Table 3

Overview—a structured approach to the management of RAS

HistoryExaminationInvestigationsManagement
To EXCLUDE systemic features that may indicate other causes and differentiate between herpetic and non-herpetic RAS:Continued monitoring of pain, dehydration, healing and treatment response

  •  Age at first onset

  •  Prodrome

  •  Onset

  •  Duration (days)

  •  Pain Severity

  •  Ulcer-free period (weeks)

  •  Site

  •  Number

  •  Size and depth (mm)

  •  Scarring

  •  EXCLUDE involvement of other systems (skin, eyes, joints)

  •  Growth

Full blood count, blood film, haematinics, viral swab for diagnostics

  1. Pain management:

    •  Topical anaesthetics

  2. Manage dehydration:

    •  Advice on feeding

    •  Promote healing

  3. Promote healing:

    •  Antimicrobial mouthwash

    •  Topical steroids

    •  Oral aciclovir if likely herpetic ulcers

  4. Preventative treatment:

    •  Oral valaciclovir

    •  Consider steroids and colchicine (rare)

  • RAS, recurrent aphthous stomatitis