Aphthous ulcer

SYARIFAH NAZIRA
1610211050
 Definisi
Recurrent aphthous stomatitis (RAS) is a common ulcerative
inflammatory condition of the oral cavity; it typically starts in childhood
or adolescence as small recurrent, painful, round or ovoid ulcers with
well-defined erythematous margins, like a halo, and a central yellow or
gray floor. 
 Faktor predisposisi
• nutritional deficiency  def. vit b12,besi and folat
• immunologic factors  immunodeficiency (hiv infection),rx silang antar
streptococcus dan antigen, regulasi imun oleh virus herpes (hipotesis)
• psychological stress –> This underlies RAS in some cases; ulcers appear to
exacerbate during school or university examination times.
• dietary allergies  Patients with aphthae may occasionally have a reaction to
cow's milk and may have been weaned at an early age.
• Systemic disease  malabsorption syndrome ex : seliac disease/gluten-sensitive
enteropathy [GSE]) (haplotype of HLA-DRW 10 and DQW1) , chron disease)
• Trauma  Biting of the mucosa and wearing of dental appliances may lead to
some ulcers
• Cessation of smoking  This may precipitate or exacerbate RAS in some cases.
• Endocrine factors in some women - RAS is clearly related to the progestogen
level fall in the luteal phase of the menstrual cycle, and ulcers may then
temporarily regress in pregnancy.
 Epidemiologi
• RAS normally first arises in childhood or adolescence, predominantly
between the ages of 10 and 19 years
• Perempuan>>
 Gambaran klinis
• RAS ulcers, which can occur in otherwise healthy patients, are
relatively small recurrent, round or ovoid ulcers with well-
circumscribed erythematous margins presenting like a halo and with a
yellow or gray floor. For 2-48 hours before an ulcer develops, RAS is
characterized by a prodromal burning sensation. [1] Ulcers commonly
present on lining oral mucosa, such as buccal and labial mucosa, and
on the tongue, rather than on attached oral mucosa.
• When an active ulcer is noted, a recall in 2 weeks will be beneficial to
monitor the prognosis.
• No specific investigations exist for RAS; however, a linear ulceration in
areas of the buccal or labial vestibule may warrant further workup,
since the other causes of recurrent mouth ulceration should be
excluded.
• Indeed, any ulcer that lasts for more than 3 or 4 weeks requires
evaluation to rule out other, serious disease processes.
• If a solitary, nonhealing ulcer is reported, a biopsy may be warranted
and the clinician should rule out malignancy.
 Px Penunjang
• Darah perifer lengkap
• Mcv,mch,mchc
• Iron studies (usually an assay of serum ferritin levels)
• Red blood cell folate assay
• Serum vitamin B-12 measurements
• Serum antiendomysium antibody and transglutaminase assay
(positive in celiac disease)
 Diagnosis
• Anamnesis
• Gambaran klinis, lokasi terjadinya lesi
• Riwayat penyakitnya, karena tidak ada tes diagnostik spesifik yang
tersedia
 Tatalaksana
• Penanganan ulser (penyembuhan dan mengurangi durasi)
• Penanganan nyeri (mengurangi nyeri dan mengembalikan fungsi),
• Penanganan nutrisi (konsumsi makanan dan buah)
• Kontrol penyakit (mengurangi kekambuhan).
 Farmakologi
• Analgetik
 NSAID topical (ibuprofen,aspirin,dll), kortikosteroid topical
(betametason,hidrokortison), larutan kumur chlorhexidine 0,2 %
• Antivirus
Acyclovir oral
- dewasa: 5 x 200 – 400 mg /hari selama 7 hari.
- anak” : 20mg/kgBB/hari/5 kali pemberian selama 7 hari.
Valacycrovil oral
- dewasa : 2 x 1 – 2 gr /hari selama 1 hari.
- anak” : 20mg/kgBB/hari/ 5 kalipemberian selama 7 hari
 Non-farmako
• Diet tinggi b12,asam folat,besi.
• The patient should avoid consuming any foods that could lead to RAS.
 Prognosis
• Dubia ad bonam
 Daftar Pustaka
• https://emedic
• http://repository.usu.ac.id/bitstream/handle/123456789/35089/Chap
ter%20II.pdf;jsessionid=B35055CA5866C8BBEF7E1E5BFA2C882E?seq
uence=4ine.medscape.com/article/867080-treatment#d9
• http://digilib.unila.ac.id/6486/124/BAB%20II.pdf
• http://ppkdokter2014.blogspot.co.id/2016/09/ulkus-mulut-aftosa-
herpes.html