Recurrent aphthous stomatitis is a chronic inflammatory disease of the oral mucosa. Clinically manifested by the formation of painful erosions of a rounded shape with a hyperemic rim, covered with fibrinous plaque. Diagnosis of recurrent aphthous stomatitis is reduced to collecting complaints, compiling a medical history of the disease, conducting a physical examination. Treatment is aimed at eliminating odontogenic sources of infection, normalizing the functioning of the gastrointestinal tract, the endocrine system. Anesthetics, antiseptics in the form of mouthwash solutions, keratoplasty applications are prescribed locally.
Recurrent aphthous stomatitis is a disease characterized by a focal violation of the integrity of the surface epithelium. Pathology is diagnosed with the same frequency in representatives of both sexes. Cases of exacerbation occur mainly in the autumn-spring period. Pathology is a non–contagious disease, the risk of infection in contact with the patient is completely excluded. When pathology is detected, complex treatment is indicated. The prognosis is determined by the form of stomatitis, the level of resistance of the body, the timeliness of patients’ treatment in a medical institution, the adequacy of therapeutic measures.
To date, there is no unambiguous opinion regarding the etiopathogenesis of recurrent aphthous stomatitis. Scientists believe that a significant provoking factor in the development of the disease is the allergic process. Recurrent aphthous stomatitis occurs against the background of sensitization of the body to conditionally pathogenic microorganisms of the oral cavity, viruses, food or microbial allergens. Studies have shown that bacterial allergy develops in patients with dysbiosis of the distal gastrointestinal tract.
Dentists also do not exclude that a possible cause may be a cross-immune reaction, the essence of which lies in the erroneous defeat of the oral mucosa by antibodies produced by the human body due to the antigenic similarity of bacteria with epithelial cells. Often, the occurrence is preceded by mucosal injuries. Also possible causes of the disease may be pathologies of the endocrine system, digestive organs. Predisposing factors contributing to the development of recurrent aphthous stomatitis are hypovitaminosis, frequent infectious diseases, changes in immunological status (exudative catarrhal diathesis, diabetes mellitus, bronchial asthma, dysbiosis, helminthiasis).
There are three degrees of severity:
- Mild. They are diagnosed with the appearance of several afts every 2 years.
- Medium. Patients go to the dentist up to 2 times during the year. Multiple lesions are found in the oral cavity.
- Severe. Relapses of the disease occur 3 times a year and more often.
- Fibrinous. In prognostic terms, it is the most favorable form of the disease. Erosions are epithelized within 7 days.
- Necrotic. It develops in patients with a reduced immune status of the body against the background of somatic diseases. As a result of vascular spasm, an area of ischemia occurs, followed by mucosal necrosis. Aphthae do not heal for a long time. Reparative processes last up to 3 weeks.
- Glandular. It proceeds with the involvement of the ducts of the small salivary glands in the pathological process. This form of the disease is characterized by atypical localization of lesion elements (most often aphthae are found in the sky). Regeneration of erosive areas occurs within a month.
- Scarring. It is the most severe form of the disease. Develops against the background of immunodeficiency conditions. It proceeds with the formation of deep ulcerative lesions, after epithelization of which scars appear, deforming the mucosa. Recovery processes last up to 2 months.
With recurrent aphthous stomatitis, aphthal erosion of a rounded shape with a hyperemic corolla appears, formed against the background of an unflammated mucosa. Most often, aphthae are found on the cheek, lip mucosa, along the transitional fold in the lower jaw area. Extremely rarely, with recurrent aphthous stomatitis, erosions are detected on the gums, palate. From above, the aphthae are covered with fibrinous layers of white color, tightly soldered to the underlying surface. Patients complain of soreness when eating and during conversation. Sometimes there is regional lymphadenitis. Purification of the aft from plaque occurs on day 4-5. The lesion site is epithelized a week after the first signs of the disease appear.
Diagnosis of recurrent aphthous stomatitis is reduced to collecting complaints, compiling a medical history of the disease, conducting a physical examination. In patients with recurrent aphthous stomatitis, mouth opening is free, carried out in full. The skin is not changed in color, the face has a symmetrical configuration. During an intraoral clinical examination, a dentist reveals a rounded erosion with a red corolla on the periphery with a diameter of up to 1 cm against the background of an unflamed mucosa. The surface of the aphta is covered with a whitish coating. When trying to remove the layers, the bleeding surface is exposed. On palpation, the aphth is painful, there is no infiltration at the base of the erosion. Sometimes there is regional lymphadenitis.
Recurrent aphthous stomatitis is differentiated with herpes infection, traumatic erosions, ulcerative necrotic stomatitis, oral syphilis, bullous dermatitis of Lort-Jacob. The examination is carried out by a dentist-therapist. To identify possible background pathology as an etiological factor in the development of recurrent aphthous stomatitis, consultations of narrow specialists are shown: gastroenterologist, otorhinolaryngologist, endocrinologist, immunologist.
Treatment and prognosis
The general treatment of recurrent aphthous stomatitis is aimed at eliminating foci of odontogenic infection, normalizing the functioning of the gastrointestinal tract, endocrine system, and increasing the reactivity of the body. In order to block the action of histamine, a biologically active substance responsible for the manifestation of signs of inflammation, antihistamines are used. To increase the indicators of general and local resistance in recurrent aphthous stomatitis, immunomodulators, multivitamin complexes, which include thiamine, folic acid and ascorbic acid, are used.
Locally, patients are prescribed anesthetics in the form of a spray or ointment to anesthetize the affected area. In order to combat secondary infection, antiseptic solutions are used. To clean the surface of the aft from plaque, applications of drugs based on proteolytic enzymes are used. At the final stage, keratoplasty is shown in the dehydration phase. A good effect in the treatment of recurrent aphthous stomatitis can be achieved with the help of such physiotherapeutic procedures as laser, phonophoresis. To prevent additional traumatization of the mucosa during the period of pronounced clinical manifestations of the disease, patients are not recommended to eat spicy, hard food. The prognosis for the fibrinous form of recurrent aphthous stomatitis is favorable. In the case of necrotic, scarring stomatitis, the prognosis is determined by the effectiveness of treatment of the underlying somatic disease.
- Preeti L., Magesh K.T., Rajkumar K. Recurrent aphthous stomatitis // J Oral Maxillofac Pathol. — 2011; 15(3): 252-256.link
- Terekhova N.V., Nikolaeva I.S., Il’ina M.T., Fomina A.N. The interferon-inducing and immunomodulating action of bonafton in chronic diseases of the oral mucosa // Stomatologiia (Mosk). — 1991; (6): 21-22.link
- Narjiss Akerzoul, Saliha Chbicheb Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations // Pan Afr Med J. — 2018; 30: 205. link