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Recurrent aphthous stomatitis (RAS; recurrent aphthous ulcers; canker sores) belongs to the group of chronic, inflammatory, ulcerative diseases of the oral mucosa. Up to now, the etiopathogenesis of this condition remains unclear; it is, however, considered to be multifactorial. The results of currently performed studies indicate that genetically mediated disturbances of the innate and acquired immunity play an important role in the disease development. Factors that modify the immunologic response in RAS include: food allergies, vitamin and microelement deficiencies, hormonal and gastrointestinal disorders (e.g., celiac disease, Crohn’s disease, ulcerative colitis), some viral and bacterial infections, mechanical injuries and stress. In this paper, we presented the main etiopathogenetic factors of RAS with a special emphasis on the mechanisms of the immune response modification. Moreover, we discussed the crucial clinical symptoms and types of RAS together with epidemiologic data based on the current medical literature reports and our own observations.

Background The association between recurrent aphthous stomatitis (RAS) and neoplasms of the mouth and pharynx (NOMAP) has been reported in some previous observational studies. However, causality is still confused. Our research aims to explore the relationship between RAS and NOMAP through a Mendelian randomization (MR) analysis and to explore whether RAS can serve as a risk factor for NOMAP to provide a reference for the clinical strategy. Methods An exposure dataset for RAS were collected from a published study based on the UK Biobank (UKB). Outcome datasets included Genome-wide association studies (GWAS) summary statistics of NOMAP from the FinnGen datasets. The core method was inverse variance weighting (IVW). The Bonferroni correction, MR-Egger, weighted median, weighted mode, Cochcan’s Q test, MR-PRESSO, and leave-one-out methods served as complementary methods. Results We found no significant evidence of causal relationships between RAS and NOMAP. After applying the Bonferroni correction, the corrected P was equal to 0.00625 (0.05/1/8). The IVW method provided the sole evidence for RAS on Benign neoplasm of floor of mouth (BNFM) (OR = 2.509, 95% CI: 1.296–4.857, P  = 0.006), but the subsequent MR-Egger regression method showed that this result may be due to horizontal pleiotropy ( P  = 0.035). The Cochran Q-test, MR-Egger regression, and MR-PRESSO did not reveal any heterogeneity or directional pleiotropy for the other outcomes. Conclusions In conclusion, this is the first MR analysis to investigate the relationship between RAS and NOMAP. Our research confirmed at the genetic level that no causal association has been identified between RAS and NOMAP, therefore facilitating a logical therapeutic perspective and the development of clinical therapies for them.

Abstract Background Extra-intestinal manifestations (EIMs) can impact morbidity in patients with inflammatory bowel diseases (IBD; Crohn's disease [CD] and ulcerative colitis [UC]). This study compared incidence rates of EIMs in patients with moderate to severe IBD receiving gut-selective vedolizumab (VDZ) vs those receiving systemic anti-tumor necrosis factor (anti-TNF) therapies. Methods Adult IBD patients receiving VDZ or anti-TNFs were identified from the MarketScan claims database from September 28, 2012, through September 30, 2016. Incidence rates of EIMs were compared between the 2 cohorts. Descriptive analyses were performed for all courses of treatment. Generalized linear models estimated the impact of treatment on the likelihood of developing EIMs. Results Compared with patients receiving anti-TNF therapy, VDZ-treated CD patients were 28% more likely to develop \"any EIMs\" (adjusted incident rate ratio [IRR], 1.28; 95% confidence interval [CI], 1.02-1.62). Specifically, CD patients treated with VDZ were more likely to develop erythema nodosum (IRR, 4.29; 95% CI, 1.73-10.64), aphthous stomatitis (IRR, 3.73; 95% CI, 1.51-9.23), episcleritis/scleritis (IRR, 2.51; 95% CI, 1.02-6.14), arthropathy (IRR, 1.45; 95% CI, 1.15-1.84), primary sclerosing cholangitis (PSC) (IRR, 7.79; 95% CI, 3.32-18.27), and uveitis/iritis (IRR, 2.89; 95% CI, 1.35-6.18). UC patients receiving VDZ did not have a statistically significant increase in \"any EIMs\" vs patients receiving anti-TNFs, but were more likely to develop specific EIMs (aphthous stomatitis: IRR, 3.67; 95% CI, 1.30-10.34; pyoderma gangrenosum: IRR, 4.42; 95% CI, 1.00-19.45; and PSC: IRR, 3.44; 95% CI, 1.23-9.68). Conclusions IBD patients receiving VDZ may be more likely to develop EIMs vs patients receiving anti-TNF therapies. The gut-selective inflammatory control of VDZ may potentially limit its clinical effect on EIM prevention.

Recurrent aphthous stomatitis (RAS) is the most common disease of oral mucosa, which almost attacks each individual once in their lifespan. Although plenty of factors have been suggested to play a role in the pathogenesis of RAS, the aetiology of RAS is still controversial, which might lead to limited clinical therapies in accordance with each RAS patient. This review mainly illustrates recent advances in potential causes associated with RAS in detail. Deeper comprehension of the aetiology of RAS will support doctors and researchers to make a better management of RAS patients and to discover new treatments. The aetiology of RAS is complicated, hence we should take a comprehensive view into its aetiology, with multiple potential factors being considered. Sample collection of RAS patients have greatly limited the progress in the aetiology of RAS. A research model of multiagency cooperation can help achieve perfect sample collection of year-round and multiposition.

Introduction Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions, characterized by painful ulcers that develop on non-keratinized oral mucosa, significantly affecting the quality of life. This study aimed to evaluate the prevalence of RAS and its associated risk factors within the Azar cohort population. Methods This cross-sectional study utilized data from the Azar cohort, which has been ongoing since 2014 in Shabestar City, East Azarbaijan, Iran, involving 15,006 adults aged 35 to 70 years. To assess the prevalence of RAS, participants were provided with a description of these lesions and asked whether they had ever experienced RAS in the oral cavity. Data collection was based on self-reports and examinations conducted by the physicians involved in the Azar cohort. Participants with RAS were classified into the RAS group, while the remaining participants were categorized into the non-RAS group. We assessed the association between RAS and various factors using binary logistic regression. Results In the study population, there were 3,503 individuals in the RAS group and 11,503 individuals in the non-RAS group. The prevalence of RAS in the Azar cohort was 23.34%. Individuals over 50 years of age ( p  < 0.001), those with a poor ( p  < 0.001) or very poor ( p  = 0.02) socio-economic status, a low educational level ( p  = 0.01), smokers ( p  < 0.001) and individuals with a history of smoking who have since quit ( p  = 0.01) were significantly less affected by RAS. Conversely, individuals with genital aphthous lesions ( p  < 0.001), depression ( p  < 0.001), rheumatoid disease ( p  = 0.01), and food allergies ( p  < 0.001) were significantly more affected by RAS. Conclusions Factors such as being under 50 years of age, possessing a high socioeconomic status, having a higher level of education, experiencing genital aphthous disease, suffering from depression, having rheumatoid disease, and having food allergies may be associated with a higher prevalence of RAS.

Correspondence to Dr Anu Goenka, Bristol Medical School, Bristol BS8 1TD, UK; anu.goenka@bristol.ac.uk Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome is characterised by episodes of fever lasting a few days that classically exhibit clockwork periodicity. Since the initial description of PFAPA syndrome by Gary Marshall in 1987, it has been recognised that stomatitis, pharyngitis and adenitis are variably present.1 Its phenotype is consistent with an autoinflammatory condition of unknown genetic aetiology possibly involving an infectious/environmental trigger, given that a family history is present in approximately 27% of cases.2 The natural history is onset before 6 years old, followed by spontaneous resolution by 15 years. [...]many of our cohort underwent multiple SARS-CoV-2 tests, and the disruption associated with repeated periods of household self-isolation may have contributed to impetus for parents to seek medical attention. [...]a biological hypothesis is possible involving autoinflammation provoked by (1) reduced viral infection or (2) SARS-CoV-2 infection itself, although there was limited evidence of COVID-19 among our cohort.

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases affecting an approximate 25% of the world's population. Some common etiological factors are genetics, nutritional deficiencies, stress and immune dysfunction. There is currently no specific medication to treat the condition but RAS tends to heal by itself within a week or two. We aimed to explore about the prevalence and related risk factors of recurrent aphthous ulcers among college students aged 18-30 years who had been affected within the preceding six months prior to the study duration. A questionnaire survey was conducted among 681 students from four colleges in Mangalore, Karnataka, India after obtaining the approval for the same from the respective colleges. Consenting participants returned a survey containing various questions. The collected data was then analyzed using descriptive statistics. The study was approved by the Institutional Ethics Committee. Of the 681 participants, 322 (47.2%) were affected with RAS in the past six months which included 131 (40.6%) males and 191 (59.3%) females. Single mouth ulcers were the most common presentation seen among the study participants (74.2%). Factors showing statistically significant association were: family history of RAS (  < 0.001), known diabetics (  < 0.001), history of smoking (  < 0.001), oral trauma (  < 0.001), history of wearing braces/dentures (  < 0.001) as well as those using toothpastes containing sodium lauryl sulphate (  < 0.001), stress and lack of sleep (  < 0.001). The most common form of medication used were topical agents (43.1%) (  < 0.001). There was a statistically significant association between the occurrence of RAS and family history of RAS, diabetes, smoking, history of braces/dentures, oral trauma, sodium lauryl sulphate toothpastes, lack of sleep, stress, menstruation, consumption of particular foods and beverages. Further research is needed in this field to truly understand the prevalence and risk factors of RAS and to help in discovering a treatment modality for this condition.

Background Various oral manifestations are associated with coeliac disease in children, whereas data on adults are scarce. Moreover, possible individual factors predisposing to these manifestations remain unresolved. The aim of this study was to investigate these issues in a large cohort of adult coeliac disease patients both at diagnosis and while on gluten-free diet (GFD). Methods This population-based study involved 873 adult patients with coeliac disease and 563 non-coeliac controls. Patients and controls were interviewed and structured questionnaires were used to assess the severity of gastrointestinal symptoms and quality of life at the time of the study. All participants were systematically asked about oral manifestations, including dental enamel defects, recurrent aphthous ulceration and glossodynia. Coeliac disease-related data were collected from medical records. Possible individual factors associated with oral manifestations were studied using logistic regression analysis. Results Dental enamel defects were more common among patients than among non-coeliac controls (27% vs. 4%, p  < 0.001). Prior to the coeliac disease diagnosis, 56% of the patients had experienced recurrent aphthous ulceration and GFD brought relief to 69% of them. While on GFD, coeliac disease patients had higher prevalence of recurrent aphthous ulceration than did the controls (17% vs. 13%, p  = 0.040), but this significance disappeared after adjusting for gender. Glossodynia on GFD was more prevalent in the coeliac cohort than in the controls (14% vs 6%, p  < 0.001). Oral manifestations at diagnosis and on GFD were associated with the presence of abdominal symptoms at the time of coeliac disease diagnosis, long diagnostic delay and female gender. At the time of the study, patients with oral symptoms had more severe gastrointestinal symptoms and poorer quality of life than those without these symptoms. Conclusions Oral manifestations were more prevalent, at diagnosis and on GFD, in patients with coeliac disease than in the controls, and they were associated with long diagnostic delay, abdominal symptoms, female gender and impaired quality of life. A GFD was shown beneficial in relieving recurrent aphthous ulcerations in patients with coeliac disease.

Background Minor Recurrent Aphthous Stomatitis (RAS) represents a disease which is very difficult to prevent. This case-control study focused on possible associations between minor Recurrent Aphthous Stomatitis in children, their oral health, and underlying behavioral indexes of children’s attitudes and habits pertaining to (home) oral hygiene, with the further goal of enabling the dentist to prevent these specific kind of lesions, both from a clinical and a broader psychosocial perspective. Methods Four hundred one school-children (5–10 years old) in Milan (Italy) were submitted to an intra-oral examination, and interviewed with the aid of a brief psychosocial questionnaire. Results At the clinical level, statistically significant associations were observed between the presence of decayed teeth and minor Recurrent Aphthous Stomatitis ( Odds Ratio : 3.15; 95% CI : lower limit 1.06; upper limit: 9.36; Z-test : 2.07, p  = 0.039; Chi-square  = 4.71, p  = 0.030), and between the Decayed Missing or Filled Teeth (DMFT) index and minor aphthous stomatitis ( Odds Ratio : 3.30; 95% CI : lower limit 1.13; upper limit: 9.67; Z-test  = 2.18, p  = 0.029; Chi-square  = 5.27; p  = 0.022), both results pointing to a significant increase—by circa 3 times—in the risk of developing minor Recurrent Aphthous Stomatitis in children exposed to the two above-identified factors (i.e., the presence of decayed teeth and a clearly compromised oral condition, as signaled by the DMFT index), if compared with the risk run by their non-exposed counterparts. At the psychosocial level of analysis, statistically significant associations were observed (1) between children’s practice of spontaneously brushing teeth when not at home and a comparatively lower (i.e. better) Decayed Missing or Filled Teeth index ( Chi-square : 8.95; p  = 0.011), and (2) between receiving parental aid (e.g., proper brushing instructions) while practicing home oral hygiene and a significantly reduced presence of decayed teeth ( Chi-square  = 5.40; p  = .067; Spearman’s Rho , p  = .038). Further, significant associations were also observed between children’s reported severity of dental pain and both (a) the presence of decayed teeth ( Chi-square  = 10.80; p  = 0.011), and (b) children’s (poor) oral health condition as expressed by the Decayed Missing or Filled Teeth index ( Chi-square  = 6.29; p  = 0.043). Interestingly, specific lifestyles and social status, showed no systematic association to other clinical or psychological/psychosocial indices. Conclusions These systematic relations suggest that, in the presence of Recurrent Aphthous Stomatitis in pediatric patients, the dentist should carefully monitor children for potential carious lesions, implement protocols of prevention to control Recurrent Aphthous Stomatitis disease in children affected by caries, and also be particularly aware of the right or wrong habits children may acquire in the course of continued social exchange with their caregivers and peers.

Background Oral mucosal health is a critical component of overall oral health and impacts an individual’s quality of life. Despite variations in prevalence rates of oral mucosal diseases across regions, previous studies often involved small sample sizes with insufficient data analysis. This study addresses the gap by providing a comprehensive analysis of the changing spectrum of oral mucosal diseases in China, with a focus on the impact of COVID-19. It also explores trends in the use of Chinese patent medicines (CPMs) for treatment. Methods This retrospective, cross-sectional study included 316,166 patients from the Department of Oral Medicine at Peking University School and Hospital of Stomatology between 2016 and 2024. Data on patient demographics, chief complaints, diagnoses, and the use of CPMs were collected and analyzed. Statistical comparisons were made using t -tests and chi-square tests, with significance set at P  < 0.05. Results The average patient age was 49.42 ± 17.92 years, and women were significantly overrepresented (male/female ratio: 0.59). The most frequent diagnoses were oral lichen planus and recurrent aphthous stomatitis, accounting for the top two positions each year. The study found significant differences in disease patterns among age groups, with oral potentially malignant disorders like oral lichen planus becoming more prevalent in older populations. CPMs were used by 52.29% of patients, with similar proportions using topical and systemic treatments. During the COVID-19 pandemic (2020–2022), the number of patients dropped significantly, and an increased prevalence of burning mouth syndrome and oral candidiasis was observed. Conclusion This study offers the largest amount of valuable epidemiological data on the management of oral mucosal diseases to date in China, underscoring the need for targeted health resource allocation. An important trend was the greater predilection for females and middle-aged and elderly populations. The top three diseases in terms of number of patients were oral lichen planus, recurrent aphthous stomatitis, and oral candidiasis. The treatment data indicated widespread use of CPMs for oral mucosal diseases. The COVID-19 pandemic was associated with a significant decrease in the number of total patients and was also characterized by an increase in the proportion of patients with diseases that have psychosomatic associations. The impact of the COVID-19 pandemic and the widespread use of CPMs warrant further investigation in future studies to ensure evidence-based medical practices. Clinical trial number Not applicable.