, J Sarabadani | | Journal of Research in Dental and Maxillofacial Sciences. 2020; 5(1): 34 | | [Pubmed] | [DOI] | | | 17 |
STRUCTURE OF SOMATIC PATHOLOGY IN CHILDREN WITH APHTHOUS STOMATITIS |
|
| Guzel' Akmalova, Sergey Chuykin, Nina Chernyshova, Svetlana Nazmieva | | Actual problems in dentistry. 2020; 16(1): 93 | | [Pubmed] | [DOI] | | | 18 |
Pleural Effusion Presenting in a Young Man With Behcet’s Disease |
|
| Hashaal F Alkhurassi, Mohammed R Ocheltree, Ahlam Alsomali, Reem A Alqunfoidi, Asmaa Saadallah | | Cureus. 2020; | | [Pubmed] | [DOI] | | | 19 |
Low-Level Laser Therapy and Topical Medications for Treating Aphthous Ulcers: A Systematic Review |
|
| Mohammed Khaleel Ahmed, Mohammed Jafer, Maryam Nayeem, Ibtisam Hussain Moafa, Mir Furruq Ali Quadri, Hema Gopalaiah, Mir Faeq Ali Quadri | | Journal of Multidisciplinary Healthcare. 2020; Volume 13: 1595 | | [Pubmed] | [DOI] | | | 20 |
A Clinic Trial Evaluating the Effects of Aloe Vera Fermentation Gel on Recurrent Aphthous Stomatitis |
|
| Yan Shi, Kehong Wei, Jiachen Lu, Jing Wei, Xiaojing Hu, Tingtao Chen, Christian Bautista | | Canadian Journal of Infectious Diseases and Medical Microbiology. 2020; 2020: 1 | | [Pubmed] | [DOI] | | | 21 |
Depression symptoms and recurrent aphthous stomatitis—Evidence from a population-based study in Indonesia |
|
| Ninuk Hariyani, Taufan Bramantoro, Rahul Nair, Ankur Singh, Kaushik Sengupta | | Oral Diseases. 2020; 26(5): 948 | | [Pubmed] | [DOI] | | | 22 |
Evaluation of 5% Amlexenox Oral Paste and Rebamipide Tablets in Treatment of Recurrent Apthous Stomatitis and Comparison with Dologel CT |
|
| Shamimul Hasan, Naila Perween, Shazina Saeed, Mandeep Kaur, Virender Gombra, Arpita Rai | | Indian Journal of Otolaryngology and Head & Neck Surgery. 2020; | | [Pubmed] | [DOI] | | | 23 |
New concentration of curcumin orabase in recurrent aphthous stomatitis: A randomized, controlled clinical trial |
|
| Seyed Javad Kia, Arash Mansourian, Maryam Basirat, Mohsen Akhavan, Zahra Mohtasham-Amiri, Mahdieh-Sadat Moosavi | | Journal of Herbal Medicine. 2020; 22: 100336 | | [Pubmed] | [DOI] | | | 24 |
Leucas aspera to Treat Pan Oral Disorders - An Experimental Study |
|
| S. Karthika Nagarajan, Vidya Rani, Aravindhababu Narayanasamy, Mahaboob Kadar Masthan | | ENVIRO Dental Journal. 2019; : 26 | | [Pubmed] | [DOI] | | | 25 |
TONGUE LESIONS - A CLINICAL STUDY |
|
| Raghu Chanakya K. S., Narmada Vatti, Nirupama V, Surya Prakasa Rao S. | | Journal of Evidence Based Medicine and Healthcare. 2019; 6(13): 1071 | | [Pubmed] | [DOI] | | | 26 |
The effects of pomegranate peel extract on recurrent aphthous stomatitis |
|
| Sara Darakhshan, Mohammad Malmir, Fereshteh Bagheri, Mohsen Safaei, Roohollah Sharifi, Masoud Sadeghi, Masoud Hatami, Hamid Reza Mozaffari, Reza Tahvilian | | Current Issues in Pharmacy and Medical Sciences. 2019; 32(3): 115 | | [Pubmed] | [DOI] | | | 27 |
Essentials of recurrent aphthous stomatitis (Review) |
|
| C?sar Rivera | | Biomedical Reports. 2019; | | [Pubmed] | [DOI] | | | 28 |
Comparative efficacy of laser and topical corticosteroid in the management of aphthous stomatitis |
|
| Neha Agrawal, Suwarna Dangore, Rahul Bhowate, Shailesh Agrawal, Amit Reche | | Journal of Datta Meghe Institute of Medical Sciences University. 2019; 14(3): 155 | | [Pubmed] | [DOI] | | | 29 |
Establishment of Role of IL-2, IL-10 and IL-12 in Patients with Recurrent Aphthous Stomatitis—A Clinical Study |
|
| Satish S Bhosale, Bhoopendra S Rajput, Harsh Takkar, Sachin V Bhagat, Rajesh M Vagger, Mohd. Ibrahim K Shaikh | | The Journal of Contemporary Dental Practice. 2018; 19(10): 1242 | | [Pubmed] | [DOI] | | | 30 |
COMPARISON OF SILVER NITRATE CHEMICAL CAUTERIZATION WITH TOPICAL APPLICATION OF AMLEXANOX AND TOPICAL STEROIDS IN THE MANAGEMENT OF APHTHOUS STOMATITIS |
|
| Muthubabu K, Srinivasan M.K, Jeeva G, Metali Rai, Chaitanya Babjee K, Vikram Raj Mohanam T.C | | Journal of Evidence Based Medicine and Healthcare. 2016; 3(21): 939 | | [Pubmed] | [DOI] | | | 31 |
The role of anxiety, depression, and psychological stress on the clinical status of recurrent aphthous stomatitis and oral lichen planus |
|
| Lidia Gavic,Livia Cigic,Dolores Biocina Lukenda,Vladimir Gruden,Josipa Sanja Gruden Pokupec | | Journal of Oral Pathology & Medicine. 2014; : n/a | | [Pubmed] | [DOI] | | | 32 |
Elevated serum IgE in recurrent aphthous stomatitis and associations with disease characteristics |
|
| G Almoznino,A Zini,Y Mizrahi,DJ Aframian | | Oral Diseases. 2014; 20(4): 386-394 | | [Pubmed] | [DOI] | | | 33 |
Acute periodontal lesions |
|
| David Herrera,Bettina Alonso,Lorenzo de Arriba,Isabel Santa Cruz,Cristina Serrano,Mariano Sanz | | Periodontology 2000. 2014; 65(1): 149 | | [Pubmed] | [DOI] | | | 34 |
Palatal ulceration |
|
| Kabir Sardana,Shuchi Bansal | | Clinics in Dermatology. 2014; 32(6): 827 | | [Pubmed] | [DOI] | | | 35 |
Prevalence of recurrent aphthous ulceration in the Indian Population |
|
| Patil, S., Reddy, S.-N., Maheshwari, S., (...), Shruthi, D., Doni, B. | | Journal of Clinical and Experimental Dentistry. 2014; 6(1): e36-e40 | | [Pubmed] | | | 36 |
Interleukin-10Gene Polymorphisms in Recurrent Aphthous Stomatitis |
|
| Shamsolmoulouk Najafi,Isaac Firooze Moqadam,Mahsa Mohammadzadeh,Alireza Zare Bidoki,Hila Yousefi,Elham Farhadi,Arghavan Tonekaboni,Ghasem Meighani,Ali Akbar Amirzargar,Nima Rezaei | | Immunological Investigations. 2014; 43(4): 405 | | [Pubmed] | [DOI] | | | 37 |
Self-Reported Prevalence & Associated Factors for Occurrence of Recurrent Aphthous Stomatitis (RAS) in Undergraduate Medical & Dental Students |
|
| Saira Afridi, Jawad Ahmad Kundi, Faisal Hayat | | Journal of Gandhara Medical and Dental Science. 2014; 1(1): 26 | | [Pubmed] | [DOI] | | | 38 |
Total Serum Oxidant/Antioxidant Status and Arylesterase Activity in Recurrent Aphthous Stomatitis |
|
| Gulsen Akoglu,Ahmet Metin,Fadime Kilinc,Suzan Demir Pektas,Semra Isikoglu,Ayse Akbas,Sertac Sener | | Annals of Dermatology. 2013; 25(3): 273 | | [Pubmed] | [DOI] | | | 39 |
Aphthous ulcers as a multifactorial problem |
|
| Ujević, A., Lugović-Mihić, L., Šitum, MMihić, J., Troskot, N. | | Acta Clinica Croatica. 2013; 52(2): 213-221 | | [Pubmed] | | | 40 |
The recognition and classification of lymphoproliferative disorders of the gut |
|
| Dennis P. O’Malley,Neal S. Goldstein,Peter M. Banks | | Human Pathology. 2013; | | [Pubmed] | [DOI] | | | 41 |
Management of common oral sores |
|
| Weinberg, M.A. and Segelnick, S.L. | | U.S. Pharmacist. 2013; 38(6) | | [Pubmed] | | | 42 |
Prevalence of recurrent aphthous ulceration experience in patients attending piramird dental speciality in sulaimani city |
|
| Abdullah, M.J. | | Journal of Clinical and Experimental Dentistry. 2013; 5(2): e89-e94 | | [Pubmed] | | | 43 |
Does propolis help to maintain oral health? |
|
| Wiȩckiewicz, Wł. and Miernik, M. and Wiȩckiewicz, M. and Morawiec, T. | | Evidence-based Complementary and Alternative Medicine. 2013; 2013(351062) | | [Pubmed] | | | 44 |
Levels of salivary IgA in patients with minor recurrent aphthous stomatitis: A matched case-control study |
|
| Mohammad, R. and Halboub, E. and Mashlah, A. and Abou-Hamed, H. | | Clinical Oral Investigations. 2013; 17(3): 975-980 | | [Pubmed] | | | 45 |
Hypervariable Region Polymorphism of mtDNA of Recurrent Oral Ulceration in Chinese |
|
| Sun, M. and Fu, S.-M. and Wang, L.-F. and Dong, G.-Y. and Wu, D. and Wang, G.-X. and Wu, Y. | | PLoS ONE. 2012; 7(9) | | [Pubmed] | | | 46 |
A review of common oral pathology lesions, with a focus on periodontology and implantology |
|
| Meiller, T.F. and Garber, K. and Scheper, M. | | Journal of Evidence-Based Dental Practice. 2012; 12(3 SUPPL.): 254-262 | | [Pubmed] | | | 47 |
Evaluation of therapeutic effects of adcortyl and myrtus communis (myrtle) in patients with recurrent aphthous stomatitis: A clinical trial study |
|
| Mortazavi, H. and Namazi, F. and Badiei, M.-R. and Bakhshi, M. | | HealthMED. 2012; 6(5): 1693-1698 | | [Pubmed] | | | 48 |
Curcumin gel in the treatment of minor aphthous ulcer: A randomized, placebo- controlled trial |
|
| Manifar, S. and Obwaller, A. and Gharehgozloo, A. and Boorboor Shirazi Kordi, H.R. and Akhondzadeh, S. | | Journal of Medicinal Plants. 2012; 11(41): 40-45 | | [Pubmed] | | | 49 |
Etiological Factors of Recurrent Aphthous Stomatitis: A Common Perplexity |
|
| Niharika Swain, Leela S Poonja, Yogita Penkar | | Journal of Contemporary Dentistry. 2012; 2(3): 96 | | [Pubmed] | [DOI] | |
|
|
|
|
|
|
|
|
