GPAtlas🧭 When to suspect
Recurrent aphthous stomatitis (RAS), or aphthous ulcers, is the most common disease of the oral mucosa, affecting up to 1 in 4 people. It usually begins in childhood or adolescence and tends to settle with age.
The hallmark is recurrent crops of painful, round or oval ulcers:
• With a yellow-grey floor and an erythematous halo
• Appearing on non-keratinised (movable) mucosa – buccal and labial mucosa, floor of mouth, and the ventral/lateral tongue
• They characteristically spare the hard palate, attached gingiva and dorsum of the tongue
Diagnosis is clinical, and the great majority are benign and self-limiting.
There are two jobs in primary care:
• The first is to recognise the benign recurrent pattern and treat symptomatically.
• The second – the one that matters most – is to never dismiss a single, persistent ulcer: an unexplained ulcer lasting more than 3 weeks needs a suspected cancer pathway referral.
Suspect a secondary cause when ulcers:
• Begin in adulthood
• Are unusually severe or frequent
• Come with systemic features
Think of:
• Haematinic deficiency
• Coeliac disease
• Inflammatory bowel disease
• Behçet's disease
| Subtype | Typical appearance | Course |
|---|---|---|
| Minor (most common) | Crops of small ulcers, each < 10 mm, on non-keratinised mucosa | Heal in 10–14 days, no scarring |
| Major | One to three larger ulcers, > 10 mm, any site including soft palate/fauces | Heal over weeks, may scar |
| Herpetiform | • 10–50 pinpoint ulcers that may coalesce • Not caused by herpes virus |
Heal in 10–14 days |
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.