Urban legends: Recurrent aphthous stomatitis

L. Baccaglini, Rv Lalla, Aj Bruce, Jc Sartori-Valinotti, Mc Latortue, M. Carrozzo, Rs Rogers

Research output: Contribution to journalArticlepeer-review

110 Scopus citations


Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6years reported some effectiveness, although potential for bias was high.

Original languageEnglish (US)
Pages (from-to)755-770
Number of pages16
JournalOral Diseases
Issue number8
StatePublished - Nov 2011
Externally publishedYes


  • Aphthous stomatitis
  • Behçet syndrome
  • Celiac disease
  • Pharyngitis
  • Therapy
  • Vitamin B12

ASJC Scopus subject areas

  • Otorhinolaryngology
  • General Dentistry


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