Contemporary Updates of Recurrent Aphthous Stomatitis

Abstract

 Recurrent Aphthous Stomatitis (RAS) is a recurrent, painful condition of the skin or mucous membranes, that commonly occurs after puberty. Minor aphthous ulcers appear on the lips, tongue, and buccal mucosa, though major lesions are more commonly found on non-keratinized areas. This review outlines the current knowledge on the etiology, pathophysiology, and clinical presentation of RAS, emphasizing the aspect of complex and multifactorial nature. A wide range of conducive factors has been recognized, including immune dysregulation, nutritional imbalances, hypersensitivity reactions, certain medications, mechanical trauma, exposure to toxins, poor oral hygiene, hormonal shifts, microbial imbalance, tobacco use, psychological stress, systemic diseases, and allergic tendencies. Furthermore, RAS is particularly common among students, with emotional stress and anxiety playing a significant role in triggering and perpetuating episodes. Environmental exposures, particularly to heavy metals may further aggravate the condition by promoting oxidative stress and disrupting the neuroimmune balance. Relevant literature was identified using PubMed, Scopus, and Web of Science databases with keywords such as “Recurrent Aphthous Stomatitis,” “oral ulcers,” “stress,” “heavy metal exposure,” and “oxidative stress.” Articles published in peer-reviewed journals over the past 20 years were screened using defined inclusion and exclusion criteria. Key data were extracted on clinical patterns, triggering factors, and environmental links, and the findings were integrated to present a comprehensive, evidence-informed understanding of RAS and its broader public health relevance.