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Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus

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Abstract

Recurrent aphthous stomatitis (RAS) is characterized by painful, oral mucosal ulcers with wide range of prevalence ranging from 2 to 78%. Etiology of RAS is idiopathic and multifactorial. There are numerous gaps in assessment and management of RAS and the absence of guidelines or a consensus document makes the treatment further difficult. The aim of this document is to provide an Indian expert consensus for management of RAS. Experts from different specialties such as Otorhinolaryngology, Oral Medicine/Dentistry and Internal Medicine from India were invited for face to face and online meetings. After a deliberate discussion of current literature, evidence and clinical practice during advisory meetings, experts developed a consensus for management of RAS. We identify that the prevalence of RAS may lie between 2 and 5%. In defining RAS, we advocate three or more recurrences of aphthous ulcers per year as criterion for RAS. Investigation should include basic hematological (complete blood count) and nutritional (serum vitamin B12, and iron studies) parameters. Primary aim of treatment is to reduce the pain, accelerate ulcer healing, reduce the recurrences and improve the quality of life. In treating RAS, initial choice of medications is determined by pain intensity, number and size of ulcers and previous number of recurrences. Topical and systemic agents can be used in combination for effective relief. In conclusion, this consensus will help physicians and may harmonize effective diagnosis and treatment of RAS.

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Acknowledgements

We thank Dr Vijay Katekhaye (Quest MedPharma Consultants, Nagpur, India) for editorial assistance.

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and informed consent: Not applicable.

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Authors and Affiliations

  1. Bhargava ENT Clinic, Mumbai, India

    Samir Bhargava

  2. Divya Advanced ENT Clinic, Bhopal, India

    Satya Prakash Dubey

  3. Department of ENT, Trustwell Hospitals, Bangalore, India

    Deepak Haldipur

  4. Department of ENT and Head and Neck Surgery, TN Medical College and Nair Hospital, Mumbai, India

    Bachi Hathiram & Vicky Khattar

  5. Consultant ENT Surgeon, Vertigo and Deafness Specialist, Jagtap Hospital, Dhule, India

    Charuhas Jagtap

  6. Associate Professor of Medicine, , MGM Medical College and UHS, Kamathe,, Navi Mumbai, India

    Shriram Vasant Kulkarni

  7. Medical Affairs, Macleods Pharmaceuticals Ltd, Mumbai, India

    Ashwin Kotamkar, Parthasarathy Muralidharan & Amit Qamra

  8. MENTS Hospital, Bangalore, India

    Pradeep Kumar

  9. Avyan Research Center, Ranchi, India

    Abhishek Ramadhin

  10. Department of Oral Medicine and Radiology, Bharati Vidyapeeth Dental College, Navi Mumbai, India

    Sreenivasan Venkatraman

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  1. Samir Bhargava
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  2. Satya Prakash Dubey
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  3. Deepak Haldipur
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Contributions

All authors contributed to the development of consensus. The first draft of the manuscript was written by Sameer Bhargava and Jagtap Charuhas and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Author sequence is as per the alphabetical order of the last name.

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Correspondence to Charuhas Jagtap.

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Bhargava, S., Dubey, S.P., Haldipur, D. et al. Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus. Indian J Otolaryngol Head Neck Surg 75, 2672–2680 (2023). https://doi.org/10.1007/s12070-023-03708-2

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