RASDX: Standardized diagnostic criteria for recurrent aphthous stomatitis.

Objectives:

Recurrent aphthous stomatitis (RAS), characterized by painful recurrent oral ulcers, is typically diagnosed via history and clinical examination. However, there is need for validated criteria to diagnose RAS without a clinical examination, for public health surveys and research studies. Thus, our aim was to validate a set of diagnostic criteria (RASDX) previously developed during hundreds of anamneses and examinations.

Methods:

Participants were enrolled during an ongoing case-control study at the University of Florida between June 2009 and March 2011. Exclusion criteria were: age below 13 years, relative enrolled, pregnancy, RAS-associated systemic disease, gastric surgery, interested because of perioral herpes, use of alcohol, tobacco or medications affecting the immune system in prior 24 hours, infection in prior 3 days, corticosteroid use in prior month and <2 RAS in past 6 months (cases). RASDX consisted of an initial phone screening using standardized questionnaires and recognition of RAS photos in the clinic. The results were compared to an examination by an oral medicine expert using an exact two-sided kappa statistic.

Results:

Of 115 persons who presented for a clinical diagnostic visit, 11 were withdrawn, including 5 persons due to instructions or scheduling issues and 6 persons with initial negative history who recalled at least one ulcer in life at the study visit. The remaining 104 participants were aged 18-50 years, 54% female, 64% White and 20% Hispanic. Of these, all 49 controls with negative RASDX had no clinical ulcers. One participant with undetermined RASDX had a mucocele. Of the 54 cases diagnosed with RAS by RASDX, 53 were clinically confirmed to have RAS lesions (kappa=0.98; p=<0.0001).

Conclusions:

RASDX, based on a combination of history and photograph recognition, was highly accurate compared to a diagnosis that employed an oral examination. This observation should be confirmed by independent studies of other populations before generalizing.