Recurrent Aphthous Stomatitis (RAS)

Recurrent aphthous stomatitis is an autoimmune pathology, forming erosive/ulcerative lesions which are termed aphthae. Clinically, three variants can be distinguished: minor, major and herpetiform.
In the minor form ulceration is small in size, less than 1 cm and surrounded by an erythematous ring with a fibrinous membrane. Minor form aphthae are present on non-keratinised  mucosa (a pathognomonic feature) and can be widespread; up to 5 can generally be present at any one time. The lesions are particularly painful, especially when in contact with hot, acidic or spicy foods. They heal spontaneously in 7-10 days without scarring.
The major form is characterised by formations of one or more lesions, greater than 1 cm and they cause a well-defined algic symptomology, leading to the impairment of the stomatological functions (phonation, mastication and swallowing). The lesions heal within approximately 1-2 months, often leaving a scar.
Finally, there is the herpitiform form, comprising numerous ulcerative lesions, reaching 100 contemporaneously, and they tend to coalesce. Pain and phlogosis are also marked in this case.
A clinical assessment and medical history are indispensable in order to diagnose recurrent aphthous stomatitis. The lesions are often reported from the early years of childhood with frequent episodes throughout the year, including periods when the condition worsens and is in remission. Although a biopsy is not useful, it is indispensable to exclude that such lesions are secondary manifestations of other systemic pathologies (see the Table below).

The aim of treatment for recurrent aphthous stomatitis is to control the symptomatology, encourage growth of the mucosa and avoid excessive bacterial infection. A multi-disciplinary approach is required where the aphthous lesions are secondary to systemic pathology.