Hematological study of patients with recurrent aphthous stomatitis - Case control study
Background and Objectives: Recurrent aphthous stomatitis is common oral condition, characterized by multiple, recurrent, small, round, or ovoid ulcers with circumscribed, erythematous haloes, and yellow or grey floors. Its etiology and pathogenesis is not entirely clear linked to systemic diseases and among these, anemia, iron deficiency, folic- acid, and vitamin B12 deficiencies. The aim of this study to investigate the association between recurrent aphthous stomatitis and hemoglobin, serum ferritin, folic acid, and vitamin B12 deficiency.
Patient and Methods: This prospective cross sectional case control clinical study was conducted on 50 patients with recurrent aphthous stomatitis. The control group composed of 50 healthy age and sex-matched subject. The patient demography about family history of recurrent aphthous stomatitis, and smoking was recorded, also the hemoglobin, serum levels of ferritin, folic acid, and vitamin B12 has been investigated.
Results: The low hemoglobin was reported in 30% and vitamin B 12 deficiency in 31% of the patient so low hemoglobin and B12 deficiency have significant correlation with recurrent aphthous stomatitis. Patients with low hemoglobin, vitamin B12 deficiency , positive family history, and non smoker have been found to have the highest risk for having recurrent aphthous stomatitis.
Conclusion: Recurrent aphthous stomatitis is a multifactorial disease. Positive family history, low hemoglobin level , vitamin B12 deficiency, and nonsmoking status are among the important predisposing factors. Routine hematological screening and tests for iron status, folic acid, and vitamin B12 status should be assessed in all patients with recurrent aphthous stomatitis.
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.
Akintoye SO, Greenberg MS. Recurrent aphthous stomatitis. Dent Clin North Am 2005; 49: 31-47.
Safadi RA. Prevalence of recurrent aphthous ulceration in Jordanian dental patients. BMC Oral Health. 2009; 9:31.
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.
Field. A, Longrman L (2003): oral ulcer chapter 5 in: Tyldesley's oral medicine. 5th ed. Oxford University Press, New York, PP: 52.
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.
Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Hayrinen-Immonen R. Recurrent aphthous ulcers today: a review of the growing knowledge. Int J Oral Maxillofac Surg 2004; 33: 221–234.
Ogura M, Yamamoto T, Morita M, Watanabe T. A case control study on food intake of patients with recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91:45 -9.
Nolan A, Lamey P-J, Milligan KA, Forsyth A. Recurrent aphthous stomatitis and food sensitivity. J Oral Pathol Med 1991; 20:473 - 5.
Piskin S, Syan C, Durukan N, Senol M. Serum iron, ferritin, folic acid and vitamin B12 levels in recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol 2002; 16:66-7.
Scully C, Gorsky M, Lozada-Nur F. Aphthous ulcerations. Dermatol Ther 2002; 15:185 - 205.
Miller MF, Garfunkel AA, Ram C, Ship II. Inheritance patterns in recurrent aphthous ulcers: twin and pedigree data. Oral Surg Oral Med Oral Pathol 1977; 43:886 - 91.
Scully C. Clinical practice. Aphthous ulceration. N Engl J Med 2006; 355: 165–172.
Challacombe SJ, Scully C, Keevil B, Lehner T. Serum ferritin in recurrent oral ulceration. J Oral Pathol 1983; 12: 290–299.
Carrozzo M, Carbone M, Gandolfo S. Recurrent aphthous stomatitis: current etiopathogenetic and therapeutic concepts. Minerva Stomatol 1995; 44: 467–475.
Thongprasom K, Youngnak P, Aneksuk V. Hematologic abnormalities in recurrent oral ulceration. Southeast Asian J Trop Med Public Health 2002; 33: 872–877.
Jurge S, Kuffer R, Scully C, Porter SR. Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis 2006; 12: 1–21.18.Messadi DV, Younai F. Aphthous ulcers. Dermatol Ther 2010; 23: 281-90.
Scully C, Porter SR. Recurrent aphthous stomatitis: current concepts of etiology pathogenesis, and management. J Oral Pathol Med 1989; 18: 21–27.
Gallagher BT. Biology and pathology of the oral mucosa. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, editors. Dermatology in General Medicine, 4th edn. McGraw-Hill, New York, 1993: 1355 –1417.
Casiglia JM, Morwski GW, Nebesio CL. Aphthous Stomatitis. Emedicine Dermatology. http://emedicine.medscape.com/article/1075570- overview Accessed February 3, 2010.
Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: Vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Path Med 1991; 20:389–91.
Field EA, Rotter E, Speechley JA, Tyldesley WR. Clinical and haematological assessment of children with recurrent aphthous ulceration. Br Dent J 1987; 11: 19–22.
Wray D, Ferguson MM, Mason DK,Hutcheon AW, Dagy JH. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Br Med J 1975; 2: 490–493.
Challacombe SJ, Barkhan P, Lehner T. Haematological features and differentiation of recurrent oral ulceration. Br J Oral Surg 1977; 15: 37–48.
Burgan SZ, Sawair FA, Amarin ZO. Hematologic status in patients with recurrent aphthous stomatitis. Jordan Saudi Med J 2006; 27: 381–384.
Compilato D, Carroccio A, Calvino F, Di Fede G, Campisi G. Haematological deficiencies in patients with recurrent aphthous. J Eur Acad Dermatol Venereol 2010; 24: 667-73.
Rogers RS III, Hutton KP. Screening for hematinic deficiencies in patients with recurrent aphthous stomatitis. Australas J Dermatol 1986; 27: 98–103.
Lopez-JP, Camacho.AF, and Martos. N Hematological study of patients with aphthous stomatitis, International Journal of Dermatology 2014, 53, 159–163.
Scully Barrons RW. Treatment strategies for recurrent oral aphthous ulcers. Am J Health Syst Pharm. 2001; 58:41-50; quiz 51-3.
Preeti L, Magesh K, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac Pathol. 2011; 15:252–6.
Woo SB, Sonis ST. Recurrent aphthous ulcers: a review of diagnosis and treatment. J Am Dent Assoc.1996; 127:1202-13.
McRobbie H, Hajek P, Gillison F. The relationship between smoking cessation and mouth ulcers. Nicotine Tob Res. 2004; 6:655-9.
Jurge S, Kuffer R, Scully C, Porter SR. Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis. 2006; 12:1- 21.
Koybasi S, Parlak AH, Serin E, Yilmaz F, Serin D. Recurrent aphthous stomatitis: investigation of possible etiologic factors. Am J Otolaryngol 2006; 27: 229-32.
Stanley HR. Aphthous lesions. Oral Surg Oral Med Oral Pathol 1972; 33: 407–416.
Field EA, Brookes V, Tyldesley WR. Recurrent aphthous ulceration in children- a review. Int J Paediatr Dent 1992; 2: 1- 10.
Chattopadhyay A, Chatterjee S. Risk indicators for recurrent aphthous ulcers among adults in the US. Community Dent Oral Epidemiol 2007; 35: 15 2–9.
McCullough MJ, Abdel-Hafeth S, Scully C. Recurrent aphthous stomatitis revisited; clinical features, associations, and new association with infant feeding practices. J Oral Pathol Med 2007; 36: 615–20.
Shohat-Zabarski R, Kalderon S, Klein T, Weinberger A. Close association of HLA-B51 in persons with recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1992; 74:463 - 5.
Jamal MA. Prevalence of recurrent aphthous ulceration experience in patient attending Piramird dental speciality in Sulaimani City. J Clin Exp Den.2013;(2):e89-94
Tuzun B, Wolf R, Tuzun Y, Serdaroglu S. Recurrent aphthous stomatitis and smoking. Int J Dermatol 2000; 39:358 - 60.
Dholakia KR, Dharmarajan TS, Yadav D, Oiseth S, Norkus EP, Pitchumoni CS. Vitamin B12 deficiency and gastric histopathology in older patients. World J Gastroenterol. 2005; 11:7078-83
Burgess J A, Haley J T. Effect of Bioactive B12 in Adhering Discs on Aphthous Ulcers. Inside Dentistry with commentary by Howard E.Strassler 2008;4(11):9.
Volkov I, Rudoy I, Freud T, Sardal G, Naimer S, Peleg R, Press Y. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind placebo-controlled trial. J Am Board Fam Med. 2009;22(1):9-16
Olson JA, Feinberg I, Silverman S Jr, Abrams D, Greenspan JS. Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1982; 54: 517–520.
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