| Recurrent aphthous ulcers (RAUs) have following | | | | incidence occurred in menstruating women. |
| characteristics: | | | | The clinical features: |
| 1. They are recurrent, painful, superficial oral ulcers that | | | | The recurrent aphthous ulcers, in the usual course of |
| persist 8 to 14 days; | | | | events, appear, regress, and heal within 4 to 10 clays. |
| 2. They are associated with a tender regional | | | | The patients are requested not to brush their teeth in |
| lymphadenopathv (swelling of lymph nodes in the head | | | | the affected area until the lesions have completely |
| and neck area); | | | | disappeared. |
| 3. They heal spontaneously, usually without sequelae in | | | | However, in rare cases, the lesions may appear |
| healthy patients. | | | | without remission for as long as 2 or 3 months. In |
| The causes and the course of the disease: | | | | these cases the patient has reported the lesions are |
| Several theories about the cause of recurrent | | | | constantly present but have shifted location during the |
| aphthous ulcers have been proposed; they include | | | | disease. Necrotic tissue and uncharacteristic ulceration |
| psychic, allergic, microbial, endocrine, hereditary, and | | | | are usually present in these cases. Instead of forming |
| autoimmune mechanisms. Many dentists also find | | | | on the oral mucosa, the lesions characteristically occur |
| mechanical trauma play a role in the precipitation of | | | | on the attached gingiva. Typically, the lesions usually |
| these ulcers. | | | | disappear within 2 weeks after starting a regimen of |
| A study reported patients, who were challenged with | | | | tetracycline mouthwash, which wipes out the |
| certain foods, begins their ulcers. No causative effect | | | | superimposed bacterial infection and allows healing. |
| was found on tomatoes, strawberries, or walnuts. Hay | | | | The differential diagnosis: |
| and Reade (1984) reported the results of their study | | | | The dentists will need to distinguish between recurrent |
| clearly showed that some food ingredients contributed | | | | aphthous ulcers (RAU) and intraoral recurrent herpes |
| to the cause of some cases of recurrent aphthous | | | | simplex (IRHS) ulcers in most cases. Herpangina and |
| ulcers. | | | | hand-foot-mouth disease are two other conditions that |
| The inheritance of recurrent aphthous ulcers was | | | | must be differentiated. |
| studied by Miller et al. (1980). Their results showed the | | | | The recommended treatment: |
| incidence of the disease in children was significantly | | | | Most of recurrent aphthous ulcers resolve in 8 to 14 |
| higher when RAUs were present in one or both | | | | days without treatment. However, our Houston dentist |
| parents. Another study reported that recurrent | | | | recommends these: |
| aphthous ulcers occurred more commonly in patients | | | | 1. Tetracycline mouthwash (an oral suspension of |
| from higher socioeconomic groups. | | | | uncoated Achromycin crystals 250 mg/tsp in 5 ml |
| Studies about the stress-related vitamin B12 and folate | | | | water) to be flushed over the affected region for at |
| levels in recurrent aphthous ulcers have yielded | | | | least 2 minutes. |
| conflicting results. Some found several RAU patients | | | | 2. After cleaning the affected area with the |
| with decreased folate levels; others failed to find | | | | tetracycline mouthwash, the ulcer is applied with a thick |
| signilicantly lower serum levels of yitamin B12 or folate | | | | laver of triamcinolone acetonide in emollient dental |
| in RAU patients. | | | | paste (Kenalog in Orabase) after meals and before |
| Currently it seems likely that the recurrent aphthous | | | | bed. Alternatively, aloe vera leaves may also be used. |
| ulcers develop because of several different | | | | 3. Oral and topical analgesics are administered if |
| mechanisms. Studies showing shifts in immune balance | | | | necessary. |
| are many. Ferguson et al. (1981) reported the highest | | | | |