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      Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis*

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          Abstract

          BACKGROUND

          Recurrent aphthous ulcerations are common benign ulcerated lesions on the mouth, whose etiology is poorly understood, with controversial treatment and difficult to control in clinical practice.

          OBJECTIVE

          To evaluate the cases of recurrent aphthous ulcerations with a focus on treatment, diagnosis and etiology.

          METHODS

          This is a retrospective study of the cases of the Oral Diagnosis service of the Rio Grande do Norte Federal University in Natal/RN. Data such as sex, age, race, location, smoking habits, types of treatment, relapsing episodes, laboratory test results and clinical characteristics were collected. The associations between the variables were analyzed using the Pearson Chi-square test (p <0.05).

          RESULTS

          A total of 4895 patients were seen in the service over a period of 11 years. Of these, 161 (3.3%) had complaints of oral aphthous ulcerations, of which 76 (47.2%) were diagnosed as suffering from recurrent aphthous ulcerations and 68 (42.2%) with clinical information necessary for evaluation. The tongue was the most affected anatomical region, with 27 individuals (39.7%), followed by the buccal mucosa, with 22 cases (32.3%).

          STUDY LIMITATIONS

          Retrospective study with data from medical records.

          CONCLUSION

          Dental surgeons, dermatologists and otorhinolaryngologists are the main responsible for the first contact with patients with this disease and should be attentive to the clinical aspects and treat each patient in an individualized way, since the therapy is palliative, its diagnosis is by exclusion and its etiology is unknown.

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          Most cited references25

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          Oral mucosal disease: recurrent aphthous stomatitis.

          Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is common worldwide. Characterised by multiple, recurrent, small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors, it usually presents first in childhood or adolescence. Its aetiology and pathogenesis is not entirely clear, but there is genetic predisposition, with strong associations with interleukin genotypes, and sometimes a family history. Diagnosis is on clinical grounds alone, and must be differentiated from other causes of recurrent ulceration, particularly Behçet disease - a systemic disorder in which aphthous-like ulcers are associated with genital ulceration, and eye disease (particularly posterior uveitis). Management remains unsatisfactory, as topical corticosteroids and most other treatments only reduce the severity of the ulceration, but do not stop recurrence.
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            Recurrent aphthous ulcers today: a review of the growing knowledge.

            Recurrent aphthous ulcers represent a very common but poorly understood mucosal disorder. They occur in men and women of all ages, races and geographic regions. It is estimated that at least 1 in 5 individuals has at least once been afflicted with aphthous ulcers. The condition is classified as minor, major, and herpetiform on the basis of ulcer size and number. Attacks may be precipitated by local trauma, stress, food intake, drugs, hormonal changes and vitamin and trace element deficiencies. Local and systemic conditions, and genetic, immunological and microbial factors all may play a role in the pathogenesis of recurrent aphthous ulceration (RAU). However, to date, no principal cause has been discovered. Since the aetiology is unknown, diagnosis is entirely based on history and clinical criteria and no laboratory procedures exist to confirm the diagnosis. Although RAU may be a marker of an underlying systemic illness such as coeliac disease, or may present as one of the features of Behcet's disease, in most cases no additional body systems are affected, and patients remain otherwise fit and well. Different aetiologies and mechanisms might be operative in the aetiopathogenesis of aphthous ulceration, but pain, recurrence, self-limitation of the condition, and destruction of the epithelium seem to be the ultimate outcomes. There is no curative therapy to prevent the recurrence of ulcers, and all available treatment modalities can only reduce the frequency or severity of the lesions.
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              Recurrent aphthous stomatitis

              Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence, etiopathogenesis remains unclear. This review article summarizes the clinical presentation, diagnostic criteria, and recent trends in the management of recurrent apthous stomatitis.
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                Author and article information

                Journal
                An Bras Dermatol
                An Bras Dermatol
                abd
                Anais Brasileiros de Dermatologia
                Sociedade Brasileira de Dermatologia
                0365-0596
                1806-4841
                May-Jun 2018
                May-Jun 2018
                : 93
                : 3
                : 341-346
                Affiliations
                [1 ] Oral Pathology Post-Graduation Program, Universidade Federal do Rio Grande do Norte (UFRN), Natal (RN), Brazil.
                [2 ] Odontology Department (Graduation), Universidade Federal do Rio Grande do Norte (UFRN), Natal (RN), Brazil.
                Author notes
                Mailing address: Éricka Janine Dantas da Silveira and Salomão Israel Monteiro Lourenço Queiroz. E-mail: ericka_janine@ 123456yahoo.com.br and salomaoisrael10@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-0150-9522
                http://orcid.org/0000-0002-4689-6223
                http://orcid.org/0000-0003-1839-1030
                http://orcid.org/0000-0002-0641-1033
                http://orcid.org/0000-0001-5971-134X
                http://orcid.org/0000-0003-2128-0147
                Article
                10.1590/abd1806-4841.20186228
                6001102
                29924245
                d6f21a7e-1ca7-4ecd-9f17-dc797b3896db

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivative License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited and the work is not changed in any way.

                History
                : 15 July 2016
                : 03 April 2017
                Categories
                Investigation

                diagnosis,mouth mucosa,stomatitis, aphthous,therapeutics

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