Recurrent aphthous stomatitis (episodic mouth ulcers)

Last reviewed: 9 Nov 2022
Last updated: 09 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • oral ulcers
  • afebrile
  • absence of genital or ocular ulceration
  • no history of immunodeficiency
  • absence of pallor
More key diagnostic factors

Risk factors

  • positive family history
  • nonsmoker or cessation of smoking
  • trauma
  • age <30 years
  • cows' milk-fed children
  • female sex
  • high stress levels
  • food intolerance
  • hormonal imbalance
  • use of sodium lauryl sulfate-containing toothpaste
More risk factors

Diagnostic investigations

Investigations to consider

  • CBC
  • serum ferritin
  • serum folate
  • serum vitamin B12
  • serum IgA-tTG
  • viral serology (e.g. HIV or Epstein-Barr virus)
  • erythrocyte sedimentation rate and CRP
  • biopsy
  • antinuclear antibody test
  • serum HIV test
More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Jennifer Taylor, BDS, MFDS RCS, MBChB FDS (OM), PhD

Consultant and Honorary Senior Lecturer in Oral Medicine

Glasgow Dental Hospital and School

Glasgow

Scotland

UK

Disclosures

JT declares that she has no competing interests.

Acknowledgements

We would like to gratefully acknowledge the late Professor Crispian Scully for his contribution to this topic.

Peer reviewers

James J. Sciubba, DMD, PhD

Consultant for Oral Pathology and Oral Medicine

The Milton J. Dance Head and Neck Center

Greater Baltimore Medical Center

Baltimore

MD

Disclosures

JJS declares that he has no competing interests.

Pepe Shirlaw, BDS, FDS RCPS

Consultant in Oral Medicine

Guy’s Hospital

Great Maze Pond

London

UK

Disclosures

PS declares that she has no competing interests.

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