#1 My Patient Story: Recurrent Aphthous Stomatitis Case
My coass has been started this year and last week, exactly Nov 21st, 2017, Iâm entering and starting to work as the real operator for all of my patients at the Clinic, RSGM FKG UI (Klinik Integrasi FKG UI). The whole week was really new for me (since last week was my very first time to meet and deal with my own patient). Adaptation, knowledge, time management and mental preparation are the most important things to deal with my coass life. I know, it wonât be easy, but Iâm sure it will be worth it for my future life and career.
In this article, I want to share about my patient case who came to me at Wed 24th, November 2017.
A 19years old girl came with the chief complain that she has a tooth cavity in the posterior right maxilla. The clinical examination shows that She apparently has the D5 cavity (ICDA) or it means that the cavity reaches the second layer of the tooth and almost reaches the pulp. She feels pain is coming when She uses that tooth to chew the foods or sometimes the pain shows spontaneously. But She feels okay when She came to the clinic. She has oral hygiene index (OHIS) 2,68 or fair. Then, after the whole clinical examinations, I also found the oral ulceration in the labial mucous or near her lower lips. She claimed that She always have ulcer every month since She was in the junior high school which is about 6 years ago. It sounds really unique case for me, thatâs why I am trying to do anamnesis for this patient and digging deeper information about the ulcer. Iâm starting to ask the patient several important questions like:
· When is the ulcer appears?
· Is there any sign before the ulcer appears?
· Do you feel fever, queasy, or weak?
· Have you treat the ulcer before? What the meditation do you take?
· How long it usually recovered?
· How many ulcer showed up?
· Where is the location of the ulcer?
· Do you feel any pain when it appears?
· Is there any family who have the ulcer history?
· How often the ulcer appears?
· How much water you consume?
· How often you consume the vegetables and fruits?
· What is your activity nowadays?
· Etc.
Those questions above help me to analyze the predisposing factor that trigger the ulcer, and here the full answer from my patient: She claimed that this ulcer appears about two weeks ago, and She feels that it appears so small before She gives albothyl on it. Sheâs using albothyl directly using cotton bud on to the ulcer without dilute it with the water. She feels that after She uses the albothyl, the ulcer is getting bigger and painful, but She still use it until four times in the last two weeks. Sheâs giving up and finally stop the usage of albothyl and let the ulcer recover by it self. She told me that the ulcer often appear in the different locations, like in the lower lip, upper lip, tongue, gingiva or inside her cheek. Like what she said at the beginning, the ulcer always appear per month, since about 6 years ago and always appear not only one but sometimes two until five ulcers. She said that Sheâs so busy lately and have so many activities, thatâs why She feels lack of sleeps. She drinks two bottles of 1.5 L water per day. Sheâs rarely consume the vegetables and fruits. When She came to the clinic, She is menstruating. She claimed that her menstrual cycle is good and the ulcer can randomly appear before, at or even after her menstrual cycle.
From her explanations above, we can conclude that the ulcer is include in the type of Recurrent Aphthous Stomatitis (RAS) due to its repeated history. RAS is considered as the most common oral mucosal lesion. These present as recurrent, multiple, small, or ovoid ulcers, having yellow floors and are surrounded by erythematous haloes, present first in childhood or adolescence.
The cause of RAS is still unknown, but from the patientâs statement, we can conclude that this ulcer appears due to hormonal factor (as the predisposing factor for this ulcer). We can see that it appears start when She is in the puberty and there is no family history who have the same problem. Itâs also can be supported by the stress factor from the patient due to busy activities and lack of sleeps.
Besides ulcer, the patient also complain about her dry lips, or in dentistry we called it as a Cheilosis. Itâs normal to happen because like her confession before, that Sheâs actually have so many activities outside, which her lips exposed by the sun, beside that She also rarely consume the vegetables and fruits, thatâs why She might be lack of vitamin and mineral intake.
So, after analyzing the case of my patient, I decide to educate her about the clinical finding of her oral conditions. I told her that her ulcer is RAS type, which means that the predisposing cause is hormonal factor, and it could be appear any time with repeated condition. She also has to know the right meditation that She could use to treat the ulcer in a proper way. I give her medical prescription for Minosep 0,2% 100ml and ask her to use it by rinse her mouth twice a day after She brushes her teeth; I also give her Vaseline album 20g for her dry lips and ask her to apply it on her lips every time if needed.
Not forget to mention that I ask her  to improve her vegetables and fruit consumption; improve her sleeping time, and also stop using albothyl, because there is no evidence based stated that we can use albothyl to treat the ulcer.
Fortunately, the patient follows my advices, She uses the meditation with obedience and after one week of treatment the RAS is gone and her lips are not dry anymore.
This is the picture of the ulcer in the day the patient came to the clinic:
This is the picture after one week treatment with Minosep 0,2%, the ulcer is recover and there is no scar on the tissue:
Thatâs all for this case report. I hope it gives you information about RAS and the importance of using the right drug to treat it! I really open If you want to ask or discuss with me about dentistry cases.
Have a nice day, everyone! -Ama-