Aphthous Stomatitis Workup

Updated: Sep 25, 2020
  • Author: Ginat W Mirowski, MD, DMD; Chief Editor: William D James, MD  more...
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Approach Considerations

In 2013, Tappuni et al introduced the Ulcer Severity Score (USS) because of the lack of standardized assessment methods for aphthous stomatitis. [79] The USS incorporates six ulcer characteristics: number, size, duration, ulcer-free period, site, and pain. This scoring template may be of value to future studies assessing treatment efficacy, although at present it is not widely used. Challacombe et al suggest using the USS in combination with the Oral Health Related Quality of Life (OHR-QoL) score in order to better estimate the impact of clinically significant aphthous stomatitis on patients. [80]


Laboratory Studies

The following laboratory studies may be helpful:

  • Complete blood cell count; to rule out cyclic neutropenia, 5 consecutive weekly evaluations should be obtained
  • Measurement of erythrocyte sedimentation rate [81]

  • HIV status

  • Determination of iron, ferritin, total iron-binding capacity, folate, homocysteine, and vitamin B-6, B-12, B-1, and B-2 levels [16, 42, 82]

  • Serum antiendomysium antibody and transglutaminase assay (positive in celiac disease).

  • Tzanck smears and viral cultures: These may be necessary to exclude herpes simplex virus infection if the patient is severely immunocompromised, such as with advanced HIV disease.


Other Tests

The following procedures may be indicated if other disease is suspected:

  • Biopsy with hematoxylin and eosin stain and cultures

  • Skin pathergy test

  • Evaluation for uveitis

  • Laboratory studies for antinuclear antibody

  • Patch or sensitivity testing


Histologic Findings

Nonspecific ulcers with chronic mixed inflammatory cells are observed. The pseudomembrane covering of aphthae is a combination of oral bacteria and fungi, as well as necrotic keratinocytes and sloughed oral mucosa.