Secretory A immunoglobulin, total proteins and salivary flow in Recurrent Aphthous Ulceration.

Rev Bras Otorrinolaringol (Engl Ed). 2007 May-Jun;73(3):323-8

Authors: Martinez Kde O, Mendes LL, Alves JB

Clinical and experimental study. Introduction. Of debatable etiology, Recurrent Aphthous Ulcerations (R.A.U), is most of the time considered an immunological deficiency. AIM: The aim of this paper is to review the literature and clinical investigations regarding IgA-s, total proteins salivary concentration and basal salivary flow of patients with R.A.U. during activity and quiescence. METHODOLOGY: Nephelometry was used to measure salivary IgA-s; Pyrogallol red was used for total salivary proteins and the gravimetrical analysis for salivary flow measurement. RESULTS: Results demonstrated a significant increase in salivary IgA-s in active lesions in relation to quiescence. On the other hand, protein concentration rates were similar in both periods. CONCLUSION: Salivary IgA-s can be used as a parameter to study the immune status of the oral mucosa.

PMID: 17684652 [PubMed - indexed for MEDLINE]

[Periodic fever syndrome in children]

Tidsskr Nor Laegeforen. 2007 Jun 14;127(12):1651-3

Authors: Øymar K, Kristoffersen EK

BACKGROUND: In children with recurrent episodes of fever, the cause may be the periodic fever syndrome (PFAPA-syndrome). The condition is not uncommon, and awareness of the syndrome is important for avoiding unnecessary investigations and treatment. The article presents an overview of the PFAPA-syndrome. MATERIAL AND METHODS: The overview was based on Pubmed and Medline searches and data from 22 children with PFAPA-syndrome diagnosed at Stavanger University Hospital. RESULTS AND INTERPRETATION: In children with PFAPA-syndrome the fever occurs regularly, appears abruptly and lasts for three to five days. Typical symptoms are cervical adenitis, tonsillitis/pharyngitis or aphthous stomatitis, often accompanied by headache, abdominal pain, nausea and reduced general condition. Of the 22 children, 17 were boys. The median age of debut was 12 months, median duration of fever four days, and median time between episodes 25 days. The most common symptoms were cervical adenitis (n = 18) and tonsillitis/pharyngitis (n = 16). During episodes, all children had high fever, reduced general condition, no proved infection but typical high levels of C-reactive protein. More than half of the children had been given antibiotics on at least five occasions before the diagnosis of PFAPA-syndrome. With a typical history and clinical investigation, the need for further investigations is limited. The diagnosis must be considered in children younger than five years of age with periodic fever without signs of airway infection. When PFAPA-syndrome is suspected, the child should be referred to a paediatrician. There is no evidence-based treatment for PFAPA-syndrome, but tonsillectomy is considered to have an effect.

PMID: 17571105 [PubMed - indexed for MEDLINE]

[Recurrent oral ulcer: clinical characteristic and differential diagnosis]

Rev Chilena Infectol. 2007 Jun;24(3):215-9

Authors: Toche P P, Salinas L J, Guzmán M MA, Afani S A, Jadue A N

Recurrent aphthous stomatitis (RAS), are common inflammatory lesions of the oral mucous, usually round or ovoid, circumscribed by erythematous haloes with a yellow-grey floor and mostly painful. The RAS has reached an incidence about 20% in general population, present on any aged group, especially adolescents and young adults. Etiopathogenesis of RAS is not entirely understood. Some factors involved include immune system anomalies, infections, nutritional deficiency, mucous traumatism, food or contact allergy, autoimmunity illness and cancer; together with psychiatric, genetic and environment agents. In this article, main clinical features, etiology related factors, differential diagnosis and initial study of patients consulting for RAS are presented.

PMID: 17554441 [PubMed - indexed for MEDLINE]

Detection, enumeration and characterization of T helper cells secreting type 1 and type 2 cytokines in patients with recurrent aphthous stomatitis.

Tohoku J Exp Med. 2007 Jun;212(2):101-5

Authors: Albanidou-Farmaki E, Markopoulos AK, Kalogerakou F, Antoniades DZ

One of the factors involved in the pathogenesis of recurrent aphthous stomatitis (RAS) is a cell-mediated immune response in which several cytokines seem to play a major role. The aim of this study was to detect, enumerate and characterize T helper cells which are secreting type 1 cytokines (interleukin [IL]-2, IL-12, interferon [IFN]-gamma, and tumor necrosis factor [TNF]-alpha) and type 2 cytokines (IL-4, IL-5, IL-6, and IL-10) in the peripheral blood of patients with RAS. Thirty-two patients in the active phase of RAS (14 men and 18 women) and 40 healthy individuals participated in the study. T helper (T) cells were detected and characterized using Elispot assay. T cells secreting IL-2, IL-12 or IFN-gamma were increased in patients with RAS compared with the controls (p < 0.05, p < 0.001 and p < 0.001, respectively). T cells secreting TNF-alpha in RAS patients and controls were not statistically different (p > 0.05). T cells secreting IL-10 were increased in patients with RAS compared with the controls (p < 0.05). T cells secreting IL-4 were decreased in patients with RAS compared with the controls (p < 0.001), No statistical difference was observed between T cells secreting IL-5 or IL-6 in patients with RAS and controls. Our findings suggest that the increased numbers of T cells secreting type 1 cytokines may influence the immune response against RAS. Whether this action is of etiological importance or epigenetic phenomenon is a question that needs to be answered.

PMID: 17548954 [PubMed - indexed for MEDLINE]

Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region.

Head Face Med. 2007;3:25

Authors: Procaccini M, Campisi G, Bufo P, Compilato D, Massaccesi C, Catassi C, Lo Muzio L

BACKGROUND: A close correlation between celiac disease (CD) and oral lesions has been reported. The aim of this case-control study was to assess prevalence of enamel hypoplasia, recurrent aphthous stomatitis (RAS), dermatitis herpetiformis and atrophic glossitis in an Italian cohort of patients with CD. METHODS: Fifty patients with CD and fifty healthy subjects (age range: 3-25 years), matched for age, gender and geographical area, were evaluated by a single trained examiner. Diagnosis of oral diseases was based on typical medical history and clinical features. Histopathological analysis was performed when needed. Adequate univariate statistical analysis was performed. RESULTS: Enamel hypoplasia was observed in 26% cases vs 16% in controls (p > 0.2; OR = 1.8446; 95% CI = 0.6886: 4.9414). Frequency of RAS in the CD group was significantly higher (36% vs 12%; p = 0.0091; OR = 4.125; 95% CI = 1.4725: 11.552) in CD group than that in controls (36% vs 12%). Four cases of atrophic glossitis and 1 of dermatitis herpetiformis were found in CD patients vs 1 and none, respectively, among controls. CONCLUSION: The prevalence of enamel hypoplasia was not higher in the study population than in the control group. RAS was significantly more frequent in patients with CD.

PMID: 17537244 [PubMed]

Topical minocycline and tetracycline rinses in treatment of recurrent aphthous stomatitis: a randomized cross-over study.

Dermatol Online J. 2007;13(2):1

Authors: Gorsky M, Epstein J, Rabenstein S, Elishoov H, Yarom N

Recurrent aphthous stomatitis (RAS) is a common ulcerative condition of the oral mucosa. We assessed minocycline and tetracycline oral rinses in patients with frequent episodes of RAS in a clinical randomized crossover trial. Seventeen patients with high frequency recurrent minor RAS were randomly allocated to a cross-over topical therapy with 0.2 percent minocycline or 0.25 percent tetracycline aqueous solution mouthwash. The minimum interval between the cross-over was 30 days. The intensity of pain was recorded daily using a visual analogue scale. Minocycline mouthwashes as compared to topical tetracycline rinses resulted in significantly improved pain control, by reducing the severity and duration of pain. Topical minocycline rinse may be a potential treatment for other mucosal diseases that result in mucosal ulceration and pain.

PMID: 17498420 [PubMed - indexed for MEDLINE]

Common oral lesions: Part I. Superficial mucosal lesions.

Am Fam Physician. 2007 Feb 15;75(4):501-7

Authors: Gonsalves WC, Chi AC, Neville BW

Common superficial oral lesions include candidiasis, recurrent herpes labialis, recurrent aphthous stomatitis, erythema migrans, hairy tongue, and lichen planus. Recognition and diagnosis require taking a thorough history and performing a complete oral examination. Knowledge of clinical characteristics such as size, location, surface morphology, color, pain, and duration is helpful in establishing a diagnosis. Oral candidiasis may present as pseudomembranous candidiasis, glossitis, or perl&#xE8;che (angular cheilitis). Oral candidiasis is common in infants, but in adults it may signify immune deficiency or other illness. Herpes labialis typically is a mild, self-limited condition. Recurrent aphthous stomatitis most often is a mild condition; however, severe cases may be caused by nutritional deficiencies, autoimmune disorders, or human immunodeficiency virus infection. Erythema migrans is a waxing and waning disorder of unknown etiology. Hairy tongue represents elongation and hypertrophy of the filiform papillae and most often occurs in persons who smoke heavily. Oral lichen planus is a chronic inflammatory condition that may be reticular or erosive. Certain risk factors have been associated with each of these lesions, such as poor oral hygiene, age, tobacco use, and alcohol consumption, and some systemic conditions may have oral manifestations. Many recommended therapies for oral lesions are unsupported by randomized controlled trials.

PMID: 17323710 [PubMed - indexed for MEDLINE]

Evaluation of salivary nitric oxide levels in oral mucosal diseases: A controlled clinical trial.

Indian J Dent Res. 2006 Jul-Sep;17(3):117-20

Authors: Sunitha M, Shanmugam S

Lichen planus is a common dermatologic disease to manifest in the oral cavity. Recurrent aphthous ulcers are the most common ulcers of the oral cavity causing discomfort to the patients. These two diseases have different clinical manifestations which require appropriate treatment after correct diagnosis. Though numerous etiological factors have been proposed for these diseases, their true etio-pathogenesis is not yet established and therefore all therapies are palliative and none is effective universally. In light of this, the role of nitric oxide as a mediator in the etio-pathogenesis of these diseases was considered. The present study was undertaken to note the salivary nitric oxide levels as measured through its product nitrite in oral mucosal diseases like lichen planus and recurrent aphthous ulcers and also to ascertain whether salivary nitric oxide level has a role to play as a pathophysiological mediator in these diseases

PMID: 17176827 [PubMed - indexed for MEDLINE]

Recurrent aphthous stomatitis as an expression of pathergy in atopics.

Acta Dermatovenerol Alp Panonica Adriat. 2006 Sep;15(3):144-7

Authors: Veller-Fornasa C, Gallina P

BACKGROUND: Recurrent Aphthous Stomatitis (RAS) may be part of the "atopic background". Recently it has been reported that aphtous stomatitis could be an expression of atopic diathesis. The aim of this study is to verify whether the prevalence of posttraumatic aphthae is higher in patients with RAS and atopic diathesis than in patients with RAS without atopy. MATERIAL AND METHODS: In the past three years 39 new patients between 14 and 56 years of age and affected by idiopathic RAS have been observed. Atopic status and history of posttraumatic aphthosis were evaluated in all patients. RESULTS: The results appear to show that in our population the prevalence of posttraumatic aphthae is higher among atopic patients. CONCLUSIONS: Not only RAS but also pathergy could be considered an expression of the rich clinical/ symptomatic constellation of atopic diathesis.

PMID: 17053851 [PubMed - indexed for MEDLINE]

Association between recurrent aphthous stomatitis and salivary thiocyanate levels.

J Oral Sci. 2006 Sep;48(3):153-6

Authors: Cherubini K, Lorandi CS, Krapf SM, de Sousa FR, Yurgel LS, Figueiredo MA, Salum FG

The aim of this work was to investigate the association between recurrent aphthous stomatitis (RAS) and salivary thiocyanate levels. The sample comprised men and women of age ranging from 15 to 55 years, who were allocated to four groups: 28 patients in RAS active phase (group 1); 28 patients in RAS remission phase (group 2); 29 smokers (group 3); 26 non-smokers without RAS (group 4). Samples of whole saliva mechanically stimulated were collected, and thiocyanate levels were measured. The results were analyzed by ANOVA and paired t-test. Mean salivary thiocyanate values were 0.55 mM, 0.64 mM, 2.36 mM and 0.96 mM in groups 1 (active RAS), 2 (remission RAS), 3 (smokers) and 4 (control), respectively. There was no significant difference in thiocyanate levels when groups 1 and 2 were compared with group 4. Group 3 showed a significantly higher thiocyanate concentration when compared with groups 1, 2 and 4 (P < 0.05). There was no significant difference in thiocyanate levels between groups 1 and 2 (P > 0.05). It is therefore suggested that there is no association between RAS and salivary thiocyanate levels.

PMID: 17023748 [PubMed - indexed for MEDLINE]

PFAPA syndrome: new clinical aspects disclosed.

Arch Dis Child. 2006 Dec;91(12):981-4

Authors: Tasher D, Somekh E, Dalal I

BACKGROUND: The recently described PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis and Adenitis) syndrome is characterised by periodic fever, aphthous stomatitis, pharyngitis and adenitis. However, there are currently relatively few data on the natural history of this syndrome. OBJECTIVE: To describe the presentation, clinical course, doctors' awareness, therapeutic response and long-term follow-up of children with PFAPA syndrome. METHODS: Children with PFAPA syndrome referred over a 5-year period (from January 1999 to January 2004) were enrolled in the study. Data were gathered from medical records, parents' interviews, physical examination and telephone calls. RESULTS: 54 patients with PFAPA syndrome were evaluated. Our patients had a higher rate of abdominal pain (65%) and a lower rate of aphthous stomatitis (39%) than those in previous reports. Four different patterns of disease evolution were identified, including the relatively common (n = 14, 26%) and newly described course of alternating remissions and relapses. The remissions lasted 8.5 months on average (range 4-36 months). Diagnosis was established by primary paediatricians in 30 of 54 (56%) patients. However, a substantial delay in diagnosis was apparent (mean 15 months). Episodes were curtailed by a much lower dose of prednisone or equivalent corticosteroid (mean 0.6 mg/kg/day, range 0.15-1.5 mg/kg/day) than reported previously. Tonsillectomy was successful in the prevention of recurrence of further episodes in all six patients who underwent the procedure. CONCLUSIONS: We describe several new characteristics of PFAPA syndrome in children, contributing to our knowledge of this relatively unrecognised but troublesome syndrome. Early diagnosis and appropriate treatment can markedly improve the quality of life of both patients and families.

PMID: 16595648 [PubMed - indexed for MEDLINE]

Serum autoantibodies to desmogleins 1 and 3 in patients with oral lichen planus.

Croat Med J. 2006 Feb;47(1):53-8

Authors: Lukac J, Brozovi&#x107; S, Vucicević-Boras V, Mravak-Stipetić M, Malenica B, Kusić Z

AIM: To determine the presence of circulating autoantibodies to desmoglein (Dsg) 1 and Dsg 3 in patients with oral lichen planus. METHODS: Serum concentrations of circulating autoantibodies to Dsg 1 and Dsg 3 were determined by ELISA in 32 patients with erosive form and 25 patients with reticular form of oral lichen planus, 13 patients with acute recurrent aphthous ulcerations and 50 healthy controls. Indirect immunofluorescence analysis was also performed. RESULTS: Concentrations of circulating autoantibodies to both Dsg 1 and Dsg 3 detected in the sera of patients with erosive form of oral lichen planus were significantly increased in comparison with those in healthy controls, patients with recurrent aphthous ulceration, and those with reticular oral lichen planus (P<0.001 for both anti-Dsg autoantibodies). Indirect immunofluorescence also revealed significantly more positive findings in patients with erosive oral lichen planus (18 positive of 22 tested) than in healthy controls (1 positive of 20 tested; P<0.001), patients with recurrent aphthous ulceration (1 positive of 10 tested; P<0.001), and those with reticular oral lichen planus (3 positive of 15 tested; P<0.001). CONCLUSION: Humoral autoimmunity seems to be involved in the pathogenesis of oral lichen planus. The differences in the serum concentration of desmoglein autoantibodies suggested that pathological mechanisms in erosive and reticular forms of oral lichen planus might not be the same.

PMID: 16489697 [PubMed - indexed for MEDLINE]

AIDS and Recurrent Aphthous Stomatitis.

Rev Bras Otorrinolaringol (Engl Ed). 2005 Jul-Aug;71(4):517-20

Authors: Miziara ID, Araujo Filho BC, Weber R

The immunodeficiency state in HIV infected patients has been the cause of severe episodes of Recurrent Aphthous Stomatitis (RAS). AIM: Our study aims to establish correlation between the manifestations of RAS and the immunosuppression state caused by HIV infection, through counting of CD4+ cells, CD8+ cells, CD4+:CD8+ cells ratio and viral load. STUDY DESIGN: Series study. MATERIAL AND METHOD: Ninety-four HIV infected patients (25 women and 69 men) with RAS were evaluated in the ENT Department of the University of Sao Paulo-Medical School from January 1998 to December 2003. The age ranged between 19 and 63 years (mean = 35.3 years). The patients were divided in two groups: AIDS group and HIV infected group. RESULTS: The patients with AIDS and HIV infection presented, respectively, eight ulcers and two ulcers by outbreaks. Similarly, patients with major RAS presented smaller counting of cells CD8+, CD4+ and CD4+/CD8+ cells, and higher mean value of viral load than the patients with herpetiform and minor RAS. Between patients with minor and herpetiform RAS there were no statistical differences. CONCLUSIONS: The emergence of the lesions, mainly in major RAS, is directly related to the immunological state of the HIV infected patient. These patients frequently present nutritional deficits and worsening in life style. Thus, diagnosis and treatment of RAS is a challenge that should not be neglected.

PMID: 16446970 [PubMed - indexed for MEDLINE]

Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E33-9

Authors: Bravo IM, Correnti M, Escalona L, Perrone M, Brito A, Tovar V, Rivera H

AIM: To determine the prevalence of oral lesions in a HIV+ group of patients, related to CD4 cell count and viral load in a Venezuelan population. MATERIALS AND METHODS: In the present study, we evaluated 75 HIV+ adult patients, attended at the Center of Infectious Diseases, at the Faculty of Dentistry, Central University of Venezuela. Each patient was clinically examined for detection of oral mucosal lesions. In addition, CD4 cell count was determined by flow cytometry, as well as viral load by RT-PCR (Amplicor HIV-RNA, TM test 1.5, Roche). RESULTS: 85% (64/75) of HIV/AIDS patients showed associated HIV lesions. Oral Candidiasis constituted the most common lesion representing a 61% (39/64), followed by Oral Hairy Leukoplakia 53% (34/64); Oral Leukoplakia 34% (22/64), Melanic Hyperpigmentation 38% (18/64); Papilloma 13 (6/64), Lineal Gingival Erythema 8% (5/64); Aphtous Recurrent Stomatitis 5% (4/64) and Kaposi's Sarcoma 5% (3/64). Only one case of the following lesions were represented by Non Hodgkin Lymphoma, Multifocal Epithelial Hyperplasia, Recurrent Herpes, Histoplasmosis and Molluscum Contagiosum. The patients with a viral load of 30.000 copies/mm3 exhibited oral lesions related with HIV, independent of CD4 cell count, although patients with CD4+ levels of 200 cel/mm3 were more susceptible to develop these lesions. CONCLUSIONS: The most common oral lesion was Oral Candidiasis followed by Oral Hairy Leukoplakia, Oral Leukoplakia and Melanic Hyperpigmentation. A high viral load was strongly associated to the oral lesions occurrence independently of CD4+ cell count.

PMID: 16388291 [PubMed - indexed for MEDLINE]

Adamantiades-Behçet disease: an enigmatic process with oral manifestations.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E6-11

Authors: Eguia A, Villarroel M, Mart&#xED;nez-Conde R, Echebarría MA, Aguirre JM

Adamantiades-Behçet disease (ABD) is a chronic multisystemic vasculitis that is able to affect any human organ or system. Recurrent oral ulcers are a very important clinical sign. ABD is a worldwide pathology, which prevalence varies according to the population and geographic location. Although ABD has been known for ages, its aetiology remains an enigma. Genetic, immunological and microbiological factors have been associated. A wide spectrum of clinical manifestations (oral, genital, cutaneous, ocular, neurological, vascular and gastrointestinal) and an unpredictable evolution with repeated periods of exacerbation and remission are the most representative aspects of this pathology. The complex treatment of ABD requires a deep multidisciplinary cooperation; therefore, there is an extensive development of new therapeutic agents that have improved the prognosis of ABD. In this review were analysed the main etiological, clinical and therapeutic aspects of the disease.

PMID: 16388284 [PubMed - indexed for MEDLINE]

Comparison of Behcet's disease and recurrent aphthous ulcer according to characteristics of gastrointestinal symptoms.

J Korean Med Sci. 2005 Dec;20(6):971-6

Authors: Rhee SH, Kim YB, Lee ES

Behcet's disease (BD) is a multisystemic chronic inflammatory disease. It is characterized by recurrent oral and genital ulcers, uveitis, skin lesions and other manifestations, including neurologic, vascular, joint, and gastrointestinal ulcers of variable severity. Recurrent aphthous ulcer (RAU) represents a very common, but poorly understood, mucosal disorder. If a patient of RAU without any other typical symptoms of BD has gastrointestinal symptoms, it is difficult to distinguish this RAU from true BD with gastrointestinal involvement. Because pathognomonic clinical features and tools are absent, the differential diagnosis of these two diseases relies on the characteristic clinical features and the judgement of an experienced physician. Sixty-five out of a total 960 RAU patients and forty-four of 556 BD patients with gastrointestinal symptoms between January 1996 and December 2003 participated in this study. All were evaluated with esophagogastroduodenoscopy and colonoscopy. Clinical, endoscopic and histopathologic findings were analyzed and ELISA tests were conducted to detect serum levels of ASCA and pANCA. No significant difference was found between the two groups. Differential diagnosis between RAU with gastrointestinal symptoms and BD with gastrointestinal involvement requires further prospective, large-scale study.

PMID: 16361807 [PubMed - indexed for MEDLINE]

Helicobacter pylori infection in oral lesions of patients with recurrent aphthous stomatitis.

Med Sci Monit. 2005 Dec;11(12):CR576-9

Authors: Mansour-Ghanaei F, Asmar M, Bagherzadeh AH, Ekbataninezhad S

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a disorder distinguished by ulcers restricted to the oral mucosa. Because of the histological similarities between peptic ulcers and RAS and the identified role of Helicobacter pylori (H. pylori) in peptic ulcer, the possibility of bacterial involvement in the progression of aphthae has been suggested. Our aim was to find H. Pylori in brushed samples of oral aphthous ulcers by the polymerase chain reaction (PCR) method. MATERIAL/METHODS: The evaluated patients were referred to the laboratory with the diagnosis of RAS from the beginning of 2001 throughout 2002 in Rasht city. We collected oral aphthous specimens by toothbrush from these patients. PCR was used to isolate H. Pylori in the samples of RAS lesions and other parts of the oral cavity. Enzyme-linked immunosorbant assay (ELISA) was also done in all patients to determine IgG antibody RESULTS: We studied 50 patients with ages between 18 to 60 years (mean+/-SD: 32.38+/-11.30). Twenty-six patients (52%) had positive ELISA test and we obtained H. Pylori DNA in only one patient (2%). CONCLUSIONS: According to the results of this study, H. Pylori DNA could not be found in the aphthous ulcers of these patients, even in those with positive anti-H. Pylori antibody (IgG), and it is probable that these bacteria are not involved in recurrent oral aphthous ulcers.

PMID: 16319788 [PubMed - indexed for MEDLINE]

Epidemiology of the most common oral mucosal diseases in children.

Med Oral Patol Oral Cir Bucal. 2005 Nov-Dec;10(5):376-87

Authors: Rioboo-Crespo Mdel R, Planells-del Pozo P, Rioboo-Garc&#xED;a R

Dentists who treat children must be alert to the possibility of finding diseases of the oral mucosa, especially in younger children. The present study aimed to review the most updated information and the experience of our group in order to yield epidemiological data that assist diagnosis of the most common diseases of the oral mucosa in children. Recent epidemiologic studies have shown a wide variability in the prevalence of oral mucosal lesions in different regions of the world and have led researchers to draw disparate conclusions. Moreover, studies have not been designed using standard criteria, further explaining the wide variability in the percentage of different groups of children with oral lesions, which ranges from 4.1 to 52.6%. The lesions most frequently considered by authors and that most often appear in the different studies are: recurrent aphthous stomatitis (0.9-10.8%), labial herpes (0.78-5.2%), fissured tongue (1.49-23%), geographic tongue (0.60-9.8%), oral candidiasis (0.01-37%) and traumatic injury (0.09%-22.15%). Dentists must be able to detect any of the numerous possible disorders and perform the correct differential diagnosis, key to the treatment plan. The aim of this paper, based on a review of the different national and international studies, is to contribute data on the most important oral mucosal diseases in the paediatric population in terms of prevalence and differential diagnosis.

PMID: 16264385 [PubMed - indexed for MEDLINE]

Prevalence of Helicobacter pylori DNA in recurrent aphthous ulcerations in mucosa-associated lymphoid tissues of the pharynx.

Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):804-8

Authors: Elsheikh MN, Mahfouz ME

OBJECTIVE: To determine the presence of Helicobacter pylori and, if detected, its potential prevalence in causing recurrent aphthous ulcers confined to mucosa-associated lymphoid tissues of the pharynx. DESIGN: Prospective, controlled clinical trial. SETTING: Otolaryngology Department of Tanta University Hospitals, Tanta, Egypt. PATIENTS: A total of 146 patients with recurrent multiple aphthous ulcers of the oral cavity and pharynx and 20 normal control subjects. INTERVENTIONS: Patients were assigned to group 1 (n = 58), in which the ulcers were strictly limited to the lymphoid tissues, or group 2 (n = 88), in which the ulcers were randomly distributed in the oral cavity and pharynx. Helicobacter pylori DNA was extracted from 3-mm-diameter tissue samples, and polymerase chain reaction amplifications were performed for the 16S ribosomal RNA gene. MAIN OUTCOME MEASURE: Positivity for H pylori. RESULTS: In group 1, 39 patients (67%) were positive for H pylori DNA, while in group 2, 9 patients (10%) were positive (chi(2) test, P<.001). It was not detected in any of the 20 control samples. CONCLUSION: Our results support a possible causative role for H pylori in recurrent aphthous ulcerations with a characteristic distribution and affinity to mucosa-associated lymphoid tissues of the pharynx.

PMID: 16172360 [PubMed - indexed for MEDLINE]

Assessment of salivary and serum antioxidant vitamins and lipid peroxidation in patients with recurrent aphthous ulceration.

Tohoku J Exp Med. 2005 Aug;206(4):305-12

Authors: Saral Y, Coskun BK, Ozturk P, Karatas F, Ayar A

Recurrent aphthous ulceration (RAU) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae. Although the exact cause of RAU is not known, local trauma, microorganisms, nutritional deficiencies, hormonal changes, genetics, and immunological factors have been suggested to contribute to its pathogenesis. The aim of this study was to assess the level of lipid peroxidation and status of antioxidant vitamins in patients with RAU. Thirty patients with RAU and 20 healthy controls were recruited. Vitamins A, E, and C and malondialdehyde (MDA) levels were measured in both serum and saliva of patients with RAU and control subjects by high performance liquid chromatography. Levels of vitamins A, E and C in both fluids were significantly lower (p < 0.05 for vitamins A and E, and p < 0.005 for vitamin C, respectively) in patients with RAU than in healthy control subjects. Conversely, the levels of MDA in serum and saliva were significantly higher (p < 0.005) in patients with RAU than in the control group. Furthermore, strong and highly significant correlation was found between serum and salivary levels of vitamins A, E and C, and MDA in patients with RAU (r > or = 0.90, p < 0.0001). The present study demonstrates that the serum and saliva levels of selected antioxidant vitamins are lower, while the degree of lipid peroxidation, as judged by the MDA levels, is higher in patients with RAU than in the control subjects. This is the first to measure specific antioxidant levels in both saliva and blood in the same patients, and indicates that the non-enzymatic anti-oxidant ability is impaired in patients with RAU.

PMID: 15997201 [PubMed - indexed for MEDLINE]

Case report: Recurrent aphthous stomatitis responds to vitamin B12 treatment.

Can Fam Physician. 2005 Jun;51:844-5

Authors: Volkov I, Rudoy I, Abu-Rabia U, Masalha T, Masalha R

PMID: 15986941 [PubMed - indexed for MEDLINE]

Celiac disease in patients having recurrent aphthous stomatitis.

Turk J Gastroenterol. 2004 Sep;15(3):192-5

Authors: Aydemir S, Tekin NS, Aktun&#xE7; E, Numanoğlu G, Ustündağ Y

BACKGROUND/AIMS: Celiac disease is a condition related to the small intestine's intolerance to gluten. In epidemiologic studies the prevalence is highly variable. The diagnosis can be difficult due to the wide spectrum of signs and symptoms. As the risk for intestinal lymphoma is higher in these patients, early diagnosis has its privileges. The higher prevalence of recurrent aphthous stomatitis in celiac disease led us to investigate the celiac disease prevalence in patients with recurrent aphthous stomatitis, which might assist in diagnosis of asymptomatic celiac disease patients. The aim of this study was to determine the prevalence of celiac disease in patients presenting with recurrent aphthous stomatitis. METHODS: The study group consisted of patients having a history of recurrent aphthous stomatitis. The control group included patients not having aphthous stomatitis. Antibodies to gliadin IgG and IgA and antibodies to endomysium were determined from the serum samples of all patients. Biopsies were obtained from the distal part of the duodenum. RESULTS: Biopsies of two patients (4.8%) out of 41 belonging to the study group were diagnosed as celiac disease. In serum samples of both, antibodies to gliadin IgA and antibodies to endomysium were found to be positive. Antibodies to gliadin IgG antibody were positive in only one of these two patients. None of the 49 patients in the control group was diagnosed as celiac disease. CONCLUSION: Further evaluation of recurrent aphthous stomatitis patients for celiac disease must be performed. As the endoscopic procedures are invasive and costly, evaluation of recurrent aphthous stomatitis patients for celiac disease must include serologic markers at the beginning. If any positivity is determined in markers, then endoscopic procedures including biopsies of the duodenum must be considered as the second-step intervention.

PMID: 15492921 [PubMed - in process]

Low frequency of anti-endomysial antibodies in recurrent aphthous stomatitis.

Ann Acad Med Singapore. 2004 Jul;33(4 Suppl):43-7

Authors: Robinson NA, Porter SR

INTRODUCTION: The aetiology of recurrent aphthous stomatitis (RAS) remains unknown. An association between RAS and coeliac diseases (CD) has previously been suggested, but the supporting evidence remains equivocal. The aim of the present study was to determine the likely frequency of CD in a large cohort of patients with well-defined RAS, by detailed haematological and serological analysis, including the detection of anti-endomysium and anti-reticulin antibodies. MATERIALS AND METHODS: The study comprised 87 patients with minor RAS. Full blood counts and the presence of IgA anti-endomysial and IgA anti-reticulin antibodies were estimated in all patients. RESULTS: The frequency of anti-endomysium and anti-reticulin antibodies was not elevated in patients with RAS and no patients with RAS had other serological features of CD. CONCLUSIONS: It is concluded that there is little significant aetiological link between RAS and CD, and that screening RAS patients for key serological markers of CD is of little clinical value.

PMID: 15389306 [PubMed - indexed for MEDLINE]

[Behcet's disease: a rare cause of multifocal lesions in the central nervous system]

Neurol Neurochir Pol. 2004 Jul-Aug;38(4):323-7

Authors: Borowik H, Ku&#x142;akowska A, Drozdowski W

Behcet's disease (BD) is a chronic multisystem inflammatory disease characterized mainly by recurrent episodes of orogenital aphthae and uveitis. In 10-30% of cases relapsing multifocal neurological symptoms occur. The authors present a 54-year-old female patient with the central nervous system manifestation of clinically diagnosed BD. Based on the reported case diagnostic (in particular differential diagnosis with multiple sclerosis) and therapeutic problems of BD are discussed.

PMID: 15383961 [PubMed - indexed for MEDLINE]

[A case of Behçet's disease with esophageal ulcers complicated with systemic sclerosis, chronic hepatitis C, and pancytopenia]

Nihon Rinsho Meneki Gakkai Kaishi. 2004 Jun;27(3):164-70

Authors: Yokota K, Hirano M, Akiba H, Adachi D, Takeishi M, Akiyama Y, Mimura T

A 62-year-old man was admitted to our hospital because of retrosternal burning pain and high fever in May, 2002. In 1995 chronic hepatitis C was diagnosed. Five years before admission he had been suffering from recurrent oral aphthous ulcers and genital ulcers. Distal scleroderma developed and the diagnosis of systemic sclerosis was made by skin biopsy in 1999. Prednisolone therapy, 5-30 mg/day, had been administered since then. In May 2000, he was referred to our department, and diagnosis of incomplete-type Beh&#xE7;et's disease was made because he had erythema nodosa, oral aphthous ulcers and genital ulcers. Asymptomatic mild pancytopenia was also found. In November 2000, gastrofiberscopy revealed that he had esophageal and gastric ulcers resistant to regular treatment and was diagnosed as entero-Behçet's disease, a subtype of the disease. The activity of esophageal and gastric ulcers was resistant to the low dose glucocorticoid and more than a moderate dose (30 mg/day) of prednisolone was necessary to reduce the activity. His gastrointestinal symptoms fluctuated with low dose prednisolone. Gastrofiberscopy on admission revealed that he had four shallow active oval ulcers in the middle-lower esophagus and distinct blind-fistula in the lower esophagus. Prednisolone were increased to 30 mg/day for his active entero-Behçet's disease, however, his burning retrosternal pain remained. He died on the 81st hospital day due to severe pneumonia. This is a rare case of Behçet's disease complicated with esophageal ulcers, systemic sclerosis, chronic hepatitis C, and pancytopenia. Of interest is the mechanism of coincidence of these diseases from the pathological point of view.

PMID: 15291253 [PubMed - indexed for MEDLINE]

Oral health is impaired in Behçet's disease and is associated with disease severity.

Rheumatology (Oxford). 2004 Aug;43(8):1028-33

Authors: Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, Direskeneli H

OBJECTIVES: This study aimed to investigate the oral health of Turkish patients with Behçet's disease (BD) and whether it is associated with the disease course. METHODS: One hundred and twenty patients with BD, 35 patients with recurrent aphthous stomatitis (RAS) and 65 healthy Turkish controls (HC) were included in the study. Oral health was investigated by indices applied in a BD out-patient clinic. RESULTS: The mean scores of plaque, sulcus bleeding and gingival indices, probing depth and the number of extracted teeth were observed to be higher in patients with BD and RAS compared to HC (P<0.05). In the linear regression analysis, plaque index score was associated with the presence of oral ulcers and male gender. An elevated plaque index score was observed to be a significant risk factor for increased severity score in patients with BD in the logistic regression analysis (P = 0.034). CONCLUSIONS: Oral health is impaired in BD and associated with disease severity. Improvement of the oral health of BD patients may affect their disease course, leading to a better prognosis.

PMID: 15161982 [PubMed - indexed for MEDLINE]

Spectrum of oral manifestations of HIV/AIDS in the Perm region (Russia) and identification of self-induced ulceronecrotic lingual lesions.

Med Oral. 2004 May-Jul;9(3):212-5

Authors: Gileva OS, Sazhina MV, Gileva ES, Efimov AV, Scully C

OBJECTIVE: To study the frequency and spectrum of oral manifestations of HIV-infected drug-users in the Perm region. SUBJECTS: 104 seropositive HIV-infected drug-users (69 male, 35 female; ages 15 to 32 years; 13 co-infected with hepatitis viruses) and 13 AIDS-infected drug-users (7 male, 6 female; ages 16 to 37 years; 12 co-infected with hepatitis viruses). RESULTS: The most frequent forms of oral mucosal lesions in the HIV-infected group -- candidiasis (32.7%), herpetic lesions (15.4%), cheilitis glandularis (3.9%), recurrent aphthous stomatitis (2%). Regional lymphadenopathy was observed in 31% cases. The ulceronecrotic oral mucosal lesions were seen in the sublingual region and tongue in 11.5% patients and manifested with pain, dysarthria, dysphagia, and dysgeusia. These lesions were found in drug-users who injected the opioids sublingually. AIDS patients had oral candidiasis (84.6%), herpetic lesions (53.8%), recurrent aphthous stomatitis (15.4%) and cheilitis glandularis (7%). All AIDS-patients had severe xerostomia, and 15.4% had unilateral or bilateral swelling of the parotid glands. Generalized ulceronecrotic gingivostomatitis was found in 50% of the patients but the sublingual ulceronecrotic lesions were not identified. CONCLUSIONS: 1. The spectrum of oral cavity lesions of HIV/AIDS patients in Perm region is widespread enough. 2. Dissemination of oral cavity lesions is increasing in proportion of disease progression. 3. Dental care of HIV/AIDS patients should include periodic oral examinations to monitor their disease progression and to alleviate symptoms of oral opportunic and neoplastic diseases, to improve the life-style of the patients infected with HIV.

PMID: 15122122 [PubMed - indexed for MEDLINE]

Ulcerative colitis followed by the development of Behçet's disease.

Intern Med. 2004 Mar;43(3):243-7

Authors: Kobashigawa T, Okamoto H, Kato J, Shindo H, Imamura T, Iizuka BE, Tanaka M, Uesato M, Ohta SJ, Terai C, Hara M, Kamatani N

A 34-year-old man who had a history of ulcerative colitis (UC) was admitted to our hospital with complaints of arthralgia, erythema nodosum, recurrent oral aphthous ulcers and bloody stools. A colonoscopy revealed multiple aphthous ulcers on his cecum and colon and also revealed a transmural ulcer on his rectum consistent with a diagnosis of UC. The patient was HLA-B51 positive. Based on clinical evidence [recurrent oral ulcers, skin lesions (erythema nodosum), positivity for pathergy test] this patient was diagnosed as having Beh&#xE7;et's disease with gastrointestinal involvement. We describe this rare case of Behçet's disease with colitis and discuss the difficulties in making a differential diagnosis between Behçet's disease and the inflammatory bowel diseases.

PMID: 15098609 [PubMed - indexed for MEDLINE]

Association between psychological disorders and the presence of Oral lichen planus, Burning mouth syndrome and Recurrent aphthous stomatitis.

Med Oral. 2004 Jan-Feb;9(1):1-7

Authors: Soto Araya M, Rojas Alcayaga G, Esguep A

OBJECTIVE: The aim of this study was to determine the existing relation between the Oral Lichen Planus (OLP), Recurrent Aphthous Stomatitis (RAS), Burning Mouth Syndrome (BMS) and psychological alterations of the patient, such as stress, anxiety and depression. DESIGN OF THE STUDY: 18 patients with RAS, 9 patients with OLP and 7 patients with BMS, that presented the condition at the moment of the examination, were studied, as well as a control group of 20 healthy patients. Both groups were extracted of hospitals and university centers, where the clinical diagnosis was made by a team of oral pathologists. Two measuring instruments were applied to them about their psychological condition: the Test of Recent Experience, to measure the stress level and scale H.A.D., to determine the level of anxiety and depression; the score given by them were statistically analyzed through T-test and the ANOVA Tukey test. RESULTS: Our results suggested a statistically significant association between these psychological disorders and the diseases of the oral mucosa in study. It was observed that the stress level is greater in patients with RAS and OLP, depression is particularly high in patients with BMS, and levels of anxiety are raised in the three groups, in comparison with the group control. CONCLUSIONS: A positive relationship can be established between psychological alterations and RAS, OLP and BMS. The RAS and the OLP stress and anxiety levels were considered as high, whereas the BMS was more related to important levels of anxiety and depression. According to these findings it is possible to assume that psychological factors should be taking into account when oral health wants to be maintain as normal.

PMID: 14704611 [PubMed - indexed for MEDLINE]

[Beh&#xE7;et's disease in childhood]

J Pediatr (Rio J). 2002 Mar-Apr;78(2):128-32

Authors: de Albuquerque PR, Terreri MT, Len CA, Hilário MO

OBJECTIVE: To make Pediatricians aware of the fact that they must investigate Behçet's disease while performing differential diagnosis of recurrent aphthous stomatitis, even though it is a vasculitis of rare occurrence in early life. METHODS: Between June 1996 and December 2000, we retrospectively evaluated seven patients of our Pediatric Rheumatology Unit. Demographic, clinical, and laboratory data as well as data regarding treatment and follow-up were presented. RESULTS: Five out of seven patients were female (71.4%), four were non-Caucasian (57.1%), the mean age at onset was 8 years and 11 months (variation of 6 months to 13 years and 8 months), the mean period until diagnosis was 2 years and 3 months (variation of 2 months to 8 years) and the mean follow-up period was 4 years and 2 months (three patients without follow-up). The major criteria of diagnosis were: oral ulcers in seven patients (100%), genital ulcers in three patients (42.8%), ophthalmic alterations in four patients (57.1%) cutaneous vasculitis in one patient (14.2%) and positive pathology test in one patient (14.2%). The minor criteria were: arthralgia/arthritis in five patients (71.4%), family history in two patients (28.5%), and sagittal sinus thrombosis in one patient (14.2%). The initial symptoms included recurrent aphthous stomatitis (more than three painful aphthous ulcers episodes in the period of 1 year), genital ulcers, arthralgia, fever and weight loss. The laboratory findings were: mild anemia in 1/6 patients, ESR>25 in 3/6 patients, increased serum gammaglobulin level in 2/4 patients, B5 histocompatibility antigen in 2/7 patients. The treatment included corticosteroids for 5/7 patients (4 oral, 1 intravenous and one local use), thalidomide for 4/7 patients, colchicine for 2/7 patients and dapsone for 1/7 patient. The outcome was favorable in 4/6, and 3/6 patients presented relapse. CONCLUSION: Our results confirm the importance of considering the diagnosis of Behçet's disease in patients with recurrent oral and genital ulcers.

PMID: 14647794 [PubMed]

Recalcitrant, recurrent aphthous stomatitis treated with etanercept.

Arch Dermatol. 2003 Oct;139(10):1259-62

Authors: Robinson ND, Guitart J

PMID: 14568829 [PubMed - indexed for MEDLINE]

Beh&#xE7;et's disease.

Arthritis Res Ther. 2003;5(3):139-46

Authors: Hirohata S, Kikuchi H

Behçet's disease is characterized by recurrent aphthous stomatitis, uveitis, genital ulcers, and skin lesions. The role of the HLA-B*51 gene has been confirmed in recent years, although its contribution to the overall genetic susceptibility to Behçet's disease was estimated to be only 19%. The production of a variety of cytokines by T cells activated with multiple antigens has been shown to play a pivotal role in the activation of neutrophils. As regards the treatment, anti-tumor necrosis factor alpha therapy has been shown to be effective for mucocutaneous symptoms as well as for sight-threatening panuveitis, although a randomized, controlled trial is required.

PMID: 12723980 [PubMed - indexed for MEDLINE]

The diagnosis and management of recurrent aphthous stomatitis: a consensus approach.

J Am Dent Assoc. 2003 Feb;134(2):200-7

Authors: Scully C, Gorsky M, Lozada-Nur F

BACKGROUND: Recurrent aphthous stomatitis, or RAS, is a common oral disorder of uncertain etiopathogenesis for which symptomatic therapy only is available. This article reviews the current data on the etiopathogenesis, diagnosis and management of RAS in a primary care setting. METHODS: The authors reviewed publications on Medline from 1995 through 2000, the period since the last major reviews were published. RESULTS: RAS may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein. Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies and HIV infection. While topical corticosteroids remain the mainstay for therapy, a number of other immunomodulatory modalities now are available. CONCLUSIONS: There is still no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore therapy can attempt only to suppress symptoms rather than to address the basic issues of susceptibility and prevention. CLINICAL IMPLICATIONS: In the majority of patients, symptomatic relief of RAS can be achieved with topical corticosteroids alone, with other immunomodulatory topical agents or by combination therapy.

PMID: 12636124 [PubMed - indexed for MEDLINE]

[Acute vulval ulcer or Lipschutz's disease]

J Gynecol Obstet Biol Reprod (Paris). 2002 Nov;31(7):684-6

Authors: Baron M, Mauger-Tinlot F, Resch B, Joly P, Marpeau L

The case of a 16-year-old woman with typical clinical features of acute vulval ulcer, Lipschutz's disease, is reported. The main differential diagnoses are discussed. Isolated vulval ulcer can reveal a recurrent aphthous ulcer, Beh&#xE7;et's disease or Crohn's disease. In contrast, acute vulval ulcer spontaneously heals with no recurrence, that must be taken into account for diagnosis.

PMID: 12457143 [PubMed - indexed for MEDLINE]

[Periodic fever]

An Esp Pediatr. 2002 Oct;57(4):334-44

Authors: Mongil Ruiz I, Canduela Martínez V

Periodic fever can be defined as recurrent episodes of fever lasting from a few days to several weeks separated by symptom-free intervals of variable duration, recurring throughout several months. Although these clinical pictures are unusual in clinical practice, in some instances the differential diagnosis with recurrent infections, malignancies and connective tissue diseases is difficult. The aim of this review is to group together these different clinical pictures, which are dispersed in the literature, to obtain an overall and detailed perspective.We classified these processes in two categories: hereditary (familial Mediterranean fever, hyper-IgD syndrome, tumor necrosis factor-receptor-associated periodic syndrome, Muckle-Wells syndrome and familial cold urticaria) and non-hereditary (periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome [PFAPA syndrome], cyclic neutropenia, chronic infantile neurological cutaneous and articular syndrome [CINCA syndrome], Castleman's disease, early onset sarcoidosis and Blau syndrome). Although diagnosis is essentially clinical, in recent years many advances have been made in the knowledge of the molecular and genetic bases of hereditary diseases, which may be of considerable help in establishing the diagnosis and improving treatment.

PMID: 12392668 [PubMed - indexed for MEDLINE]

[Silent celiac disease: exploring the iceberg in the school-aged population]

An Esp Pediatr. 2002 Oct;57(4):321-6

Authors: Cilleruelo Pascual ML, Román Riechmann E, Jiménez Jiménez J, Rivero Martín MJ, Barrio Torres J, Castaño Pascual A, Campelo Moreno O, Fernández Rincón A

BACKGROUND: Epidemiological studies have shown a high prevalence of silent celiac disease (CD) among unselected pediatric populations and a low ratio of diagnosed to undiagnosed CD. OBJECTIVES: To quantify the prevalence of silent CD, to assess the clinical features of subclinical CD and to determine the total prevalence of CD (silent plus symptomatic cases). METHODS: We determined total serum IgA, IgA antiendomysial antibodies (EMA) and IgG antigliadin antibodies (IgG AGA), if IgA deficiency was found, in schoolchildren aged 10-12 years from health district IX in Madrid. RESULTS: A total of 3,378 schoolchildren (47.8 % of the eligible population) were studied. Fifteen were EMA-positive and one child with IgA deficiency was IgG AGA-positive. CD was confirmed by intestinal biopsy in 12 children, representing a prevalence of undiagnosed CD of 1/281. Of these 12 children, 7 showed clinical features of CD. The most frequent symptom was iron-deficiency, followed by recurrent aphthous stomatitis and mild malnutrition. Before the start of this study, CD had been diagnosed in seven children from the same population, which would increase the total prevalence of the disease to 1/220 with an estimated ratio of diagnosed to undiagnosed CD of 1 to 3.5. CONCLUSIONS: We confirm the high prevalence of silent celiac disease among the school-aged population. This ratio is one of the highest published and could be due to a high diagnostic suspicion for CD among pediatricians in our health district. Greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

PMID: 12392666 [PubMed - indexed for MEDLINE]

Aphthous ulcers.

Br Dent J. 2002 Sep 28;193(6):301-2

Authors: Ghelani A, Mastana S, Samanta A

PMID: 12374993 [PubMed - indexed for MEDLINE]

Differential diagnosis: is it herpes or aphthous?

J Contemp Dent Pract. 2002 Feb 15;3(1):1-15

Authors: Tilliss TS, McDowell JD

Recurrent aphthous stomatitis (RAS) and recurrent intraoral herpes (RIH) are the two most commonly presenting oral lesions in the dental setting. It is critical that the oral health professional be able to accurately discriminate between these disorders. To facilitate the differential diagnosis between RAS and RIH, important components of assessment are discussed. These include: prodromal signs and symptoms, lesion location, and appearance of the initial and mature lesion. The comparative etiology, prevalence, pathogenesis, and treatment considerations for these lesions are presented. A familial case report is provided.

PMID: 12167909 [PubMed - indexed for MEDLINE]

IL-1B and IL-6 gene polymorphisms encode significant risk for the development of recurrent aphthous stomatitis (RAS).

Genes Immun. 2002 Aug;3(5):302-5

Authors: Bazrafshani MR, Hajeer AH, Ollier WE, Thornhill MH

Recurrent aphthous stomatitis (RAS) is an, ulcerative condition of the mouth, with a polygenic mode of inheritance in which cytokines are thought to play an important role. Ninety-one RAS patients and 91 controls were genotyped for known IL-1A, IL-1B, IL-1RN and IL-6 gene polymorphisms. Inheritance of the G allele of the IL-1B -511 polymorphism was strongly associated with RAS (OR = 2.5, P < 0.00002), with increased numbers of G/G homozygotes (OR = 4.5, P < 0.0005). The G allele of IL-6 -174 also occurred more frequently in RAS (OR = 2.6, P < 0.0001) with greatest risk associated with G/G homozygosity (OR = 3.4, P < 0.0001). IL-1RN VNTR 1/1 homozygotes also occurred more frequently in RAS (OR = 2.0, P < 0.02). Inheritance of the G/G genotype of both IL-1B and IL-6 was a particularly strong predictor for RAS (OR = 8.5).

PMID: 12140751 [PubMed - indexed for MEDLINE]

PFAPA syndrome in children evaluated for tonsillectomy.

Arch Dis Child. 2002 Jun;86(6):434-5

Authors: Galanakis E, Papadakis CE, Giannoussi E, Karatzanis AD, Bitsori M, Helidonis ES

Among 40 children undergoing tonsillectomy for recurrent pharyngitis, 15 (37.5%) had presented preoperatively with complaints compatible with PFAPA syndrome. All 15 had had periodic fever every three to four weeks and pharyngitis; 12 (80%) had cervical adenitis and five (33%) aphthous stomatitis. All children had been well between episodes and showed a dramatic postoperative improvement. PFAPA syndrome is not uncommon among children having tonsillectomy. Tonsillectomy is curative in most of these patients.

PMID: 12023179 [PubMed - indexed for MEDLINE]

Defining a T-cell epitope within HSP 65 in recurrent aphthous stomatitis.

Clin Exp Immunol. 2002 May;128(2):318-25

Authors: Hasan A, Shinnick T, Mizushima Y, van der Zee R, Lehner T

The 65 kD heat shock protein (HSP) has been implicated in the aetiology of recurrent aphthous stomatitis (RAS). We have previously demonstrated that peptide 91-105 derived from the sequence of mycobacterial 65 kD HSP stimulates specifically lymphocytes from patients with RAS. In this investigation, we show that both CD4+ and CD8+ T cells were significantly stimulated with mycobacterial peptide 91-105. In contrast, the human homologous peptide 116-130 stimulated only CD4+ T cells. Inhibition studies showed that CD4+ T cells were class II restricted, whereas CD8+ T cells were class I restricted. We then used truncated or substituted peptides, and demonstrated that residues 95-105 appear to be important, and residue 104(Arg) critical, in stimulating the T cells. Thus, peptide 95- 105 may constitute a T-cell proliferative epitope in RAS. We postulate that the high load of micro-organisms that colonize the oral mucosa may initiate an immune response by the microbial HSP 65-derived peptide 95-105, stimulating the numerous Langerhans cells in the oral mucosa to activate a cross-reacting immune response to the homologous peptide 116-130 within the epithelial HSP 60, initiating the immunopathological changes that lead to RAS.

PMID: 11985522 [PubMed - indexed for MEDLINE]

Prevalence of Behçet's disease in an Arab community in Israel.

Ann Rheum Dis. 2002 Apr;61(4):365-6

Authors: Jaber L, Milo G, Halpern GJ, Krause I, Weinberger A

OBJECTIVE: To evaluate the prevalence of Behçet's disease (BD) in an Israeli Arab town (Taibe). METHODS: Questionnaires about the occurrence and prevalence of aphthous ulcers were distributed randomly to the parents of children attending a paediatric centre in Taibe. The parents were asked whether they or any of their children aged between 10 and 20 years had recurrent aphthous stomatitis. Any who had had more than four aphthous episodes (each episode lasting more than seven days) during the previous year were invited for an extensive interview and examination by a rheumatologist or a paediatrician. RESULTS: A total of 4876 subjects were included in this survey, of whom six (one male, five female) were diagnosed as having BD. Of these six, two were siblings (a brother and a sister). Five had skin lesions, four had visual involvement, and all had genital ulcers and joint symptoms; one in two patients had a positive pathergy test. Five of the six carried HLA-B5 antigens. The results showed a prevalence of 12/10,000 in Taibe. CONCLUSION: The prevalence of BD found in our survey is high and concurs with that found in other Mediterranean and Asian countries.

PMID: 11874845 [PubMed - indexed for MEDLINE]

Close association of HLA-B52 and HLA-B44 antigens in Israeli Arab adolescents with recurrent aphthous stomatitis.

Arch Otolaryngol Head Neck Surg. 2001 Feb;127(2):184-7

Authors: Jaber L, Weinberger A, Klein T, Yaniv I, Mukamel M

OBJECTIVES: To investigate the incidence and clinical features of recurrent aphthous stomatitis (RAS) among Israeli Arab adolescents and to determine the HLA typing profile in affected subjects. STUDY DESIGN: Cross-sectional study. SETTING: Junior high school in the largest Arab town in Israel. PARTICIPANTS: Four hundred seventy-seven Israeli Arab junior high school students filled out a questionnaire. Students who reported more than 4 episodes of RAS during the previous year were interviewed by telephone. Those whose responses were confirmed were invited to the clinic. Of these, 22 were chosen at random for HLA typing. Findings were compared with those in 117 healthy Israeli Arabs who were candidate donors of bone marrow to patients at the Institute of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tiqva. RESULTS: Recurrent aphthous stomatitis was confirmed in 80 subjects (16.7%). Of the 22 patients who underwent HLA typing, 7 (31.4%) had HLA-B52 antigens and 8 (36.4%) had HLA-B44 antigens; corresponding figures for the control group were 10 subjects (8.5%) (P = .007) and 9 subjects (7.7%) (P = .001), respectively. CONCLUSIONS: There is a close association of HLA-B52 and HLA-B44 in Israeli Arab youths with RAS. Long-term follow-up is needed to determine the relationship between RAS and Beh&#xE7;et disease.

PMID: 11177036 [PubMed - indexed for MEDLINE]

[Herpetiform ulceration: 5 cases]

Ann Dermatol Venereol. 2000 Aug-Sep;127(8-9):707-10

Authors: Viguier M, Fouere S, Pascal F, Morel P

BACKGROUND: Mouth ulcers are frequently observed, mostly caused by trauma and aphthae. We report five cases of herpetiform ulceration, a rare clinical form of aphthae often mistaken for herpetic stomatitis because of the similar clinical presentation. CASE REPORTS: All patients were men with late age at onset (44.8 years). All had numerous tiny very painful ulcers covering all parts of the oral cavity. Consequences were sometimes severe (weight loss and general weakness in two patients, requiring hospitalization in one). Diverse clinical courses were observed (from no recurrence to monthly recurrence). Systemic steroids resulted in dramatic improvement in two patients, colchicine prevented recurrences in three of them. DISCUSSION: These observations illustrate well this rare disease: herpetiform ulceration. We found oral corticosteroids provide effective cure and observed the preventive action of colchicine. Both findings should be confirmed in larger series.

PMID: 11011159 [PubMed - indexed for MEDLINE]

Treatment of recurrent oral ulcers with mometasone furoate lotion.

Postgrad Med J. 1999 Sep;75(887):574

Authors: Teixeira F, Mosqueda-Taylor A, Monta&#xF1;o S, Domínguez-Soto L

PMID: 10616703 [PubMed - indexed for MEDLINE]

Gammadelta T cells in Behçet's disease (BD) and recurrent aphthous stomatitis (RAS).

Clin Exp Immunol. 1999 Dec;118(3):451-7

Authors: Freysdottir J, Lau S, Fortune F

The immunopathogenesis of BD is believed to be T cell-mediated. The objective of this study was to characterize the activation stage and cytokine profile of peripheral blood lymphocytes (PBL), with particular emphasis on gammadelta T cells. Venous blood was collected from 20 patients with BD, and for comparison, from 11 patients with RAS and from 15 healthy controls. Both the expression of activation markers (CD25, CD29, CD40 ligand, CD69 and HLA-DR) on freshly isolated PBL and T cell subsets, and the expression of intracellular cytokines (IL-4, IL-10, interferon-gamma (IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha)) on mitogen-stimulated PBL and T cell subsets were analysed by double immunofluorescent staining and flow cytometry. Significantly decreased proportion of alphabeta T cells and increased proportion of gammadelta T cells, CD56+ cells and CD8+ gammadelta T cells were found in BD patients compared with healthy controls. This was also seen to a lesser extent in patients with RAS. Furthermore, in BD a significantly increased proportion of the gammadelta T cell population expressed CD69 and high levels of CD29 and were induced to produce IFN-gamma and TNF-alpha compared with healthy controls. In contrast, an increased percentage of gammadelta T cells from RAS patients was induced to produce IFN-gamma, but not TNF-alpha. These results indicate that in BD, activated gammadelta T cells, capable of producing IFN-gamma and TNF-alpha, are present in peripheral blood, suggesting that gammadelta T cells are dynamic and may be regulating immunopathogenic events.

PMID: 10594567 [PubMed - indexed for MEDLINE]

Recurrent aphthous stomatitis.

Crit Rev Oral Biol Med. 1998;9(3):306-21

Authors: Porter SR, Scully C, Pedersen A

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal disorders. Nevertheless, while the clinical characteristics of RAS are well-defined, the precise etiology and pathogenesis of RAS remain unclear. The present article provides a detailed review of the current knowledge of the etiology, pathogenesis, and management of RAS.

PMID: 9715368 [PubMed - indexed for MEDLINE]

Elevated levels of interferon gamma, tumor necrosis factor alpha, interleukins 2, 4, and 5, but not interleukin 10, are present in recurrent aphthous stomatitis.

Arch Dermatol. 1998 Jul;134(7):827-31

Authors: Bu&#xF1;o IJ, Huff JC, Weston WL, Cook DT, Brice SL

OBJECTIVE: To investigate our hypothesis that recurrent aphthous stomatitis (RAS), an inflammatory disease of the oral mucosa, is the result of an abnormal oral mucosal cytokine cascade leading to an enhanced cell-mediated immune response directed toward focal areas of the oral mucosa. DESIGN: Prospective nonrandomized case-control study. SETTING: Academic referral center PATIENTS: For part 1, 21 patients with RAS and 7 control patients; for part 2, 6 patients with RAS and 6 control patients. INTERVENTION: For study part 1, lesional and clinically normal oral mucosal biopsy specimens were obtained during an acute episode (within 72 hours of onset of ulcer) from 21 patients with RAS. Normal oral mucosal biopsy specimens were obtained from 7 healthy individuals, who served as controls. In study part 2, oral mucosal biopsy specimens were obtained from 6 RAS and 6 control patients at 24 and 48 hours after surgical trauma to those sites. MAIN OUTCOME MEASURES: Detection of the following messenger RNA (mRNA) types by use of semiquantitative reverse transcriptase polymerase chain reaction. For part 1, interleukins (IL) 2, 4, 5, and 10, interferon gamma, and tumor necrosis factor alpha were measured. For study part 2, IL-10 and interferon gamma were measured. RESULTS: In part 1, elevated levels of IL-2, interferon gamma, and tumor necrosis factor alpha mRNAs were detected in RAS lesions, consistent with a cell-mediated immune response. The IL-10 mRNA was not increased in RAS lesions. In addition, lower resting levels of IL-10 mRNA were detected in the clinically normal mucosa from patients with RAS, as compared with levels seen in the healthy controls. In part 2, at both 24 and 48 hours following trauma to the oral mucosa, the levels of mucosal IL-10 mRNA remained lower in patients with RAS than those observed in healthy controls, while interferon gamma mRNA levels were higher. CONCLUSION: Failure to suppress the inflammatory reaction initiated by trauma or other external stimuli, likely involving a functional deficiency of IL- 10 in the oral mucosa, appears to be important in the pathogenesis of RAS.

PMID: 9681346 [PubMed - indexed for MEDLINE]

Recurrent aphthous stomatitis in the diagnosis of Behçet's disease.

Yonsei Med J. 1997 Dec;38(6):370-9

Authors: Rogers RS

Recurrent aphthous stomatits (RAS) is also known as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. RAS has been the subject of active investigation along multiple lines of research including epidemiology, immunology, clinical correlations and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MIAU, MJAU, HU) and severity (simple versus complex). In order to properly diagnose and treat a patient with lesions of RAS, the clinician must exclude other causes of acute oral ulcers. Complex aphthosis and complex aphthosis variants associated with systemic disorders should be considered. The aphthous-like oral ulcerations of patients with HIV disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause" which, with appropriate treatment, can result in a remission or substantial lessening of disease activity. Finally, when all of these factors are considered, the evaluation of the patient for Behçet's disease can be continued on firm grounds that one of the major criteria for the diagnosis of Behçet's disease has been met.

PMID: 9509906 [PubMed - indexed for MEDLINE]

Recurrent aphthous ulcers: a review of diagnosis and treatment.

J Am Dent Assoc. 1996 Aug;127(8):1202-13

Authors: Woo SB, Sonis ST

Recurrent aphthous ulcers, or RAU--also called canker sores--are among the oral mucosal conditions that dentists and physicians see most commonly in their patients. Several systemic conditions are associated with oral aphthouslike ulcers, and aphthae themselves often are mistaken for recrudescent oral herpes simplex virus, or HSV, infections. This article will review RAU, describe systemic conditions associated with aphthous-like ulcerations and discuss the differences between RAU and recrudescent oral HSV infections.

PMID: 8803396 [PubMed - indexed for MEDLINE]