|Year : 2017 | Volume
| Issue : 1 | Page : 25-28
Prevalence of recurrent aphthous stomatitis in western population of Maharashtra, India
Yojari R Rajmane1, SR Ashwinirani2, Girish Suragimath3, Ajay Nayak2, Vijaya S Rajmane4, Mohini Lohana3
1 Intern, Bachelor of Dental Surgery, School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
2 Department of Oral Medicine and Radiology, School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
3 Department of Periodontology, School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
4 Department of Microbiology, Institute of Medical Sciences and Research, Mayani, Satara, Maharashtra, India
|Date of Web Publication||2-Mar-2017|
S R Ashwinirani
Reader, Department of Oral Medicine and Radiology, School of Dental Sciences, Karad, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: Recurrent aphthous stomatitis (RAS) is characterized by recurrent painful, single, multiple ulcers appearing in oral mucosa. Various studies have been conducted to find the prevalence of RAS worldwide. Till now, no studies have been conducted to report the prevalence of RAS in Maharashtra. The aim of the present study was to evaluate the prevalence of RAS in western population of Maharashtra.
Materials and Methods: A total of 71,851 patients within the age group between 10 and 70 years were screened for a period of 5 years from March 2011 to March 2016 in western population of Maharashtra. Collected data were recorded and entered, verified, processed, and analyzed using software package SPSS program version 19. The frequency and distribution of RAS in gender, age, and site were calculated.
Results: Out of 71,851 patients, only 72 patients were clinically diagnosed to be suffering from RAS. The prevalence of RAS was 0.1%. There was a higher prevalence in females as compared to males and it was most common in the second and third decades of life, with buccal mucosa as the predominant site followed by labial mucosa and tongue.
Conclusion: Based on the results of our study, the prevalence of RAS in western population of Maharashtra was 0.1%, which was very low as compared to other Indian population. Females were more commonly affected. The most common age affected in our study group was second and third decades. The most common site was buccal mucosa followed by labial mucosa and tongue.
Keywords: Aphthae, buccal mucosa, recurrent, ulcer
|How to cite this article:|
Rajmane YR, Ashwinirani S R, Suragimath G, Nayak A, Rajmane VS, Lohana M. Prevalence of recurrent aphthous stomatitis in western population of Maharashtra, India. J Oral Res Rev 2017;9:25-8
|How to cite this URL:|
Rajmane YR, Ashwinirani S R, Suragimath G, Nayak A, Rajmane VS, Lohana M. Prevalence of recurrent aphthous stomatitis in western population of Maharashtra, India. J Oral Res Rev [serial online] 2017 [cited 2018 Jan 16];9:25-8. Available from: http://www.jorr.org/text.asp?2017/9/1/25/201402
| Introduction|| |
An ulcer is a well-circumscribed sometimes depressed lesion with an epithelial defect that is covered by a fibrin clot, resulting in yellow-white appearance. Recurrent aphthous stomatitis (RAS) is a type of recurrent ulcer where it heals and reappears after a period of time. The term “aphthae” was first used by Hippocrates and later described by Miculizc and Kummel as “Miculizc's aphthae.” The accepted classification of aphthae is based on the three parameters of lesions such as size, duration, and the presence of residual scarring. RAS is classified on the basis of ulcer size into major, minor, or herpetiform. Minor aphthous ulcers are small (<1 cm in diameter), well defined, shallow, and heal within 2 weeks without scars. Major ulcers are bigger, deeper, and take up to 6 weeks to heal, leaving a scar behind. Herpetiform ulceration is characterized by multiple, small (3–6 mm), shallow ulcers which take weeks to heal. RAS is also called “canker sores,” and the previous terminology of “Miculizc's aphthae” is now recognized as minor aphthous ulcers whereas the old terminology of Sutton's aphthae or periadenitis mucosa necrotica recurrens is now recognized as major aphthous ulcers.
The trigger of an episode of RAS is unknown, but extensive investigations in large patient series have identified a range of local, hematological, gastrointestinal, immunologic, genetic, nutritional, allergic, psychological, and medication reactions as probable triggers in some patients with RAS.,, A study conducted by Patil et al. showed stress as the most common factor followed by nutritional deficiency as the second most common factor related to RAS.
Successful management of RAS is variable but, in most cases, a useful strategy can be tailored to the individual patient. It does require both patient compliance with instructions and an understanding and acceptance of the recurrent nature of this disease. Clinically, patients and clinicians are often able to map the sequence of presentation through resolution into the following stages:
- Prodromal: Symptoms but without any visible clinical sign
- Preulcerative: Initial presentation, usually erythema and slight edema
- Ulcerative: Formation of the epithelial defect
- Healing: Symptom abatement and progressive healing
- Remission: No evidence of lesions.
However, each lesion tends to follow a set presentation and course, albeit with variation in the duration and size of lesions. The prodromal stage is the period when application of a topical corticosteroid may inhibit the further development of the lesion or at least minimize the severity and duration of any lesion that does progress to the ulcerative stage. The preulcerative stage is also transient and again is an ideal time to apply a topical corticosteroid. The ulcerative stage is the dominant stage where early epithelial destruction and breakthrough causes a small clinical ulcer which rapidly progresses to the full size determined for that particular lesion, most frequently 0.3–0.5 cm in diameter.
The ulcerative stage lasts for 3–7 days. The healing stage is identified by the abrupt cessation of pain and the appearance of granulations within the decreasing surface exudate. The remission stage identifies the ulcer-free periods and triggered by some dietary items and occasionally in the premenstrual phase.
Various studies regarding the prevalence of RAS were conducted across the world, prevalence rate was varied. The purpose of this paper was to present the prevalence of RAS in western population of Maharashtra, India.
| Materials and Methods|| |
A total of 71,851 patients were screened for 5 years from March 2011 to March 2016, aged between 10 and 70 years in western population of Maharashtra. The research protocol was initially submitted to the Institutional Ethical Committee and Review Board of Krishna Institute of Medical Sciences Deemed University (KIMSDU). The ethical clearance was obtained from KIMSDU before commencing the study. The study was conducted from March 2011 to March 2016.
Two examiners specialized in the subject of oral medicine examined all the cases to recognize oral mucosal lesions. The criteria for RAS in this study were similar to the criteria for oral mucosal lesions used in the study by Axell on 20,333 Swedish people. These criteria are also in accordance with the criteria by the World Health Organization in its “Guide to epidemiology and diagnosis of oral mucosal diseases and conditions.” Age, sex, gender and site of RAS were recorded in the clinical proforma. Collected data were recorded, entered, verified, processed, and analyzed using statistical package for social sciences (SPSS) software version 19, IBM corporation, Armonk, Newyork, USA. The frequency and distribution of RAS in gender, age, and site were calculated.
| Results|| |
The total number of patients reported to the Department of Oral Medicine and Radiology from March 2011 to March 2016 were 71,851. Out of these patients, 72 patients were clinically diagnosed with RAS. The prevalence of RAS was 0.1%. The study sample consisted of 45 females (62.5%) and 27 males (37.5%). The age of patients with RAS ranged from 13 to 65 years. The mean age of the study population was 31.36 years. The mean age of men was 32 years and of women was 30 years. Majority of the age group were in the second and third decades [Table 1]. There was higher RAS prevalence in women as compared to men. The most common site was buccal mucosa followed by labial mucosa and tongue [Table 2].
|Table 2: Site-wise distribution of recurrent aphthous stomatitis according to gender|
Click here to view
| Discussion|| |
Oral ulcer causes a lot of suffering and agony for the patients throughout the life. RAS is the most common inflammatory ulcerative condition of the oral mucosa, with a high prevalence among women. A diagnosis of RAS depends mainly on history and clinical examination. It occurs in the nonkeratinized areas such as lips, tongue, buccal mucosa, and soft palate. They are usually painful, shallow, round ulcers with an erythematous halo covered by a yellowish-gray fibromembranous layer. Patients with mild recurrent aphthous ulceration usually do not require any treatment for the lesion. Aloe Vera extracts also show relieve to this condition. However, topical corticosteroids therapy may be used to reduce the frequency and severity of attacks.
Epidemiological studies performed over the past few years have shown considerable variation in the prevalence of RAS among different regions throughout the world. The prevalence range among differing populations has been documented as 0.5%–66%.,,
In our study, the prevalence of RAS was 0.1%, which indicates that the prevalence of RAS was lower in western Maharashtra population compared to other regions of India. This may be due to the genetic factors, socioeconomic level, life style of individuals of this particular region, and tobacco and mishri usage. Most of the patients in this region use mishri and tobacco which might reduce their psychological stress. When compared with other studies across the world, the prevalence was very low. It was reported (25.2%) in Iran, (25.5%) in Turkey, and 17.7% in Sweden.
Studies conducted by Mathew et al. and Patil et al. in South and North India showed 2.1% and 21.7% of RAS prevalence, respectively, which was higher than our study. These studies indicate that the prevalence varies in different parts of India among the general population.
In relation to female predisposition to RAS, some authors have suggested that this association is related to hormonal rates. The incidence of RAS is related to the luteal phase of the menstrual cycle , and also a decrease in its incidence during pregnancy, thus relating the episodes of RAS to progesterone levels.
A prospective study was carried out by Patil et al. in Jodhpur Dental College, Rajasthan, who stated that there is a higher prevalence of females (56.3%) than males (43.7%). On the contrary, few studies reported higher prevalence of RAS among males without statistical significance.
In this study, the most commonly affected age group was 20–29 years (56.9%), the prevalence decreased as the age increased. This result was in accordance with the finding of Davatchi et al. and Patil et al. The peak age of onset is usually second decade. Studies have shown a general trend of low RAS prevalence in the first decade with an increase in the prevalence of RAS in the second and third decades. After the third decade, a decrease in RAS prevalence was observed.
In our study, among 72 patients, 39 (54.16%) patients were affected by RAS on buccal mucosa, 22 (30.55%) patients on labial mucosa, and 11 patients (15.27%) were affected on tongue. The results of our study were in accordance with studies conducted by Safadi in Jordanian dental patients, which revealed that lips and buccal mucosa were the most common sites of ulcerations (55%), whereas gingiva or tongue was affected in one-fifth of the patients. Floor of the mouth was the least affected site by recurrent aphthous ulceration (8%).
| Conclusion|| |
Based on the results of our study, the prevalence of RAS in western population of Maharashtra was 0.1% which was very low as compared to other Indian population. Females were more commonly affected than men, and the most common age group affected in our study was the second and third decades. The most common site was buccal mucosa followed by labial mucosa and tongue.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ship JA. Recurrent aphthous stomatitis. An update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:141-7.
Sciubba JJ. Oral mucosal diseases in the office setting – Part I: Aphthous stomatitis and herpes simplex infections. Gen Dent 2007;55:347-54.
Kramer IR, Pindborg JJ, Bezroukov V, Infirri JS. Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization. Community Dent Oral Epidemiol 1980;8:1-26.
Akintoye SO, Greenberg MS. Recurrent aphthous stomatitis. Dent Clin North Am 2005;49:31-47.
Greenberg MS, Pinto A. Etiology and management of recurrent aphthous stomatitis. Curr Infect Dis Rep 2003;5:194-8.
Rogers RS 3rd
. Recurrent aphthous stomatitis: Clinical characteristics and associated systemic disorders. Semin Cutan Med Surg 1997;16:278-83.
Patil S, Reddy SN, Maheshwari S, Khandelwal S, Shruthi D, Doni B. Prevalence of recurrent aphthous ulceration in the Indian population. J Clin Exp Dent 2014;6:e36-40.
Axell T. A prevalence study of oral mucosal lesions in an adult Swedish population. Odontol Revy Suppl 1976;36:51-2.
Scully C, Porter S. Oral mucosal disease: Recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 2008;46:198-206.
Safadi RA. Prevalence of recurrent aphthous ulceration in Jordanian dental patients. BMC Oral Health 2009;9:31.
Bruce AJ, Rogers RS 3rd
. Acute oral ulcers. Dermatol Clin 2003;21:1-15.
Rivera-Hidalgo F, Shulman JD, Beach MM. The association of tobacco and other factors with recurrent aphthous stomatitis in an US adult population. Oral Dis 2004;10:335-45.
Neena IE, Ganesh E, Poornima P, Korishettar R. An ancient herb aloevera in dentistry: A review. J Oral Res Rev 2015;7:25-30.
Sedghizadeh PP, Shuler CF, Allen CM, Beck FM, Kalmar JR. Celiac disease and recurrent aphthous stomatitis: A report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:474-8.
Femiano F, Lanza A, Buonaiuto C, Gombos F, Nunziata M, Piccolo S, et al.
Guidelines for diagnosis and management of aphthous stomatitis. Pediatr Infect Dis J 2007;26:728-32.
Dubal M, Nayak A, Suragimath A, Sande A, Kandagal S. Analysis of smoking habits in patients with varying grades of smoker's palate in South Western region of Maharashtra. J Oral Res Rev 2015;7:12-5.
Davatchi F, Tehrani-Banihashemi A, Jamshidi AR, Chams-Davatchi C, Gholami J, Moradi M, et al.
The prevalence of oral aphthosis in a normal population in Iran: A WHO-ILAR COPCORD study. Arch Iran Med 2008;11:207-9.
Ciçek Y, Canakçi V, Ozgöz M, Ertas U, Canakçi E. Prevalence and handedness correlates of recurrent aphthous stomatitis in the Turkish population. J Public Health Dent 2004;64:151-6.
Axéll T, Henricsson V. The occurrence of recurrent aphthous ulcers in an adult Swedish population. Acta Odontol Scand 1985;43:121-5.
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res 2008;19:99-103.
Ship JA, Chavez EM, Doerr PA, Henson BS, Sarmadi M. Recurrent aphthous stomatitis. Quintessence Int 2000;31:95-112.
Field EA, Allan RB. Review article: Oral ulceration – Aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. Aliment Pharmacol Ther 2003;18:949-62.
Balan U, Gonsalves N, Jose M, Girish KL. Symptomatic changes of oral mucosa during normal hormonal turnover in healthy young menstruating women. J Contemp Dent Pract 2012;13:178-81.
Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: A consensus approach. J Am Dent Assoc 2003;134:200-7.
[Table 1], [Table 2]