Keywords
Estomatitis aftosa recurrente; Deficiencias nutricionales; Vitamina B12; Ácido fólico; Hierro; Tratamiento.
How to Cite
Abstract
Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year-old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.
References
Jurge S., Kuffer R., Scully C., Porter S. R. Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis. 2006; 12: 1-21. https://doi.org/10.1111/j.1601-0825.2005.01143.x
Belenguer-Guallar I., Jiménez-Soriano Y., Claramunt-Lozano A. Treatment of recurrent aphthous stomatitis. A literature review. Journal of Clinical and Experimental Dentistry. 2014; 6 (2): e168-e174. doi:10.4317/jced.51401.
Scully C., Shotts R. Mouth ulcers and other causes of orofacial soreness and pain. BMJ: British Medical Journal. 2000; 321 (7254): 162-165.
Ship J. A., Chavez E. M., Doerr P. A., Henson B. S., Sarmadi M. Recurrent aphthous stomatitis. Quintessence Int. 2000; 31 (2): 95-112.
Akintoye S. O., Greenberg M. S. Recurrent Aphthous Stomatitis. Dental clinics of North America. 2014; 58 (2): 281-297. doi: 10.1016/j.cden.2013.12.002.
Baccaglini L., Theriaque D. W., Shuster J. J., Serrano G., Lalla R. V. Validation of Anamnestic Diagnostic Criteria for Recurrent Aphthous Stomatitis. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2013; 42 (4): 290-294. doi:10.1111/jop.12015.
Scully C., Porter S. Oral mucosal disease:recurrent aphthous stoma¬titis. Br J Oral Maxillofac Surg. 2008; 46: 198-206.
Chavan M., Jain H., Diwan N., Khedkar S., Shete A., Durkar S. Recu¬rrent aphthous stomatitis: a review. J Oral Pathol Med. 2012; 41: 577-83.
Preeti L., Magesh K. T., Rajkumar K., Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac Pathol. 2011; 15: 252-6.
Subramanyam R. V. Occurrence of recurrent aphthous stomatitis only on lining mucosa and its relationship to smoking—a possible hypothesis. Med Hypotheses. 2011; 77: 185-187. doi: 10.1016/j.mehy.2011.04.006.
Ślebioda Z., Szponar E., Kowalska A. Etiopathogenesis of Recurrent Aphthous Stomatitis and the Role of Immunologic Aspects: Literature Review. Archivum Immunologiae et Therapiae Experimentalis. 2014; 62.(3): 205-215. doi:10.1007/s00005-013-0261-y.
Cui R. Z., Bruce A. J., Rogers R. S. III. Recurrent aphthous stomatitis. Clin Dermatol. 2016; 34 (4): 475-81.
Wu Y. H., Yu-Fong Chang J., Wang Y. P., Wu Y. C., Chen H. M., Sun A. Hemoglobin, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia in Behcet's disease patients with atrophic glossitis. J Formos Med Assoc. 2018;117 (7): 559-565. doi: 10.1016/j.jfma.2018.03.005.
Bao Z. X., Shi J., Yang X. W., Liu L. X. Hematinic deficiencies in patients with recurrent aphthous stomatitis: variations by gender and age. Med Oral Patol Oral Cir Bucal. 2018 Mar 1; 23 (2): e161-7.
Sun A., Chen H. M., Cheng S. J., Wang Y. P., Chang J. Y., Wu Y. C., Chiang C. P. Significant association of deficiencies of hemoglobin, iron, vitamin B12, and folic acid and high homocysteine level with recurrent aphthous stomatitis. J Oral Pathol Med. 2015; 44 (4): 300-5. doi: 10.1111/jop.12241.
Koury M. J., Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12, and iron. Annu Rev Nutr. 2004; 24: 105-31.
Kozlak S. T., Walsh S. J., Lalla R. V. Reduced dietary intake of vita¬min B12 and folate in patients with recurrent aphthous stomatitis. J Oral Pathol Med. 2010; 39:420-3.
Lopez-Jornet P., Camacho-Alonso F., Martos N. Hematolo¬gical study of patients with aphthous stomatitis. Int J Dermatol. 2014; 53: 159-63.
Lee Y., Krawinkel M. The nutritional status of iron, folate, and vitamin B-12 of Buddhist vegetarians. Asia Pac J Clin Nutr 2011; 20 (1): 42-49.
Zijp I. M., Korver O., Tijburg L. B.: Effect of tea and other dietary factors on iron absorption. Crit Rev Food Sci Nutr 2000; 40: 371-398.
Gorczyca D., Prescha A., Szeremeta K., Jankowski A. Iron Status and Dietary Iron Intake of Vegetarian Children from Poland. Ann Nutr Metab. 2013; 62 (4): 291-297.
Schlesier K., Kühn B., Kiehntopf M., Winnefeld K., Roskos M., Bitsch R., Böhm V. Comparative evaluation of green and black tea consumption on the iron status of omnivorous and vegetarian people. Food Research International. 2012; 46 (2): 522-27.
Watanabe F. Vitamin B12 sources and bioavailability. Exp Biol Med (Maywood) 2007; 232 (10): 1266-1274.
Gilsing A. M., Crowe F. L., Lloyd-Wright Z., et al. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians, and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. European journal of clinical nutrition. 2010; 64 (9): 933-939. doi:10.1038/ejcn.2010.142.
Bai J. C., Fried M., Corazza G. R., Schuppan D., Farthing M., Catassi C., et al. World gastroenterology organisation global guidelines on celiac disease. J Clin Gastroenterol. 2013; 47 (2): 121-6.
González-Moles M. A., Scully C. Vesiculo-erosive oral mucosal disease--management with topical corticosteroids: (2) Protocols, monitoring of effects and adverse reactions, and the future. Review. J Dent Res. 2005; 84 (4): 302-8.
Tarakji B., Gazal G., Al-Maweri S. A., Azzeghaiby S. N., Alaizari N. Guideline for the Diagnosis and Treatment of Recurrent Aphthous Stomatitis for Dental Practitioners. Journal of International Oral Health : JIOH. 2015;7(5):74-80.
Lee J. H., Jung J. Y., Bang D. The efficacy of topical 0.2% hyaluronic acid gel on oral ulcers:comparison between recurrent aphthous ulcers and the oral ulcers of Behçet’s disease. J Eur Acad Dermatol Venereol. 2008; 22: 590-5.
Silverman S. Jr., Lozada-Nur F., Migliorati C. Clinical efficacy of prednisone in the treatment of patients with oral inflammatory ulcerative diseases: a study of fifty-five patients. Oral Surg Oral Med Oral Pathol. Apr; 1985 59 (4): 360-363.
Natah S. S., Konttinen Y. T., Enattah N. S., et al. Recurrent aphthous ulcers today: a review of growing knowledge. Int J Oral Maxillofac Surg. 2004; 33: 221-234.
Axell T., Henricsson V. Association between recurrent aphthous ulcers and tobacco habits. Scand J Dent Res 1985; 93: 239-42.