IJCRR - Vol 06 Issue 10, May, 2014
ETIOLOGY AND PATHOPHYSIOLOGY OF RECURRENT APHTHOUS STOMATITIS: A REVIEW
Author: Arun Kumar M., Vasanthi Ananthakrishnan, Jaisri Goturu
Recurrent aphthous stomatitis is the most common oral mucosal ulcer disease. It causes severe pain and occurs repeatedly, causing discomfort in daily routine activities. The description of etiology is varied and none of the explanations given so far are satisfactory. Clinically this condition presents itself in three forms: major, minor and herpetiform ulcers. Causes for the ulcers could be related to host and / or environment. Host factors include genetic, nutritional deficiency, immune dysregulation and stress which can again be multifactorial. Environmental factors include trauma (both physical and chemical) and infections. There are several clinical syndromes which are associated with RAS like Behcet’s syndrome. There are several causes acting together in initiating formation of ulcer unlike a single etiological factor as was thought previously. This means combination of host and environmental factors are essential not only for triggering the ulcer but also for an increase in size. The severity of etiological factors to which an individual is exposed would decide the type of ulcer. Identification of the trigger for a particular individual seems to be important in management of the disease. Hence understanding etiopathogenesis for recurrent aphthous stomatitis would be helpful in formulation of individualized treatment modalities. This review is intended to understand the cause and pathogenesis of recurrent aphthous stomatitis.
Keywords: Recurrent Aphthous Stomatitis, Oral Ulcers, RAS syndromes
Arun Kumar M., Vasanthi Ananthakrishnan, Jaisri Goturu. ETIOLOGY AND PATHOPHYSIOLOGY OF RECURRENT APHTHOUS STOMATITIS: A REVIEW International Journal of Current Research and Review. Vol 06 Issue 10, May, 16-22
1. Ship JA, Chavez EM, Doerr PA, Henson BS, Sarmadi M. Recurrent aphthous stomatitis. Quintessence Int. 2000; 31(2):95-112.
2. E. A. Field and R. B. Allan. Oral ulceration – aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. Aliment PharmacolTher 2003; 18: 949–962.
3. Scully C, Gorsky M, Lozada. The diagnosis and management of recurrent aphthous stomatitis: A consensus approach. J Am Dent Assoc 2004; 134: 200–207.
4. Miller MF, Garfunkel AA, Ram C, Ship II. Inheritance patterns in recurrent aphthous ulcers: twin and pedigree data. Oral Surg Med Oral Pathol. Jun 1977;43(6):886-91.
5. Mustafa Özdemir1, HasanAcar et al. HLAB51 in Patients with Recurrent Aphthous Stomatitis. ActaDermato-Venereologica. 2008: 203-203.
6. LutfiJaber, Abraham Weinberger, Tirza Klein, Isaac Yaniv, Mukamel. Close Association of HLA-B52 and HLA-B44 Antigens in Israeli Arab Adolescents with Recurrent Aphthous Stomatitis. Arch Otolaryngol Head Neck Surg. 2001; 127(2):184-187.
7. Wilhelmsen NS, Weber R, Monteiro F, Kalil J, Miziara ID. Correlation between histocompatibility antigens and recurrent aphthous stomatitis in the Brazilian population. Braz J Otorhinolaryngol. MayJun 2009;75(3):426-31.
8. Zuzanna ?lebioda1, El?bieta Szponar1, Anna Kowalska. Recurrent aphthous stomatitis: genetic aspects of etiology. Post?pyDermatologii i Alergologii XXX 2013;2 :96-102
9. Kozlak ST, Walsh SJ, Lalla RV. Reduced dietary intake of vitamin B12 and folate in patients with recurrent aphthous stomatitis. J Oral Pathol Med. Feb 7 2010;
10. Carrozzo M. Vitamin B12 for the treatment of recurrent aphthous stomatitis. Evid Based Dent. 2009;10(4):114-115.
11. Yasui K, Kurata T, Yashiro M, Tsuge M, Ohtsuki S, Morishima T. The effect of ascorbate on minor recurrent aphthous stomatitis. ActaPaediatr. 2009; 99 (3): 442- 445.
12. Rogers III RS. Recurrent aphthous stomatitis: Clinical characteristics and evidence for an immunopathogenesis. J Invest Dermatol. 1977; 69: 499-509.
13. Sun A, Chu CT, Wu YC, Yuan JH. Mechanisms of depressed natural killer cell activity in recurrent aphthous ulcers. ClinImmunolImmunopathol. Jul 1991; 60(1):83-92.
14. Taylor LJ, Bagg J, Walker DM, Peters TJ. Increased production of tumour necrosis factor by peripheral blood leukocytes in patients with recurrent oral aphthous ulceration. J Oral Pathol Med. Jan 1992; 21(1):21-5.
15. Hasan A, Childerstone A, Pervin K, et al. Recognition of a unique peptide epitope of the mycobacterial and human heat shock protein 65-60 antigen by T cells of patients with recurrent oral ulcers. ClinExpImmunol. Mar 1995;99(3):392-7. 16. Miyamoto NT Jr, Borra RC, Abreu M, Weckx LL, Franco M. Immune-expression of HSP27 and IL-10 in recurrent aphthous ulceration. J Oral Pathol Med. Sep 2008;37(8):462-7. 17. Borra RC, de Mesquita Barros F, de Andrade Lotufo M, Villanova FE, Andrade PM. Toll-like receptor activity in recurrent aphthous ulceration. J Oral Pathol Med. Mar 2009;38(3):289-98. 18. Arikan S, Durusoy C, Akalin N, Haberal A, Seckin D. Oxidant/antioxidant status in recurrent aphthous stomatitis. Oral Dis. Oct 2009; 15(7):512-5. 19. Seung-Ho Rhee, Young-Bae Kim, Eun-So Lee. Comparison of Behcet’s Disease and Recurrent Aphthous Ulcer according to Characteristics of Gastrointestinal Symptoms. J Korean Med Sci 2005; 20: 971-6. 20. Hong Shang, Jingjing Ye, Min Ji. Anticoagulant and Fibrinolytic Disorders in Patients with Behçet’s Disease and Recurrent Aphthous Ulcer. Chinese Journal of Physiology 2011; 54:1-6. 21. David Wray, Edward A Graykowski, Abner Louis Notkins. Role of mucosal injury in initiating recurrent aphthous stomatitis. British Medical Journal 1981; 283: 1569- 1570. 22. Camila de Barros Gallo, Maria Angela Martins Mimura, Norberto Nobuo Sugaya. Psychological stress and recurrent aphthous stomatitis. Clinics 2009; 64(6):645-648. 23. Hoover, J. A. Olson, J. S. Greenspan. Humoral Responses and Cross-reactivity to Viridans Streptococci in Recurrent Aphthous Ulceration. J Dent Res 1986; 65(8):1101-1104. 24. A Hasan, A Childerstone, K Pervin, et al. Recognition of a unique peptide epitope of the mycobacterial and human heat shock protein 65-60 antigen by T cells of patients with recurrent oral ulcers. ClinExpImmunol. 1995; 99(3): 392–397. 25. Birek C, Grandhi R, McNeill K, Singe;r D, Ficarra G, Bowden G. Detection of Helicobacter pylori in oral aphthous ulcers. J Oral Pathol Med. May 1999;28(5):197- 203. 26. Elsheikh MN, Mahfouz ME. Prevalence of Helicobacter pylori DNA in recurrent aphthous ulcerations in mucosa-associated lymphoid tissues of the pharynx. Arch Otolaryngol Head Neck Surg 2005;131(9): 804-808. 27. KamileMarako?luand RecepErolSezeret al. Recurrentaphthous stomatitis frequency in the smoking cessation people: Clin Oral Invest 2007; 11:149–153. 28. Seung-Ho Rhee, Young-Bae Kim, Eun-So Lee. Comparison of Behcet’s Disease and Recurrent Aphthous Ulcer according to Characteristics of Gastrointestinal Symptoms. J Korean Med Sci 2005; 20: 971-6. 29. Kelly L Brown1, Per Wekell et al., Profile of blood cells and inflammatory mediators in periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome: BMC Pediatrics 2010, 10:65.30. ArnonBroides, Baruch Yerushalmi, Rachel Levy et al. Imerslund-Grasbeck Syndrome Associated With Recurrent Aphthous Stomatitis and Defective Neutrophil Function. J PediatrHematolOncol 2006: 28(11); 715-720. 31. SelimAydemir, NilgünSolakTekin, ErolAktunç et al. Celiac disease in patients having recurrent aphthous Stomatitis. Turk J Gastroenterol 2004; 15 (3): 192-195. 32. Roy S. Rogers III.Recurrent aphthous stomatitis: Clinical characteristics and associated systemic disorders. Seminars in Cutaneous Medicine and Surgery 1997; 16 (4): 278-283. 33. Arunkumar M, VasanthiAnanthakrishnan, JaisriGoturu. Role of Serum Cortisol in Recurrent Aphthous Stomatitis. Biomedicine 2012, 32(3), 331-336.