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 and keratinization. This subgroup often experiences remission during pregnancy. However, other studies report no correlation between aphthous stomatitis and menstrual period, pregnancy or menopause. Aphthous stomatitis is uncommon in people who smoke, and there is also a correlation between habit duration and severity of the condition. Tobacco use is associated with an increase in keratinization of the oral mucosa. In extreme forms, this may manifest as leukoplakia or stomatitis nicotina (smoker's keratosis). This increased keratinization may mechanically reinforce the mucosa and reduce the tendency of ulcers to form after minor trauma, or present a more substantial barrier to microbes and