Recurrent aphthous stomatitis (RAS) is the most common cause of recurrent oral ulcers in children, characterized by painful ulcerations affecting oral mucosa without systemic disease.
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✅ Introduction
Recurrent oral ulcers in children, clinically known as recurrent aphthous stomatitis (RAS), represent a frequent complaint in pediatric dentistry. Although benign and self-limiting, RAS significantly affects oral function, nutrition, and quality of life. Early recognition and accurate diagnosis are essential to distinguish RAS from systemic or infectious diseases presenting with similar lesions.
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The exact etiology of RAS remains multifactorial and incompletely understood. Proposed contributing factors include:
▪️ Genetic predisposition, particularly a positive family history
▪️ Immune dysregulation, involving T-cell–mediated responses
▪️ Nutritional deficiencies, especially iron, folate, vitamin B12, and zinc
▪️ Local trauma to the oral mucosa
▪️ Psychological stress
▪️ Food hypersensitivity and sodium lauryl sulfate exposure
RAS is not considered infectious and is not associated with viral replication.
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Recurrent aphthous ulcers typically present on non-keratinized oral mucosa, including the labial mucosa, buccal mucosa, floor of the mouth, and ventral tongue.
Clinical Types
▪️ Minor RAS: Small (less than 10 mm), shallow ulcers healing within 7–14 days without scarring
▪️ Major RAS: Larger, deeper ulcers with prolonged healing and possible scarring
▪️ Herpetiform RAS: Multiple small ulcers occurring in clusters
Common symptoms include pain, burning sensation, and difficulty eating or speaking.
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There is no definitive cure for RAS; treatment focuses on symptom control, lesion duration reduction, and recurrence prevention.
Local Therapies
▪️ Topical corticosteroids (e.g., triamcinolone acetonide)
▪️ Topical anesthetics for pain relief
▪️ Antimicrobial mouth rinses (chlorhexidine) to prevent secondary infection
Systemic and Adjunctive Approaches
▪️ Nutritional supplementation when deficiencies are identified
▪️ Avoidance of known triggers
▪️ Maintenance of optimal oral hygiene
Systemic therapy is rarely indicated in children and should be reserved for severe cases.
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Despite its benign nature, recurrent aphthous stomatitis may indicate underlying systemic or nutritional disorders. Accurate diagnosis is essential to prevent overtreatment and to differentiate RAS from viral, autoimmune, or hematologic diseases. Pediatric dentists play a critical role in early identification and appropriate referral when systemic involvement is suspected.
🎯 Recommendations for Pediatric Dental Practice
▪️ Perform thorough medical and dietary history assessments
▪️ Educate caregivers on trigger avoidance and oral hygiene practices
▪️ Use topical therapy as first-line treatment
▪️ Refer patients with atypical or severe lesions for medical evaluation
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Recurrent aphthous stomatitis is the leading cause of recurrent oral ulcers in children, with multifactorial etiology and characteristic clinical presentation. Evidence-based diagnosis and conservative management allow effective symptom control while minimizing unnecessary interventions.
📊 Comparative Table: Differential Diagnosis of Recurrent Oral Ulcers in Children
| Condition | Key Clinical Features | Distinguishing Factors |
|---|---|---|
| Recurrent Aphthous Stomatitis | Painful, shallow ulcers on non-keratinized mucosa | No systemic symptoms, recurrent pattern |
| Primary Herpetic Gingivostomatitis | Multiple vesicles progressing to ulcers | Fever, lymphadenopathy, viral etiology |
| Behçet Disease | Recurrent oral and genital ulcers | Systemic involvement, ocular lesions |
| Traumatic Ulcers | Single ulcer at trauma site | History of mechanical injury |
✔ Edgar, N. R., Saleh, D., & Miller, R. A. (2017). Recurrent aphthous stomatitis: A review. Journal of Clinical and Aesthetic Dermatology, 10(3), 26–36.
✔ Preeti, L., Magesh, K. T., Rajkumar, K., & Karthik, R. (2011). Recurrent aphthous stomatitis. Journal of Oral and Maxillofacial Pathology, 15(3), 252–256.
✔ Scully, C., & Porter, S. (2008). Oral mucosal disease: Recurrent aphthous stomatitis. British Journal of Oral and Maxillofacial Surgery, 46(3), 198–206.
✔ Shulman, J. D. (2004). An epidemiologic study of recurrent aphthous ulceration in U.S. children. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 98(4), 405–410.
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