Aphthous stomatitis caused by a reduction in numbers of CD4+ T cells may be implicated in RAS-type ulceration in HIV infection. The thickness of the mucosa may be an important factor in aphthous stomatitis. Usually, ulcers form on the thinner, non-keratinizing mucosal surfaces in the mouth. Factors which decrease the thickness of the mucosa increase the frequency of occurrence, and factors which increase the thickness of the mucosa correlate with decreased ulceration. The nutritional deficiencies associated with aphthous stomatitis (Vitamin B12, folate, and iron) can all cause a decrease in the thickness of the oral mucosa (atrophy). Local trauma is also associated
Aphthous stomatitis spicy and acidic foods and beverages. Many different topical and systemic medications have been proposed (see table), sometimes showing little or no evidence of usefulness when formally investigated. Some of the results of interventions for RAS may in truth represent a placebo effect. No therapy is curative, with treatment aiming to relieve pain, promote healing and reduce the frequency of episodes of ulceration. In cases of folate deficiency, daily folic acid (vitamin B9) supplements may prevent or reduce aphthous stomatitis reoccurrence. The first line therapy for aphthous stomatitis is topical agents rather than systemic medication, with topical corticosteroids being the