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