✅ Abstract
Recurrent aphthous stomatitis (RAS) is the most frequent ulcerative disorder of the oral mucosa in children.
📌 Recommended Article :
Dental Article 🔽 Aphthous Stomatitis vs Traumatic Ulcers: Clinical Differences, Symptoms, and Treatment Guidelines ... Despite their similar appearance, their etiology, pathophysiology, and management differ significantly. Accurate differentiation is essential for effective treatment and prevention of recurrence.This article reviews its definition, etiology, clinical diagnosis, differential features, and evidence-based treatment approaches to guide pediatric dentists and clinicians in accurate management.
Advertisement
✅ Introduction
Recurrent aphthous stomatitis (RAS), commonly known as canker sores, affects approximately 20–30% of children worldwide (Akintoye & Greenberg, 2021). These painful ulcers significantly impact oral comfort, nutrition, and quality of life. Understanding the pathogenesis and differentiating RAS from other ulcerative oral conditions is essential for appropriate and minimally invasive management.
📌 Recommended Article :
Dental Article 🔽 Enamel Hypoplasia vs Dental Fluorosis: Key Differences, Diagnosis, and Treatment ... Enamel hypoplasia and dental fluorosis are two developmental defects of enamel frequently encountered in clinical dentistry.✅ Definition
Recurrent aphthous stomatitis is a chronic, relapsing condition characterized by round or oval ulcers with a yellowish fibrinous center and an erythematous halo, occurring on non-keratinized oral mucosa such as the buccal mucosa, floor of the mouth, and labial surfaces. Episodes typically recur every 1–4 months, lasting 7–14 days per episode.
✅ Etiology
The etiopathogenesis of RAS is multifactorial, involving a combination of genetic, immunologic, microbial, and environmental factors:
▪️ Genetic predisposition: Positive family history in up to 40% of cases.
▪️ Immune dysregulation: Altered T-cell response and increased TNF-α levels.
▪️ Nutritional deficiencies: Low levels of vitamin B12, folate, iron, and zinc are commonly associated.
▪️ Stress and trauma: Minor oral trauma can trigger ulcer formation.
▪️ Allergic or microbial factors: Hypersensitivity reactions to certain foods (e.g., chocolate, nuts) or bacteria.
▪️ Systemic diseases: Behçet’s disease, Crohn’s disease, and celiac disease must be ruled out.
📌 Recommended Article :
Dental Article 🔽 Differential Diagnosis of Perioral Dermatitis: Clinical Insights and Management ... Since its clinical presentation overlaps with other dermatoses such as acne vulgaris, rosacea, seborrheic dermatitis, and contact dermatitis, establishing a clear differential diagnosis is critical for effective treatment and prognosis.✅ Diagnosis
Diagnosis is clinical, based on history, lesion morphology, recurrence pattern, and exclusion of systemic conditions.
Typical RAS lesions are:
▪️ Minor aphthae: less than 10 mm, heal without scarring.
▪️ Major aphthae: more than 10 mm, last longer, may scar.
▪️ Herpetiform aphthae: Multiple pinpoint ulcers that coalesce.
Laboratory tests (CBC, ferritin, folate, vitamin B12, and celiac antibodies) are indicated when recurrent or severe ulcers are present.
📌 Recommended Article :
Dental Article 🔽 Dental Management of Hand-Foot-Mouth Disease: Updated Clinical Guide for Dentists ... Dentists play a crucial role in early recognition, supportive management, and patient education. This article provides updated clinical guidelines for oral healthcare professionals in the diagnosis and management of HFMD.✅ Differential Diagnosis
Distinguishing RAS from other oral ulcerations is essential to avoid misdiagnosis. Common differential diagnoses include herpetic gingivostomatitis, traumatic ulcers, hand-foot-and-mouth disease, and Behçet’s disease.
📊 Comparative Table: Differential Diagnosis of Recurrent Aphthous Stomatitis in Children
| Condition | Distinguishing Features | Diagnostic Clues |
|---|---|---|
| Herpetic Gingivostomatitis | Multiple vesicles on keratinized mucosa; painful and febrile onset | Positive HSV-1 culture or PCR; affects both attached gingiva and lips |
| Traumatic Ulcer | Single ulcer with history of mechanical or thermal trauma | Heals rapidly after eliminating the causative factor |
| Hand-Foot-and-Mouth Disease | Vesicular lesions on oral mucosa, palms, and soles | Coxsackievirus A16 or Enterovirus 71 infection confirmed by PCR |
| Behçet’s Disease | Oral and genital ulcers with ocular involvement | Positive pathergy test; systemic vasculitis signs |
✅ Modern Management
Management focuses on symptom control, ulcer healing, and prevention of recurrence.
Current evidence-based strategies include:
1. Topical Therapies
▪️ Corticosteroids (e.g., triamcinolone acetonide 0.1%): First-line for reducing pain and inflammation.
▪️ Chlorhexidine gluconate 0.12% mouthwash: Reduces bacterial load and secondary infection.
▪️ Topical anesthetics (lidocaine gel): For pain relief prior to meals.
2. Systemic Treatments (for severe or major RAS)
▪️ Oral corticosteroids (prednisone ≤15 mg/day) for short-term control.
▪️ Colchicine or dapsone in recurrent or immune-mediated cases under specialist supervision.
▪️ Vitamin B12, folate, and iron supplementation if deficiency is detected.
3. Adjunctive and Preventive Measures
▪️ Maintain excellent oral hygiene using non-sodium lauryl sulfate toothpaste.
▪️ Avoid trigger foods (acidic, spicy, or allergenic).
▪️ Manage psychological stress through behavioral interventions.
📌 Recommended Article :
Dental Article 🔽 Cold Sore, Canker Sore, and Oral Thrush: Key Differences You Should Know ... Cold sores, canker sores, and oral thrush are among the most frequent oral lesions, often mistaken for one another. This article explains their main features, clinical presentation, diagnosis, and treatment in both children and adults, providing practical keys for differentiation.✅ Conclusion
Recurrent aphthous stomatitis in children remains a multifactorial condition requiring comprehensive evaluation. Early identification of underlying causes and application of evidence-based topical or systemic therapies can significantly reduce recurrence and improve quality of life.
🔎 Recommendations
1. Pediatric dentists should conduct routine screening for systemic conditions in children with frequent oral ulcers.
2. Use topical corticosteroids and chlorhexidine as first-line therapy.
3. Encourage nutritional evaluation to detect deficiencies contributing to recurrence.
4. Educate caregivers on trauma prevention and stress reduction strategies.
📚 References
✔ Akintoye, S. O., & Greenberg, M. S. (2021). Recurrent aphthous stomatitis. In M. S. Greenberg (Ed.), Burket’s Oral Medicine (13th ed., pp. 49–55). Wiley-Blackwell.
✔ Belenguer-Guallar, I., Jiménez-Soriano, Y., & Claramunt-Lozano, A. (2014). Treatment of recurrent aphthous stomatitis. A literature review. Journal of Clinical and Experimental Dentistry, 6(2), e168–e174. https://doi.org/10.4317/jced.51395
✔ Chiang, C. P., Yu-Fong Chang, J., Wang, Y. P., & Wu, Y. H. (2022). Recurrent aphthous stomatitis – Etiology, pathogenesis, diagnosis, and ✔ management. Journal of the Formosan Medical Association, 121(6), 1073–1082. https://doi.org/10.1016/j.jfma.2021.09.012
✔ Scully, C., & Porter, S. (2008). Oral mucosal disease: Recurrent aphthous stomatitis. British Journal of Oral and Maxillofacial Surgery, 46(3), 198–206. https://doi.org/10.1016/j.bjoms.2007.07.201
📌 More Recommended Items
► Oral lesions in neonates, children and adolescents. Characteristics, diagnosis and treatment
► How is an oral biopsy taken? - Step by step procedure
► What is Oral Candidiasis? - Everything you need to know - Symptoms, diagnosis and treatment