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A Patient Having Recurrent Aphtous Stomatitis After Three Years Of ion Res ict ea d rc d h A & f o T Journal of l h a e n r r a u p Unal et al., J Addict Res Ther 2014, 5:4 o y J 10.4172/2155-6105.1000202 ISSN: 2155-6105 Addiction Research & Therapy DOI: Case Report Open Access A Patient Having Recurrent Aphtous Stomatitis After Three Years of Smoking Cessation; A Case Report and Review of Literature Mustafa Unal1, Bektas Murat Yalcin2* and Onur Ozturk3 1 Department of Family Practice, Asistant Professor, Dr.Ondokuz Mayis University Medical Faculty, Turkey 2 Department of Family Practice, Associate Professor, Dr. Ondokuz Mayis University Medical Faculty, Turkey 3Family Physician, Samsun Education and Specialization State Hospital, Turkey *Corresponding author: Bektas Murat YALCIN, Associate Professor, Ondokuz Mayıs University medical Faculty Department of Family Medicine Kurupelit/Samsun, Turkey, Tel: 0362 3121919-346 ; E-mail: [email protected] Received date: December 18, 2014, Accepted date: December 29, 2014, Publication date: December 31, 2014 Copyright: © 2014 Unal M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Cigarette smoking is the foremost health risk issue affecting individuals of all age groups globally. It is the most important causes of the preventable deaths and diseases. Aware of these facts many smokers wish to quit. However smoking cessation is though for smokers who experiences many unpleasant and troublesome physiological or psychological problems. After cessation oral ulcers and other oral aphtous lesions which are considered as mild and expected to disappear in time, can be seen. These problems are attributed with either nicotine withdrawal or nicotine replacement therapy. Recurrent oral aphtous stomatitis however can be very severe and diminish quality of life even some years after cessation. There are growing epidemiologic evidences for the effects of tobacco use and tobacco cessation therapy on a variety of oral diseases and conditions. In this case report we would like to introduce an ex-smoker patient who had severe recurrent aphtous stomatitis attacks for three years after he had quitted and the current data about the management of oral ulcers and aphtous stomatitis. Keywords: Tobacco; Smoking; Cessation; Recurrent aphtous after a month. Quitting smoking was not a problem for him. But each stomatitis; Resistant oral ulcers time oral ulcers in various places were appearing and preventing him eating or drinking. He was seeking medical help visiting Introduction dermatologists and family physician, using various mouthwashes and local corticosteroids but nothing seemed working. At the end he was The use of tobacco products has significant effect on oral health feeling compelled to start smoking again and soon after starting the such as tooth stains, abrasions and loss, smoker's melanosis, acute ulcers was disappearing for good or recurring only mild form for a necrotizing ulcerative gingivitis and other periodontal conditions, brief period. However, he was very motivated to quit smoking but burns and keratotic patches, black hairy tongue, nicotinic stomatitis, afraid to have oral ulcers. Therefore first we explained that potential palatal erosions, leukoplakia, epithelial dysplasia and squamous-cell harms of smoking outweighs any unwanted effects of quitting carcinoma. [1] Smoking cessation is a difficult process that causes including oral ulcers, secondly we offered him to device more effective some unwanted effects such as oral ulcers and aphtous lesions [2]. strategies to combat the problem and lastly we reassured him to be on These problems are considered as frequent, normally mild and early to his side in every stages of the problems. mid-term nicotine withdrawal symptoms. However some of them are quite severe and requires more investigation and intervention. The Oral Aphtous Lesions purpose of this paper is to present an ex-smoker whose main problem was not quitting smoking but suffering from recurrent aphtous This term comes from Greek word “aphtha”, meaning ulceration stomatitis (RAS) even after three years and review the evidences about [3]. It is a common condition which is characterized by the topic. He had numerous attacks and among all treatment multiple recurrent small, round ulcers with circumscribed margins, modalities he trusted oral vitamin B12 most. erythematous haloes, and yellow or grey floors [4]. They appear on lips, gingiva, buccal mucosa, tongue and more rarely on palate, tonsil Case (Part 1) and pharynx. In our case the first attack after cessation was on right tonsil and when he complained about sore throat he was prescribed E.S. was a 46 year old male patient, security officer in the university, antibiotics by his family doctor. His tonsil was red but not swollen. applied to smoking cessation clinic in Department of Family Practice, Three types of aphthae are described; Minor aphthae, smaller than 1 Medical Faculty of Ondokuz Mayis University. He had started cm in diameter and 1-5 in numbers are seen in 80-85% of the cases. smoking at 15 and buying package at 16. He had “9” points from They heal in 4-14 days without leaving any scars. Major aphthae, Fagerstrom Nicotine Dependence Test and his tobacco consumption larger than1 cm in diameter and 1-10 in number are seen in 15% of the were calculated as 36 package/year. He had three attempts to quit case. They are more painful, healing takes longer (2-6 weeks) and leave smoking previously on his own without professional assistance. First scar. Herpetiform aphthae (5%) are painful groups of many 2-3 mm was 22 years ago and relapsed in 10 days, second 20 years ago and aphthae that heal in 10-14 days without leaving scar [5]. They first relapsed after a week and last was 2 years ago and he relapsed again J Addict Res Ther Volume 5 • Issue 4 • 202 ISSN:2155-6105 JART, an open access journal Citation: Unal M, Yalcin BM, Ozturk O (2014) A Patient Having Recurrent Aphtous Stomatitis After Three Years of Smoking Cessation; A Case Report and Review of Literature . J Addict Res Ther 5: 1000202. doi:10.4172/2155-6105.1000202 Page 2 of 5 occur in earlier ages than other aphthae and if recurrent, an The diagnosis of recurrent aphthous stomatitis (RAS) is made in the underlying systematic disease should be suspected [6]. presence of typical ovoid or round ulcer on examination and history of oral ulcers since childhood. The prevalence of RAS in society is around Some patients feel tingling and burning 1-2 days before aphthae 5-66% with a lifetime prevalence of 36.5 % [10]. Although RAS is formation. The most common patient complaints are pain and considered more common in women, some studies claim the difficulty of eating and swallowing. Speaking difficulty can be seen in prevalence is equal in both sexes [11]. RAS is more common in people some patients [7]. Behçet's syndrome should be suspected if genital with high socioeconomic status, under the age of 40 and white race. ulcers are seen alongside with Aphthae. [8]. In recurrent aphthae, the The prognosis is worse in those with RAS beginning under the age of patient should be examined for inflammatory intestinal diseases, five [12]. Reiter syndrome, systemic lupus erythematosus, celiac disease, neutropenia, iron and folic acid deficiency [3-6]. Diseases and conditions associated with recurrent aphthae are seen in Table 1 [1-6,9]. Gastrointestinal diseases Rheumatoid Diseases Microbial Diseases Bullous and lichenoid dermatoids Reactive Other Diseases Malignant Diseases Table 1. The diseases and conditions responsible for RAS Case (Part 2) considered that the hormonal changes during pregnancy, premenstrual and menopausal period increase RAS prevalence [3]. After a motivational interview with the patient we advise the The role of diet in the RAS etiology has been examined frequently. patients to exercise some life style modifications described elsewhere Gönül, et al, stated that parsley, orange, white cheese, tea, lemon, [13]. In the initial physical examination the vital signs and all systems yoghurt and lettuce could have a role in RAS pathogenesis [16]. While checks were normal (systolic and diastolic blood pressure 120 / 80 mm walnut, chocolate and brown bread could provide protection, over Hg). His body mass index was 25 kg / m2 with a waist circumference consuming tea and herbs could cause aphtha. [9]. psychological factors of 98 cm. He had no history of head trauma, epilepsy or seizures, are implicated in aphtha formation [17]. Iron, vitamin B12 and folic eating disorders or any symptoms of cardiovascular disease. acid deficiencies are reported in RAS patients two times more than Hemoglobin level, differential white cell account, red cell indices and controls [18]. In patients with neutropenia RAS is seen more blood chemistry were all normal (Including lipid panel, ALT, AST, frequently [19]. Toothpastes containing sodium lauryl sulphate are fasting blood glucose, urea, creatinine etc.). He used Bupropion 150 blamed in RAS etiology [20]. mg daily initially for three days and then the dose was increased to 300 mg a day. He tolerated the drug well with no important side effect. He Aphtous ulcers and RAS appear to occur less frequently in smokers quitted smoking at the 14th day totally and 2 mg nicotine gum 6 times than non-smokers [21, 22]. Smoking cessation results in worsening of a day started at the same day. When he came a week later for the first aphtous ulcers, and resumption of smoking improves the condition after cessation visit he had three ulcers about 1x1 cm in diameter, one [23]. Cessation of smoking may precipitate or exacerbate RAS in some on the soft palate, one on the right tonsil and one on the border of the cases. The hypothesis is that smokers develop mucosal tongue.
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