Predisposing factors in recurrent aphthous stomatitis and geographic tongue: A case report

Dwi K. Sari, Gus P. Subita, Ambar K. Astuti

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Introduction: To provide an overview of the predisposing factors for recurrent aphthous stomatitis (RAS) and geographic tongue (GT) in a young female patient. Case report: A 21-year-old woman presented with a large, painful lesion on the left lip for seven days. The patient was used to experiencing canker sores 3 or 4 times a year. In addition, she complained of pain, sores, and heat on the tongue. Upon intra-oral examination, we found a single, irregularly shaped ulcer, with a white base and surrounded by erythema in the left labial mucosa and multiple erythematous lesions surrounded by white edges and migratory in the dorsal, ventral and lateral of her tongue. We diagnosed the patient as having a minor recurrent aphthous stomatitis (RAS) and symptomatic geographic tongue (GT) and prescribed chlorhexidine gluconate 0.2% and multi-vitamins. At the next visit a month later, the initial RAS lesions had disappeared but a few new ones had appeared; the GT lesions were still present. Suspecting that there could be psychological reason for prolonged duration of the oral lesions, the patient was then given Perceived Stress Scale (PSS) questionnaires. In search for other predisposing factors, the patient also was sent for CBC examination. PSS score showed mild stress in patient and CBC results of normal Hemoglobin (13.1g/dL), low count on MCV (71.8fL), and decrease count on MCH (23.4pg). From these results we concluded that stress, small average red blood cells and low average content of hemoglobin per red cells have contributed to the clinical picture. Without anemia, condition of low blood count as describe above called pre-anemic stage. The complete management for these cases should include communication, information and education and dietary recommendations, including taking multi-vitamins, and finding stressors to implement interventions to alleviate the stress. Conclusion: Finding and eliminating stressors and pre-anemic stage as predisposing factors may influence the success of RAS and GT management.

Original languageEnglish
Title of host publicationClinical Reports in Dentistry
PublisherNova Science Publishers, Inc.
Number of pages9
ISBN (Electronic)9781536173291
ISBN (Print)9781536173284
Publication statusPublished - 3 Apr 2020


  • Geographic Tongue (GT)
  • Perceived tress scale
  • Pre-anemic stage
  • Recurrent Aphthous Stomatitis (RAS)
  • Stress


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