TY - JOUR
T1 - Recurrent Aphthous Stomatitis
T2 - Towards Evidence-Based Treatment?
AU - Challacombe, Stephen J.
AU - Alsahaf, Surab
AU - Tappuni, Anwar
N1 - Funding Information:
Stephen J Challacombe, Surab Alsahaf and Anwar Tappuni declare that they have no conflict of interest. This article does not contain any studies with human or animal subjects performed by any of the authors.
Publisher Copyright:
© 2015, Springer International Publishing AG.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2015/9
Y1 - 2015/9
N2 - Recurrent aphthous stomatitis is one of the most common oral mucosal diseases seen by dental professionals, and yet its aetiology remains unclear, and its management based on less than robust evidence. The literature remains confused because of the lack of clarity in diagnosis and the lack of a standardised ulcer severity scoring system and agreed outcome measures. However, recent literature is encouraging in meeting these aims. There is agreement that recurrent aphthous stomatitis (RAS) is a localized mucosal disease not secondary to systemic disease and therefore distinguishable from over 40 other types of oral ulcers. Disease severity scores have been introduced and outcome measures have become more standardised. RAS appears to be an auto-immune disease directed at epitopes of heat shock proteins whilst most recent work on aetiology has focused on cytokines and genetics. Pro-inflammatory cytokines including TNF-a and IL-6 and IL-17 are raised in RAS and TNF inhibitors can inhibit episodes of ulceration. Many local anti-inflammatory agents will help ulcers heal, and local steroids remain the treatment of choice. Some systemic drugs have evidence-based data indicating efficacy at preventing new ulcers including colchicine, prednisolone, thalidomide, pentoxyfilline and dapsone. The field would benefit from further trials combining local and systemic therapy using defined outcome measures.
AB - Recurrent aphthous stomatitis is one of the most common oral mucosal diseases seen by dental professionals, and yet its aetiology remains unclear, and its management based on less than robust evidence. The literature remains confused because of the lack of clarity in diagnosis and the lack of a standardised ulcer severity scoring system and agreed outcome measures. However, recent literature is encouraging in meeting these aims. There is agreement that recurrent aphthous stomatitis (RAS) is a localized mucosal disease not secondary to systemic disease and therefore distinguishable from over 40 other types of oral ulcers. Disease severity scores have been introduced and outcome measures have become more standardised. RAS appears to be an auto-immune disease directed at epitopes of heat shock proteins whilst most recent work on aetiology has focused on cytokines and genetics. Pro-inflammatory cytokines including TNF-a and IL-6 and IL-17 are raised in RAS and TNF inhibitors can inhibit episodes of ulceration. Many local anti-inflammatory agents will help ulcers heal, and local steroids remain the treatment of choice. Some systemic drugs have evidence-based data indicating efficacy at preventing new ulcers including colchicine, prednisolone, thalidomide, pentoxyfilline and dapsone. The field would benefit from further trials combining local and systemic therapy using defined outcome measures.
KW - Azathioprine
KW - Colchicine
KW - Disease severity scores
KW - Interleukins
KW - Levamisole
KW - Oral ulceration
KW - Recurrent aphthous stomatitis
KW - Steroids
KW - Thalidomide
UR - http://www.scopus.com/inward/record.url?scp=85028874654&partnerID=8YFLogxK
U2 - 10.1007/s40496-015-0054-y
DO - 10.1007/s40496-015-0054-y
M3 - Review article
AN - SCOPUS:85028874654
SN - 2196-3002
VL - 2
SP - 158
EP - 167
JO - Current Oral Health Reports
JF - Current Oral Health Reports
IS - 3
ER -