Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2015, vol. 52, nr 4, October-December, p. 472–478

doi: 10.17219/dmp/59557

Publication type: review article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Recurrent Aphthous Stomatitis – a Reflection of Gastrointestinal Diseases?

Afty nawracające jako objaw chorób przewodu pokarmowego

Natalia Lewkowicz1,

1 Department of General Dentistry, Medical University of Lodz, Łódz, Poland

Abstract

Recurrent oral ulceration is a common condition accompanied by pain which often interferes with food intake and speaking. A variety of etiological factors can contribute to oral ulceration, e.g. local factors, such as trauma or viral infection, or systemic diseases that manifest in the oral cavity. Recurrent aphthous stomatitis (RAS) is one of the most frequently diagnosed condition characterized by repeated appearance of oral ulcers. Clinical features of RAS are not homogenous (different ulcer types, different severity of the disease), and the etiology is unclear. No objective criteria are known for definitive RAS diagnosis, and descriptive criteria are not well-defined. The majority of RAS cases are believed to be idiopathic, but some can be associated with an underlying systemic diseases, including nutritional deficiencies and inflammatory conditions. RAS is relatively often described to be associated with inflammatory diseases of gastrointestinal tract, and sometimes oral manifestation precedes gastrointestinal symptoms.Therefore, dentists might help to diagnose a range of systemic diseases. In the present review, the literature on most commonly RAS-associated conditions, inflammatory diseases associated with gastrointestinal tract, has been analyzed, providing practical tips helping to differentiate between idiopathic RAS and RAS accompanying systemic disease, and to facilitate adequate ulcer management.

Key words

gastrointestinal diseases, recurrent aphthous stomatitis, oral ulcers

Słowa kluczowe

afty nawracające, zamiany nadżerkowe i owrzodzenia jamy ustnej, choroby przewodu pokarmowego

References (50)

  1. Rogers R.S.: Recurrent aphthous stomatitis: clinical characteristics and associated systemic disorders. Semin. Cutan Med. Surg. 1997, 16, 278–283.
  2. Scully C., Porter S.: Oral mucosal disease: recurrent aphthous stomatitis. Br. J. Oral Maxillofac. Surg. 2008, 46, 198–206.
  3. Scully C.: Clinical practice: Aphthous ulceration. N Engl. J. Med. 2006, 355, 165–172.
  4. Lehner T.: Autoimmunity in oral diseases, with special reference to recurrent oral ulceration. Proc. R Soc. Med. 1968, 61, 515–24.
  5. Scully C., Porter S.: Recurrent aphthous stomatitis: Current concepts of etiology, pathogenesis and management. J. Oral Pathol. Med. 1989, 18, 21–7.
  6. Porter S.R., Scully C., Pedersen A.: Recurrent aphthous stomatitis. Crit. Rev. Oral Biol. Med. 1998, 9, 306–21.
  7. Scully C., Gorsky M., Lozada-Nur F.: The diagnosis and management of recurrent phthous stomatitis: a consensus approach. J. Am. Dent. Assoc. 2003, 134, 200–207.
  8. Shashy R.G., Ridley M.B.: Aphthous ulcers: A difficult clinical entity. Am. J. Otolaryngol. 2000, 21, 389–93.
  9. Natah S.S., Konttinen Y.T., Enattah N.S., Ashammakhi N., Sharkey K.A., Häyrinen-Immonen R.: Recurrent aphthous ulcers today: A review of growing knowledge. Int. J. Oral Maxillofac. Surg. 2004, 33, 221–34.
  10. Tappuni A.R., Kovacevic T., Shirlaw P.J., Challacombe S.J.: Clinical assessment of disease severity in recurrent aphthous stomatitis. J. Oral Pathol. Med. 2013, 42, 635–641.
  11. Hill I., Dirks M., Liptak G.S., Colletti R.B., Fasano A., Guandalini S.: Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J. Pediatr. Gastroenterol. Nutr. 2005, 40, 1–19.
  12. Veloso F.T., Saleiro J.V.: Small-bowel changes in recurrent ulceration of the mouth. Hepatogastroenterol. 1987, 34, 36–37.
  13. Jokinen J., Peters U., Maki M., Miettinen A., Collin P.: Celiac sprue in patients with chronic oral mucosal symptoms. J. Clin. Gastroenterol. 1998, 26, 23–26.
  14. Olszewska M., Sulej J., Kotowski B.: Frequency and prognostic value of IgA and IgG endomysial antibodies in recurrent aphthous stomatitis. Acta Derm. Venereol. 2006, 86, 332–334.
  15. Ferguson M.M., Wray D., Carmichael H.A., Russell R.I., Lee F.D.: Coeliac disease associated with recurrent aphthae. Gut, 1980, 21, 223–226.
  16. Cranney A., Zarkadas M., Graham I.D., Butzner J.D., Rashid M., Warren R.: The Canadian Celiac Health Survey. Dig. Dis. Sci. 2007, 52, 1087–1095.
  17. Rashid M., Cranney A., Zarkadas M., Graham I.D., Switzer C., Case S.: Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 2005, 116, 754–759.
  18. Rashid M., Zarkadas M., Anca A., Limeback H.: Oral manifestations of celiac disease: a clinical guide for dentists. J. Can. Dent. Assoc. 2011, 77, 1–6.
  19. Vavricka S.R., Schoepfer A., Scharl M., Lakatos P.L., Navarini A., Rogler G.: Extraintestinal manifestations of inflammatory bowel disease. Inflamm. Bowel Dis. 2015, 21, 1982–1992.
  20. Su C.G., Judge T.A., Lichtenstein G.R.: Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol. Clin. North Am. 2002, 31, 307–327.
  21. Vavricka S.R., Brun L., Ballabeni P.: Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am. J. Gastroenterol. 2011, 106, 110–119.
  22. Greenstein A.J., Janowitz H.D., Sachar D.B.: The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine, 1976, 55, 401–412.
  23. Halme L., Meurman J.H., Laine P.: Oral findings in patients with active or inactive Crohn’s disease. Oral Surg. Oral Med. Oral Pathol. 1993, 76, 175–181.
  24. Vavricka S.R., Rogler G., Gantenbein C., Spoerri M., Prinz Vavricka M., Navarini A.A., French L.E., Safroneeva E., Fournier N., Straumann A., Froehlich F., Fried M., Michetti P., Seibold F., Lakatos P.L., Peyrin-Biroulet L., Schoepfer A.M.: Chronological order of appearance of extraintestinal manifestations relative to the time of IBD diagnosis in the Swiss inflammatory bowel disease cohort. Inflamm. Bowel Dis. 2015, 21, 1794–1800.
  25. Katsanos K.H., Torres J., Roda G., Brygo A., Delaporte E., Colombel J.F.: Review article: non-malignant oral manifestations in inflammatory bowel diseases. Aliment. Pharmacol. Ther. 2015, 42, 40–60.
  26. Simpson H.E., Summersgill G.B., Howell R.A.: Oral lesions in Crohn’s disease. J. Oral. Med. 1976, 31, 67–68.
  27. Snyder M.B., Cawson R.A.: Oral changes in Crohn’s disease. J. Oral Surg. 1976, 34, 594–599.
  28. Weiss J.S., Gupta A.K., Regezi J., Rasmussen J.E.: Oral ulcers and cobblestone plaques. Oral Crohn’s disease (CD). Arch. Dermatol. 1991, 127, 889–892.
  29. Femiano F., Lanza A., Buonaiuto C., Perillo L., Dell’Ermo A., Cirillo N.: Pyostomatitis vegetans: a review of the literature. Med. Oral Patol. Oral Cir. Bucal 2009, 14, 114–117.
  30. Ruiz-Roca J.A., Berini-Aytés L., Gay-Escoda C.: Pyostomatitis vegetans. Report of two cases and review of the literature. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2005, 99, 447–454.
  31. Thornhill M.H., Zakrzewska J.M., Gilkes J.J.H.: Pyostomatitis vegetans: report of three cases and review of the literature. J. Oral Pathol. Med. 1992, 21, 128–133.
  32. Massironi S., Rossi R.E., Cavalcoli F.A., Della Valle S., Fraquelli M., Conte D.: Nutritional deficiencies in inflammatory bowel disease: therapeutic approaches. Clin. Nutr. 2013, 32, 904–910.
  33. Lemberg D.A., Day A.S.: Crohn disease and ulcerative colitis in children: an update for 2014. J. Paediatr. Child Health, 2015, 51, 266–270.
  34. Al Asqah M., Al Hamoudi N., Anil S., Al Jebreen A., Al-Hamoudi W.K.: Is the presence of Helicobacter pylori in the dental plaque of patients with chronic periodontitis a risk factor for gastric infection? Can. J. Gastroenterol. 2009, 23, 177–179.
  35. Eskandari A., Mahmoudpour A., Abolfazli N., Lafzi A.: Detection of Helicobacter pylori using PCR in dental plaque of patients with and without gastritis. Med. Oral Patol. Oral Cir. Bucal 2010, 15, 28–31.
  36. Assumpção M.B., Martins L.C., Melo Barbosa H.P., Barile K.A., de Almeida S.S., Assumpção P.P.: Helicobacter pylori in dental plaque and stomach of patients from Northern Brazil. World J. Gastroenterol. 2010, 16, 3033–3039.
  37. Birek C., Grandhi R., McNeill K., Singer D., Ficarra G., Bowden G.: Detection of Helicobacter pylori in oral aphthous ulcers. J. Oral Pathol. Med. 1999, 28,197–203.
  38. Karaca S., Seyhan M., Senol M., Harputluoglu M.M., Ozcan A.: The effects of gastric Helicobacter pylori eradication on recurrent aphthous stomatitis. Int. J. Dermatol. 2008, 47, 615–617.
  39. Shimoyama T., Horie N., Kato T., Kaneko T., Komiyama K.: Helicobacter pylori in oral ulcerations. J. Oral Sci. 2000, 42, 225–229.
  40. Taş D.A., Yakar T., Sakalli H., Serin E.: Impact of Helicobacter pylori on the clinical course of recurrent aphthous stomatitis. J. Oral Pathol. Med. 2013, 42, 89–94.
  41. Albanidou-Farmaki E., Giannoulis L., Markopoulos A., Fotiades S., Aggouridaki X., Farmakis K., Papanayotou P.: Outcome following treatment for Helicobacter pylori in patients with recurrent aphthous stomatitis. Oral Dis. 2005, 11, 22–26.
  42. Long B.J., Chen K., Wu B.L., Duan J.M.: Detection of Helicobacter pylori in oral cavity of patients with recurrent aphthous ulcer. J. South Med. Univ. 2007, 27, 477–478.
  43. Li L., Gu H., Zhang G.: Association between recurrent aphthous stomatitis and Helicobacter pylori infection: a meta-analysis. Clin. Oral Invest. 2014, 18, 1553–1560.
  44. Lewkowicz N., Kurnatowska A.J., Lewkowicz P., Banasik M., Tchórzewski H.: Peripheral blood neutrophils in pathogenesis of recurrent aphthous ulcers. Dent. Med. Probl. 2002, 39, 69–77 [in Polish].
  45. Lewkowicz N., Kur B., Kurnatowska A., Tchorzewski H., Lewkowicz P.: Expression of Th1/Th2/Th3/Th17- related genes in recurrent aphthous ulcers. Arch. Immunol. Ther. Exp. 2011, 59, 399–406.
  46. Taş D.A., Yakar T., Sakalli H., Serin E.: Impact of Helicobacter pylori on the clinical course of recurrent aphthous stomatitis. J. Oral Pathol. Med. 2013, 42, 89–94.
  47. Adler I., Muiño A., Aguas S., Harada L., Diaz M., Lence A., Labbrozzi M., Muiño J.M., Elsner B., Avagnina A., Denninghoff V.: Helicobacter pylori and oral pathology: relationship with the gastric infection. World J. Gastroenterol. 2014, 20, 9922–9935.
  48. Talley N.J., Vakil N.: Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the management of dyspepsia. Am. J. Gastroenterol. 2005, 100, 2324–2337.
  49. Chattopadhyay A., Chatterjee S.: Risk indicators for recurrent aphthous ulcers among adults in the US. Community Dent. Oral Epidemiol. 2007, 35, 152–159.
  50. Porter S.R., Kingsmill V., Scully C.: Audit of diagnosis and investigations in patients with recurrent aphthous stomatitis. Oral Surg. Oral Med. Oral Pathol. 1993, 76, 449–452.