Elsevier

American Journal of Otolaryngology

Volume 27, Issue 4, July–August 2006, Pages 229-232
American Journal of Otolaryngology

Original contribution
Recurrent aphthous stomatitis: investigation of possible etiologic factors

https://doi.org/10.1016/j.amjoto.2005.09.022Get rights and content

Abstract

Objective

To investigate the association of serum vitamin B12, folic acid, iron, calcium, magnesium, and phosphorus levels as well as family history and cigarette smoking with recurrent aphthous stomatitis (RAS).

Methods

Thirty-four patients with RAS and 32 control subjects were included in this controlled prospective screening study. Both groups received a questionnaire, and serum screening tests were performed. The collected data were analyzed using χ2 test and binary logistic regression analysis.

Results

Family history was found to be the most significant predisposing factor for RAS among the investigated ones. Regarding the serum tests, only vitamin B12 was found to have significant correlation with RAS. Patients with vitamin B12 deficiency, positive family history, and nonsmoking status have been found to have the highest risk for having RAS.

Conclusions

RAS is a multifactorial disease. Positive family history, vitamin B12 deficiency, and nonsmoking status are among the important predisposing factors.

Introduction

Recurrent aphthous stomatitis (RAS) is one of the most common oral diseases worldwide. The prevalence ranges from 2% to 66% in different populations [1], [2]. RAS is a disease characterized by recurring ulcers in the oral mucosa without any sign of other diseases. Aphthous ulcers are painful and shallow ulcers, usually covered with a grayish white pseudomembrane that is surrounded by an erythematous margin. Recurrent aphthous ulcers arise on nonkeratinized oral mucosa such as lateral margins of the tongue and buccal and labial mucosa.

RAS is classified according to clinical characteristics of the ulcers as minor ulcers, major ulcers, and herpetiform ulcers. The most common type is RAS with minor ulcers and comprises approximately 80% of the cases. In this type, the ulcers are less than 1 cm in diameter, round, clearly defined, and painful ulcers and heal within 10 to 14 days without scarring. In major RAS (Sutton disease), painful lesions are more than 1 cm in diameter, may last for weeks, and usually heal with scar formation. The herpetiform aphthous stomatitis, the least common type, presents itself as multiple clusters of pinpoint lesions that may give rise to large irregular ulcers lasting 7 to 10 days [3].

Although there are many factors accused in the etiology of RAS, we still need to seek for more accurate and strong statements regarding the etiology because of the contradictory literature and for patients' benefit.

In this prospective study, we aimed to investigate possible roles of predisposing factors for RAS. These included family history, cigarette smoking, and serum tests. Serum tests included vitamin B12, folic acid, iron (Fe++), Fe++ saturation levels, total iron-binding capacity (TIBC), ferritin, calcium (Ca++), magnesium (Mg++), and phosphorus (P) levels. Complete blood count with hemoglobin and hematocrit levels was also performed.

Section snippets

Materials and methods

Thirty-four patients with a diagnosis of RAS with recurrent minor ulcers were included in this study.

The control group was composed of 32 healthy volunteers without oral aphthae history and undergoing preoperative blood tests for septoplasty operation with a diagnosis of nasal septal deviation. After obtaining an informed consent (according to principles outlined in the Declaration of Helsinki), both groups were given a questionnaire about the disease. Questionnaire included age, sex, smoking

Results

Patient group was composed of 34 patients with 17 men and 17 women, and the control group was composed of 32 individuals with 13 men and 19 women. Age ranged between 10 and 66 years with a mean of 36.7 years in the patient group and between 11 and 74 years in the control group with a mean of 34.3 years. We did not show any significant influence of age or sex on RAS (binary logistic regression analysis, P > .05).

The most striking result was the influence of family history on RAS. The rates of

Discussion

Morbidity is quite high in RAS; quality of life of RAS patients is affected in that the recurrent and painful intraoral mucosal lesions and increased salivation give discomfort while eating, drinking, and speaking. Because the exact etiology of RAS is still unknown, most patients with RAS are usually given some medications to relieve their pain only, instead of an etiologic screening and curative treatment.

RAS may be associated with several diseases such as Behçet disease, gluten-sensitive

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