Recurrent aphthous stomatitis (RAS), also known as "canker sores," is a common disease of the oral and, occasionally, genital mucosa characterized by
the repeated development of one to many discrete, painful ulcers that usually heal within 7 to 1 4 days. The lesions are typically 3 to 5 mm, round to oval ulcers with a peripheral rim of erythema and a yellowish adherent exudate centrally. The process may range in severity, with some patients noting only an occasional lesion and others experiencing such frequent episodes that they have almost continuous ulcer activity.
the repeated development of one to many discrete, painful ulcers that usually heal within 7 to 1 4 days. The lesions are typically 3 to 5 mm, round to oval ulcers with a peripheral rim of erythema and a yellowish adherent exudate centrally. The process may range in severity, with some patients noting only an occasional lesion and others experiencing such frequent episodes that they have almost continuous ulcer activity.
EPIDEMIOLOGY
RAS is seen throughout the world, with the greatest prevalence in the Middle East, Mediterranean region, and South Asia. In North America, it
occurs approximately in one out of five individuals and is the most common cause of acute recurrent oral ulcers. Most individuals first develop RAS during adolescence, although it is not uncommonly seen in children. The disease may continue into adulthood but typically wanes with increasing age. It is unusual for patients over the age of 40 to develop new-onset RAS.
occurs approximately in one out of five individuals and is the most common cause of acute recurrent oral ulcers. Most individuals first develop RAS during adolescence, although it is not uncommonly seen in children. The disease may continue into adulthood but typically wanes with increasing age. It is unusual for patients over the age of 40 to develop new-onset RAS.
CLASSIFICATION
Simple aphthosis — RAS is referred to as simple aphthosis (also called Mikulicz ulcers) when the individual experiences several episodes per year involving one to several ulcers lasting up to 1 4 days and limited to the oral mucosa. This is the most common form of the disease.
Complex aphthosis — In "complex aphthosis," the patient may have
involvement of both the oral and genital mucosa, although oral lesions are more common. The lesions are more numerous, more painful, and larger (>1 cm in diameter), often taking up to four to six weeks to resolve. Some patients with complex aphthosis will have such frequent episodes that they are almost never without at least one active ulcer. In patients with complex aphthosis, the diagnosis of Behçet syndrome must be excluded.
Ulcer morphology — Three morphologic types of ulcers are recognized in
patients with RAS; they can be seen both in patients with simple and complex RAS:
●Minor ulcers, <1 cm in diameter, usually 3 to 5 mm
●Major ulcers, >1 cm in diameter
●Herpetiform ulcers, 1 to 2 mm in diameter, typically present in clusters, sometimes coalescing in larger ulcers.
PATHOGENESIS
The pathogenesis of RAS is unknown and is likely multifactorial. Most investigations have supported the concept of immune dysregulation involving the oral mucosa leading to an exaggerated proinflammatory process and/or a relatively weak anti-inflammatory response. There appears to be a genetic predisposition to developing RAS, as it is common for patients to have a family history of RAS.
Although certain foods may exacerbate RAS, there is no evidence to suggest an etiologic role for food allergy. Vitamin and mineral deficiencies have also been implicated in the pathogenesis of RAS, particularly deficiency of vitamin B1 2, although the role of vitamin supplementation in the treatment
of RAS remains uncertain. Infectious etiologies have been explored, but not documented, to be a direct cause of disease. Many patients with RAS observe pathergy, so that any trauma to the lining of the mouth may result in the
development of an ulcer in that location. Emotional stress will frequently lead to an exacerbation of disease. Certain drugs have been documented to induce oral ulcers similar to aphthous ulcers. The ulcers typically resolve when the drug is discontinued. Although a few observational studies reported a temporary increase of RAS in the first few weeks after smoking cessation, other studies have not found an association between RAS and smoking.
of RAS remains uncertain. Infectious etiologies have been explored, but not documented, to be a direct cause of disease. Many patients with RAS observe pathergy, so that any trauma to the lining of the mouth may result in the
development of an ulcer in that location. Emotional stress will frequently lead to an exacerbation of disease. Certain drugs have been documented to induce oral ulcers similar to aphthous ulcers. The ulcers typically resolve when the drug is discontinued. Although a few observational studies reported a temporary increase of RAS in the first few weeks after smoking cessation, other studies have not found an association between RAS and smoking.
“Ozone” – The New Option for Canker Sore
Research and development in the field of medicine has revolutionized therapeutics. Integrating ozone therapy is one such revolution in the treatment of oral diseases. Ozone is found to work effectively when applied topically to the affected cutaneous and mucosal sites. Neverthless, the ozone is unstable. This unstable form of ozone molecules is stabilized with the monounsaturated fatty acid such as oleic acid. This product obtained as ozonated oil is employed to treat the abnormal cutaneous and mucosal areas of the body. There have been few studies on therapeutic effects of ozonated oil in recurrent aplhous ulceration. The application of ozonated oil has been widely used with better results achieved in oral diseases.
Hemp seed ozonaed oil which is regarded as “queen of ozonated oils”. Literature supports the use of this ozonated oil as a house hold remedy to maintain the oral health. The evidence based research suggest the use of hemp seed ozonated oil in treating RAS patients owing to its inherent antimicrobial and anti- inflammatory activity which enhances in alleviating the pain symptoms there by fastening the wound healing.