Recurrent aphthous stomatitis (RAS): guideline for differential diagnosis and management

Aim Recurrent aphthous stomatitis (RAS) is a painful and common ulcerative form that can pose a diagnostic challenge. In fact, similar oral ulcers can appear secondary to a variety of welldefined pathological conditions. Thus, the purpose of this work was to update the current knowledge about RAS Methods A narrative review is presented aiming to clarify the extensive differential diagnosis of RAS and its management. Results Clinically, RAS ulcers need to be differentiated from Behçet’s disease, nutritional deficiencies, Crohn’s disease and ulcerative colitis, PFAPA, MAGIC, HIV and xerostomia-related oral ulcers. A thorough medical history and review of symptoms, in addition to a careful evaluation of any oral feature, will help the clinician understand whether the ulcers are related to a systemic disorder or can be defined as idiopathic. The management of RAS is also challenging and currently there is not a defined treatment for controlling the symptoms. Conclusion As a first aid in relieving the pain, topical applications of corticosteroids, antibiotics, and analgesics are highly recommended, while systemic therapy of RAS should be used in the case of multiple painful ulcerations compromising the quality of life of the patient. Also, natural anti-inflammatory substances from medicinal herbs, in the form of essential oils and extracts are promising agents in the management of RAS.