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Recurrent Aphthous Stomatitis (RAS)

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Recurrent apthous stomatitis (RAS) is a common condition where a person suffers from repeated appearance of mouth ulcers (aphthae). The affected person usually healthy otherwise. These ulcers are benign in nature and non-contagious.


Recurrent aphtous stomatitis causes round or oval-shaped painful ulcers. These ulcers develop on the oral mucusa and affects about 20 to 30% of the adults in their lifetime. There are three forms of RAS:

  • Minor RAS: They appear singly or as multiple lesions. They have an acute onset and are about 0.5 cm in diameter.
  • Major RAS: They are less common than minor RAS and are more than 1 cm in diameter. These ulcers tend to be more painful lesions.
  • Herpetiform RAS: These appear as multiple small ulcers that may coalesce and form irregular ulcers.

Predisposing Factors That Lead to RAS

The exact cause of recurrent apthous stomatitis is not known. However, it is understood that it involves a T cell-mediated immune response. Factors that can trigger this response include:

  • Genetic predisposition that can lead to formation of apthous ulcer
  • Trauma to the oral mucosa due to presence of a sharp tooth, dental treatment, injections, tooth brush injury, etc.
  • Use of tobacco and tobacco products such as smoking cigarettes, cigars or consumption of tobacco products.
  • Use of drugs such as NSAIDs, phenobarbital, nicorandil, etc.
  • Nutritional deficiency of iron, vitamin B12 and folic acid.
  • Gluten sensitive enteropathy, an autoimmune inflammatory disease can lead to RAS
  • Changes in the hormones, especially in case of women
  • Stress is a contributing factor that leads formation of ulcers in the mouth

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Symptoms of RAS

In most cases, the symptoms of recurrent aphtous stomatitis are seen in childhood. The frequency of their recurrence reduces with age. The symptoms include:

  • Formation of just one ulcer 2 to 4 times a year or continuous appearance of ulcers as old ones heal and new continue to appear
  • Burning sensation for the 1 or 2 days
  • Severe pain for 4 to 7 days
  • The ulcer is well-demarcated, ovoid, round and has a necrotic center with yellow-graypseudomembrane and a red halo. The margins may be slightly raised

Diagnosis for RAS

Diagnosis is based on the appearance of the ulcers. There are no definitive laboratory tests that help confirm recurrent apthous stomatitis. A medical history of the patient is taken to rule out ulcerative disorders and other diseases such as Behcet’s disease, HIV infection, Herpes simplex infection, neutropenia, etc.  A complete blood count will help rule out iron deficiencies, malabsorption, vitamin deficiencies as well as autoimmune conditions.

Management of RAS

Treatment for recurrent apthous stomatitis includes application of topical chlorhexidineand corticosteroids. Use of chlorhexidinegluconate mouthwashes as well as corticosteroids will help reduce the pain and discomfort. Avoid eating spicy and acidic foods and  beverages to reduce the pain. There is no curative therapy available as such and all treatments suggested is usually helpful in relieving pain, accelerating the healing process and reducing the occurrence of the episodes.

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These ulcers are not contagious, neither do they indicate cancer of any form. However, recurrent aphtous stomatitis can cause significant discomfort, especially during eating. This condition lasts for several years and then it may disappear on its own. If you suffer from RAS, speak to your doctor and find a solution to the discomfort due to these aphthous ulcers.

Written by: healthplus24.com team

Date last updated: January 22, 2015

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