Talk:Aphthous stomatitis/Archive 2

Archive 1

Archive 2

Don't think it should be added

I was going to replace the following, but after a bit of research there doesn't seem to be much use of the compound - there's only the one study on pubmed, wikipedia doesn't have an article, and the pubmed abstract is 10 years old with no follow-up. Ergo, I don't think there's much point. WLU (talk) 17:20, 8 May 2008 (UTC)

Some dentists precribe the drug for recurrent aphthous ulcers. Debacterol is a liquid mixture of sulfonated phenolic compounds and sulfuric acid that work as a topical debriding agent that forms a natural barrier over the ulcer site.Rhodus NL, Bereuter J (1998). "An evaluation of a chemical cautery agent and an anti-inflammatory ointment for the treatment of recurrent aphthous stomatitis: a pilot study". Quintessence Int. 29 (12): 769–73. PMID 10196853. {{cite journal}}: Unknown parameter |month= ignored (help)

it's a pilot study anyway. The best one could hope for out of it is that further research may have significant findings. Results from a pilot study should not be used in a encyclopedia unless maybe it is in support of a phenomena that is already understood intuitively and just doesn't have any scientific studies performed yet.65.10.148.213 (talk) 04:18, 5 November 2008 (UTC)

UPDATE: there is still only 1 primary source on Debacterol listed on PubMed. No google books results. None of the secondary sources currently used in the article appear to list debacterol. Not convinced it is commonly used. Reference to Debacterol removed already by another user. 188.28.128.90 (talk) 20:09, 29 June 2014 (UTC)

Treatment section tidyup

<copied over from User talk:Davidruben> I ended up re-writing the treatment section, thus, which deleted your reference to UK treatment options. I basically removed everything that didn't have a source, unfortunately that included the text you inserted here. My WP:PROVEIT approach tends to be a bit scorched earth, I think most of the information is still there in a more general form. I'll be adding a bit of text back, but after that edit I think I'm done; feel free to re-insert. I ended up with an edit conflict and over-wrote (worst collaborator ever!), I don't know if you prefer my more generic version, or your more specific one. Please feel free to expand if you'd like. WLU (talk) 17:15, 8 May 2008 (UTC)

I'm done, earth is scorched, feel free to replace. WLU (talk) 17:22, 8 May 2008 (UTC)

No problem, I approve of the tidyup :-) I had only reinserted topical soothing agents, which in turn had been a past sort-out of multiple brand-name articles which I converted into redirects. So see 11 March 2008 overall work on article and then 17 March 2008 as the brand name articles made into redirects.

I've reordered your well sourced material to give a step up through treatments (vs tetracyclines being mentioned near the top). Your WP:PROVEIT approach spurred me to try and find links for the OTC management of oral ulcers, which forms by far the greatest treatment of this common condition, albeit out of the oversight of us doctors and with very little formal supportive evidence ("lack of evidence of effectiveness" of course not being "evidence of lack of effect"), still I managed to come up with some official and well respected UK links (as well as NEJM) refs to confirm usage.

Let me know what you think :-) David Ruben ^Talk 03:19, 9 May 2008 (UTC)

Looks good, I re-wrote it some more and tried to chunk the information a bit as well as adding some more involved references on the evidence for some OTC stuff. One thing I did change was to remove the brand names of medications - if the sources name them that's OK, but they're not going to be useful world-wide. In my mind the active ingredient is the important information (plus I dislike putting up brand names if I can avoid it because of a generational knee-jerk anti-corporate sentiment). Is the weasel word tag still needed? I haven't read through from top to bottom.

I love PROVEIT for it's ability to kick-start sourcing and expansion : ) Also a great shortcut title. WLU (talk) 15:02, 9 May 2008 (UTC)

Vast improvement in structure and clarity of description - well done - I must remember to consider asking you to review some of my future convoluted article edits :-). David Ruben ^Talk 19:27, 9 May 2008 (UTC)

Not a problem, I like copy-editing when I've got the time but finding the time is difficult these days. --WLU (talk) 19:41, 9 May 2008 (UTC)

The linked page for the reference to L-Lysine at NIH (footnote 33) does not cite lysine as a potential treatment of cankersores/aphthous ulcers, but rather for cold sores/herpetic lesions, since the NIH page deals with both topics. I suggest that this reference and recommendation be removed or at a minimum toned down. The NIH page speculates that cankersores might be caused by a virus, and if it is, and that virus is in the herpes family and lysine is actually effective for reducing the symptoms of herpetic lesions, then lysine might also help cankersores, but there's an awful lot of 'if' and 'might' in that line of argument. —Preceding unsigned comment added by 75.212.165.232 (talk) 18:59, 7 October 2010 (UTC)

Causes

The causes section seems to say that SLS does and does not cause these sores. Maybe it would be helpful to change the wording to be more accurate? I.e. causation versus correlation? --Jp07 (talk) 05:40, 21 October 2008 (UTC)

Walnuts are a known cause, according to the UCSF Oral Medicine faculty. Watch that fudge at Christmas time!

• I think it´s short of inadequate to gather all kind of ulcers in the mouth as afte. Afte are considered idiopatic recurrent ulcerations - hence of unknown etiology. In prehistoric times they were called `aftae recurrentes `- recurrent afte - so they could be distinguished from ulcerations of known etiology.  ;-) jmak (talk) 09:31, 24 December 2009 (UTC)

The causes section should mention Behçet's Disease. Mouth sores are a hallmark symptom of this disorder. I would add it myself, but still have not figured out the whole reference-citing thing. (References for mouth sores in Behçet's Disease can be found in the Wikipedia article of the same name.) Leha Carpenter (talk) 17:54, 14 March 2010 (UTC)

I've done as you suggest, but I think there's a risk that this article will become unfocused if all causes are listed; jmak makes an excellent point in highlighting the need for determining whether common practice is to consider only idiopathic oral ulcers to be "aphthous", or all ulcers with similar gross characteristics. -- Scray (talk) 20:48, 14 March 2010 (UTC)

I see no mention of B12 deficiency in the article. Recent studies suggest that B12 deficiency can cause aphthous ulcers. For example, see Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis and Aphthous ulcers and vitamin B12 deficiency.67.58.84.150 (talk) 18:00, 15 June 2011 (UTC)

Coldsore Vs Cold Sore

Why does "Cold sore" redirect here but "Coldsore" (one word) redirects to Herpes AFIK doctors use coldsore to refer exclusively to herpes pustules not to aphthous ulcers —Preceding unsigned comment added by 74.72.241.193 (talk) 06:59, 11 November 2008 (UTC)

Some of these are not true!!! —Preceding unsigned comment added by 71.147.7.113 (talk) 02:38, 31 March 2010 (UTC)

Smoking

It´s noticible you revert smoking when stopping smoking is a well known factor to precipitate afte jmak (talk) 09:10, 24 December 2009 (UTC)

phonetic?

How would one pronounce this?

AP-thus, with a hard 'th,' as in 'with.' 148.177.1.216 (talk) 14:14, 18 June 2009 (UTC)

I attempted to transcribe the pronunciation you describe. dictionary.com gives parochial pronunciations so it's unclear what they mean. I omitted suprasegmentals which someone may want to add. -Craig Pemberton 19:10, 2 March 2010 (UTC)

Commercial treatments

A new editor added this section:

The use of Canker-Rid has been reported by many to quickly and effectively treat the canker sores.

Canker-Rid users also report that taking Queen's Delight has drastically reduced or eliminated canker sores from occuring.

I think this needs some independent verification before it goes in here. Bhimaji (talk) 21:13, 30 December 2008 (UTC)

While this cannot be added to the page because it's impossible for me to provide independent verification, Kanka is amazing stuff. It coats the thing and keeps it from hurting for quite a while. —Preceding unsigned comment added by 96.39.163.151 (talk) 04:32, 15 January 2009 (UTC)

If this stuff is good than one should be able to find an RCT. --Doc James (talk · contribs · email) 15:03, 11 March 2009 (UTC)

I recently started using a commercial stick-on patch called "Canker Cover". I've tried every treatment under the sun across the last 35 years and this is the first thing which I could call a "miracle cure". The pain stops in seconds and the ulcer is gone in 18 hours. I don't have any scientific references but this stuff is going to obsolete every other treatment, methinks. 64.47.56.210 (talk) 21:01, 21 March 2009 (UTC)

If it is so go all we need is a small study to show effectiveness. So as that is published we can add it.--Doc James (talk · contribs · email) 22:02, 21 March 2009 (UTC)

There is a product called Canker Cure which comes in the form of pills. It not only heals existing canker sores but also prevents new ones from occuring, when taken on a regular basis. I've had canker sores all my life, occuring about about once per month. Since I started using this product 2 years ago I haven't had any. Their website goes into detail about how the product works on the molecular level. —Preceding unsigned comment added by 68.104.1.120 (talk) 19:39, 22 December 2009 (UTC)

Inaccurate

This page needs lots of work. We need to base it on a couple good literature reviews.

• Altenburg A, Zouboulis CC (2008). "Current concepts in the treatment of recurrent aphthous stomatitis". Skin Therapy Lett. 13 (7): 1–4. PMID 18839042. {{cite journal}}: Unknown parameter |month= ignored (help)

--Doc James (talk · contribs · email) 15:02, 11 March 2009 (UTC)

This source now utilized in the article. 188.28.128.90 (talk) 20:09, 29 June 2014 (UTC)

"Ulcerous ulcer"?

"An aphthous ulcer, [...] The term aphtha means ulcer; [...]" An ulcerous ulcer.. Wouldn't the correct term be Aphthous Stomatitis? 80.202.121.148 (talk) 22:38, 21 December 2009 (UTC)

This is now discussed in the article, with references. It is a half-truth as far as I have been able to uncover. Aptha in greek means "ulcer" or alternatively "eruption". So I think it depends on the translation. We also have a few secondary sources explicitely stating that the term "aphthous ulcer" is in common use. 188.28.128.90 (talk) 20:09, 29 June 2014 (UTC)

How to diagnose the cause ?

Hi all,

I was wondering, is there a way to diagnose the cause of the Aphtous ulcer ?

I failed to have found a doctor that knew of tests to perform in order to better know what causes the wounds.

Thanks.

Talgalili (talk) 14:14, 7 January 2010 (UTC)

The diagnosis section is better now. Blood tests maybe, but most of diagnosis comes from patient history. 188.28.128.90 (talk) 20:09, 29 June 2014 (UTC)

Use of glutamine (L-glutamine) to treat or prevent

I believe certain studies have shown the benefits; some of them relate to people who got the sores during cancer treatment.

http://www.ncbi.nlm.nih.gov/pubmed/9762946?dopt=Abstract

http://www.ncbi.nlm.nih.gov/pubmed/9722068?dopt=Abstract —Preceding unsigned comment added by 75.85.14.106 (talk) 13:13, 3 March 2010 (UTC)

This edit

I removed the new content because it represented original research and, in presenting medical recommendations rather than being directed to improving the article content itself, violated Talk page guidelines. I meant to simply revert, but hit rollback instead. I'm commenting here as a surrogate for the edit summary I would have entered. -- Scray (talk) 02:00, 14 March 2010 (UTC)

Contagious?

I get these things like crazy, but no girl I've ever made out with has ever had to deal with them. If anyone can find a source on the non-contagious nature of the condition, please mention it early on. Cold sores CAN be passed on because they are viral, but canker sores can't because they are an immune system peculiarity. —Preceding unsigned comment added by Neveos (talk • contribs) 07:28, 31 May 2010 (UTC)

Aphthae are not contagious, we have this reliably sourced in the article now. 188.28.128.90 (talk) 20:14, 29 June 2014 (UTC)

Link to Canker Sore Toothpaste?

I added a link to a canker sore toothpaste and Doc James removed it for good reason (I wasn't following external link guidelines). I'd like to get feedback as to whether it is useful to add to the external links section of the page. I think the value of the link is the 172 reviews of the toothpaste, many of which indicate that the toothpaste solved their canker sore problem. I too am someone who had his canker sore problem solved by changing to a toothpaste without SLS (though not the linked-to one), so I'm biased. And, reviews like this don't come close to comparing to a real scientific study. But, I think they contribute something to the canker sore body of knowledge. Thoughts?

Jrennie (talk) 02:05, 20 June 2010 (UTC)

Health claims need to be based on WP:MEDRS. As ulcer resolve on their own without a control group there is no way to decide if this is effective. Not appropriate as an external link either. Doc James (talk · contribs · email) 03:41, 20 June 2010 (UTC)

I agree with the application of WP:EL here - it's a good illustration of the value of this WP guidance. Testimonials are not reliable. If this really works, it should be studied, published in a reliable source, and then cited. -- Scray (talk) 03:50, 20 June 2010 (UTC)

In particular, WP:ELNO #5 specifically says that such a link should not be included in the external links section. Thanks for the poitners. -- Jrennie (talk) 22:35, 21 June 2010 (UTC)

links to PubMed

Material inserted on Talk page without discussion of how it might be used in the article -- Scray (talk) 02:21, 8 August 2010 (UTC)

(start of collapsed content)

PMID 17848886

PMID 17850936 —Preceding unsigned comment added by 68.165.11.148 (talk) 16:42, 7 August 2010 (UTC)

Guidelines for diagnosis and management of aphthous stomatitis PMID 17848886

Femiano F, Lanza A, Buonaiuto C, Gombos F, Nunziata M, Piccolo S, Cirillo N.

Guidelines for diagnosis and management of aphthous stomatitis

PMID 17848886

Pediatr Infect Dis J. 2007 Aug;26(8):728-32.

Stomatology Department, II University of Medicines and Surgery, Naples, Italy. femiano@libero.it

Abstract

Aphthous ulcers are the most common oral mucosal lesions in the general population. These often are recurrent and periodic lesions that cause clinically significant morbidity. Many suggestions have been proposed but the etiology of recurrent aphthous stomatitis (RAS) is unknown. Several precipitating factors for aphthous ulcers appear to operate in subjects with genetic predisposition. An autoimmune or hypersensitivity mechanism is widely considered possible. Sometimes aphthous ulcers can be the sign of systemic diseases, so it is essential to establish a correct diagnosis to determine suitable therapy. Before initiating medications for aphthous lesions, clinicians should determine whether well-recognized causes are contributing to the disease and these factors should be corrected. Various treatment modalities are used, but no therapy is definitive. Topical medications, such as antimicrobial mouth-washes and topical corticosteroids (dexamethasone, triamcinolone, fluocinonide, or clobetasol), can achieve the primary goal to reduce pain and to improve healing time but do not improve recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective.

PMID 17848886 [PubMed - indexed for MEDLINE]

cf PMID 17850936 —Preceding unsigned comment added by 68.165.11.148 (talk) 16:48, 7 August 2010 (UTC)

Scully C, Porter S.

Oral mucosal disease: recurrent aphthous stomatitis

Br J Oral Maxillofac Surg. 2008 Apr;46(3):198-206. Epub 2007 Sep 11.

University College London, Eastman Dental Institute, London, UK. c.scully@eastman.ucl.ac.uk

Abstract

Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is common worldwide. Characterised by multiple, recurrent, small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors, it usually presents first in childhood or adolescence. Its aetiology and pathogenesis is not entirely clear, but there is genetic predisposition, with strong associations with interleukin genotypes, and sometimes a family history. Diagnosis is on clinical grounds alone, and must be differentiated from other causes of recurrent ulceration, particularly Behçet disease - a systemic disorder in which aphthous-like ulcers are associated with genital ulceration, and eye disease (particularly posterior uveitis). Management remains unsatisfactory, as topical corticosteroids and most other treatments only reduce the severity of the ulceration, but do not stop recurrence.

PMID 17850936 —Preceding unsigned comment added by 68.165.11.148 (talk) 16:51, 7 August 2010 (UTC)

(end of collapsed content)

"Study on 10,000 people suffering from canker sores" - unreliable?

Source: http://www.aftazen.com/discover-our-study-on-canker-sores

The statistics of this informal "study" are taken from voluntary response. Subjects are not asked when their condition has broken out strongest, but rather, simply what age the subjects are at the time of the submission. For the record, I don't think lots of kids are going to take the time to fill out this (60 second) survey.

See for yourself: http://www.aftazen.com/join-our-study-on-canker-sores

X-Fi6 (talk) 01:42, 27 July 2011 (UTC)

removing links to "howtoremovecankersores.com"

the website isn't of any substance other than being a huge advertising billboard — Preceding unsigned comment added by Jessyisasmith (talk • contribs) 03:39, 29 June 2012 (UTC)

Agreed, and removed. Yobol (talk) 03:42, 29 June 2012 (UTC)

picture captions reversal...

why does the caption of the picture in mouth ulcer say that it is an aphthous ulcer and the caption of the picture in aphthous ulcer say that it is a mouth ulcer. lesion (talk) 02:08, 27 December 2012 (UTC)

also, would the "gallery" be better on the mouth ulcer page? Canker sores (i.e. aphthous ulceration), Herpes labialis, Angular cheilitis and Chapped Lips...the other pictures are different conditions to aphthous ulceration...aphthae are a type of mouth ulcers, and there can be many other types of mouth ulceration, including these listed in this gallery. lesion (talk) 02:13, 27 December 2012 (UTC)

Requested move

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: Move to Aphthous stomatitis. Per the discussion below, this seems to be the title that most effectively satisfied WP:MEDMOS. Yunshui 雲‍水 15:08, 19 February 2013 (UTC) Yunshui 雲‍水 15:08, 19 February 2013 (UTC)

---

Aphthous ulcer → Recurrent oral aphthae – as per WP:MEDMOS#Naming_conventions we should be using "the scientific or recognised medical name that is most commonly used in recent, high-quality, English-language medical sources". The ICD-10 classification of this condition is "Recurrent oral aphthae". lesion (talk) 17:14, 23 January 2013 (UTC) Also, this page really is about the group of disorders characterized by aphthous stomatitis, rather than discussing the characteristics of an "aphthous ulcer" in abstraction from its causative factors. In fact, all but a few sentences in the article are about the disorders, only one or two in the lead are specifically about an aphthous ulcer. I hope this makes sense, I don't feel I am explaining this point very well. A similar example would be the mouth ulcer page, really this should be named oral ulceration.lesion (talk) 02:04, 24 January 2013 (UTC)

• Comment. Either way, both aphthous and aphthae are completely obscure to me. Apteva (talk) 04:04, 26 January 2013 (UTC)
• Aphtha is an old term meaning ulcer. Now it means a specific type of ulceration, even though "aphthous ulcer" technically means ulcer-ulcer. I think aphthae is the plural, and aphtha singular. Aphthous is an adjective, like ulcerous.lesion (talk) 07:07, 26 January 2013 (UTC)
• Why not canker sore for a more WP:COMMONNAME name instead of an official name name? Biosthmors (talk) 00:10, 6 February 2013 (UTC)
• Yes clearly canker sore per WP:COMMONNAME. Zad68 00:48, 6 February 2013 (UTC)
• does WP:COMMONNAME override our own WP:MEDMOS#Naming_conventions ? Lesion (talk) 01:33, 6 February 2013 (UTC)

• You're right, the two guidelines are in direct opposition to each other... I don't know! Zad68 04:44, 6 February 2013 (UTC)

I don't think the guidelines are in opposition. COMMONNAME says to use the term commonly used in reliable sources. For a medical topic, that would be MEDRS. MEDRS commonly use "aphthous ulcer". -- Scray (talk) 06:24, 6 February 2013 (UTC)

• Oppose move, per my comment immediately above. -- Scray (talk) 06:24, 6 February 2013 (UTC)

BTW, that there is a term "recurrent oral aphthae" (as noted above) does not invalidate the term "aphthous ulcer" for the lesion that defines that condition. -- Scray (talk) 06:27, 6 February 2013 (UTC)

• Scray, I feel your comment above and recent edits of mouth ulcer are borne of misunderstanding on this topic. I am still getting my head around this, but I think there is no histologic difference between aphthous ulceration and many other causes of oral ulceration. The addition of the term aphthous implies a specific type of oral ulceration that is recurrent and occurs for largely unknown reasons. This is incredibly common phenomenon and the most popular medical term has changed a bit over time. Currently it is "recurrent aphthous stomatitis", but then I looked at the ICD code and wasn't sure if that was best. Textbooks of oral medicine have an oral ulceration chapter, which is largely occupied by "RAS". RAS is subdividied into the 3 main clinical variants, but also "RAS like ulceration" or similar term meaning RAS associated with systemic disease or syndromes. I am finding it difficult to explain, but my main point I guess is that aphthous ulceration is only aphthous ulceration if there is recurrent oral oral ulceration in the patterns described in this article. Any individual "aphthous ulcer" is just a mouth ulcer, it is the clinical presentation and history that makes it aphthous. Really, this article discuses recurrent oral ulcers that form for largely unknown reasons, which medicine has traditionally grouped together under various names...and the current most popular term I feel is RAS, although ICD-10 uses "recurrent oral aphthae". Lesion (talk) 08:56, 6 February 2013 (UTC)

• I looked through all the textbooks I have on the subject to see which term is most common use:

Textbook	Term used
<ref>{{cite book|last=Tyldesley|first=Anne Field, Lesley Longman in collaboration with William R.|title=Tyldesley's Oral medicine|year=2003|publisher=Oxford University Press|location=Oxford|isbn=0192631470|edition=5th ed.}}</ref> p52	Recurrent Aphthous Stomatitis (RAS)
<ref>{{cite book|last=Scully|first=Crispian|title=Oral and maxillofacial medicine : the basis of diagnosis and treatment|year=2008|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780443068188|edition=2nd ed.}}</ref>p151	RAS (although chapter is headed "Aphthae", RAS is used thereafter in the chapter
<ref>{{cite book|last=Bouquot|first=Brad W. Neville , Douglas D. Damm, Carl M. Allen, Jerry E.|title=Oral & maxillofacial pathology|year=2002|publisher=W.B. Saunders|location=Philadelphia|isbn=0721690033|edition=2. ed.}}</ref> p285	RAS
<ref>{{cite book|last=Porter|first=R.A. Cawson, E.W. Odell ; avec la collab. de S.|title=Cawsonś essentials of oral pathology and oral medicine.|year=2002|publisher=Churchill Livingstone|location=Edinburgh|isbn=0443071063|edition=7. ed.}}</ref> p192	RAS
<ref>{{cite book|last=Glick|first=Martin S. Greenberg, Michael|title=Burket's oral medicine diagnosis & treatment|year=2003|publisher=BC Decker|location=Hamilton, Ont.|isbn=1550091867|edition=10th ed.}}</ref> p63	RAS
<ref>{{cite book|last=Treister|first=Jean M. Bruch, Nathaniel S.|title=Clinical oral medicine and pathology|year=2010|publisher=Humana Press|location=New York|isbn=978-1-60327-519-4}}</ref> p53	chapter is headed "aphthous stomatitis" but RAS is used thereafter in the chapter

• and here are the number of hits from various combinations of keywords on pubmed (crude):

Keyword	No. hits
"Recurrent aphthous stomatitis"	522
"Aphthous stomatitis"	2949 (note: probably includes RAS hits)
"Recurrent oral aphthae"	37
"oral aphthae"	115 (note: probably includes "recurrent oral aphthae" hits)
"aphthous ulceration"	267
"aphthous ulcer"	112
"apthae"	425 (includes other hits already mentioned)
"recurrent aphthous ulceration"	149 (includes other hits already mentioned)

Conclusion is that specialized texts tend to use RAS, whereas ICD uses "Recurrent oral aphthae" and most common pubmed use is "Aphthous stomatitis". Unsure of best way forwards, arguments could be made to follow ICD, to follow the textbooks or pubmed... Lesion (talk) 09:34, 6 February 2013 (UTC)

It seems likely that oral surgeons and other sub-subspecialists would focus on recurrent disease; however, more common presentations would be handled by primary care practitioners. Primary care textbooks (Nelson's Pediatrics, Cecil's Medicine) have sections in their oral disease chapters on "aphthous stomatitis (canker sores)". Since primary care physicians see far more patients with oral ulcers than the sub-specialists, this coverage is relevant (and perhaps more representative of the general population). So, I think "aphthous stomatitis" would be a good way to go. Clinicians understand that ICD codes are very poor representations of practice, and exist for billing purposes. -- Scray (talk) 17:25, 6 February 2013 (UTC)

• I would be happy to rename this article "athphous stomatitis" based on the pubmed results. However I still feel there is confusion, the conditions described in this article are by definition recurrent, irregardless of whether these patients are seen in primary or secondary care, and this is also independent to what term is used, whether it has "recurrent" included or not...If it is not recurrent, then this diagnosis is not appropriate and it is a different kind of oral ulceration, (or so I understand). Lesion (talk) 17:57, 6 February 2013 (UTC)

I think you're coming up with the idea that aphthous ulcers are exclusively recurrent. That is not a prevailing notion in the clinical world. -- Scray (talk) 23:28, 6 February 2013 (UTC)

The sources I read usually define this topic within the first few sentences with the word recurrent. If you have sources that state otherwise, I would be interested to read these and maybe this information should be introduced to the article. Lesion (talk) 23:38, 6 February 2013 (UTC)

I know you have already stated your feelings about the ICD, but I point out there is no non recurrent category of aphthous stomatitis there... Lesion (talk) 13:29, 7 February 2013 (UTC)

• Comment I think aphthous ulcer is a good balance between common name and technical name. Oppose moving to "canker sore". Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:56, 6 February 2013 (UTC)
• This would be valid argument, except as per WP:MEDMOS#Naming conventions we should not be using the common name? Therefore compromise from the current, recognized medical term is not desirable... Lesion (talk) 23:38, 6 February 2013 (UTC)
• There is one cochrane RV on the subject of mouth ulcers: <ref>{{cite journal|last=Brocklehurst|first=P|coauthors=Tickle, M; Glenny, AM; Lewis, MA; Pemberton, MN; Taylor, J; Walsh, T; Riley, P; Yates, JM|title=Systemic interventions for recurrent aphthous stomatitis (mouth ulcers).|journal=Cochrane database of systematic reviews (Online)|date=2012 Sep 12|volume=9|pages=CD005411|pmid=22972085}}</ref> http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005411.pub2/full First two sentences: "Recurrent aphthous stomatitis (RAS) is the most frequent form of oral ulceration with a prevalence in the general population ranging between 5% and 60%. It is characterised by recurrent oral mucosal ulceration in an otherwise healthy individual"... I move that this article be renamed "Recurrent aphthous stomatitis" or "Aphthous stomatitis" as both could be argued to be the most commonly used terms in the literature... Lesion (talk) 11:24, 10 February 2013 (UTC)
• "Aphthous stomatitis" is the best name in my opinion. Is recurrent almost of the time, we don't need to say recurrent again. Doc Elisa ^✉ 18:09, 17 February 2013 (UTC)
• Thanks for comment. We have 3 votes for renaming to aphthous stomatitis, 1 vote for canker sore, 1 for no move, and 1 unsure. I'm working on a new version of this article in a sandbox and will update the name to aphthous stomatitis when I have finished it...if there are no further votes against. Lesion (talk) 18:26, 17 February 2013 (UTC)
• I still like the idea we could use canker sore because of its prominence as a common name. WebMD, Mayo, and NIH (a lot of our competition) use canker sore. I was talking with a 4th year medical student the other day and they used the phrase canker sore. And Wikipedia shouldn't be speaking over the heads of our audience with technical article titles, in my opinion. The WP:LEAD, title, and first sentence are supposed to be accessible, not difficult to understand. Thanks Lesion for the research that shows we should definitely bold and at least use term aphthous stomatitis in the first sentence. One question, though: does aphthous stomatitis account for all canker sores? Biosthmors (talk) 16:54, 18 February 2013 (UTC)
• Your vote has been counted and will not be ignored...I just realized I did not look at how many pubmed hits there were for "canker sores"...result was 50 for "canker sores" and 10 for "canker sore" [1]. Probably canker sores would be much more commonly used if someone did a google search of all these terms. Canker (like aphtha) is just another dated (imo) word which used to mean lots of things [2] and now the meaning has been almost forgotten, leading to very common terms being used like "aphthous ulceration" which means "ulcerous ulceration". But in answer to your question, every source I have read lists canker sore as synonymous with aphthous stomatitis and recurrent aphthous stomatitis. I propose to have the first sentence read as follows:

"Aphthous stomatitis (also known as recurrent aphthous stomatitis) is the medical term for canker sores, and refers to a condition ..."

and then move all the minefield of synonyms and etymology to the history section.Lesion (talk) 17:21, 18 February 2013 (UTC)

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

image requested showing herpetiforme RAS and major RAS.

We have pics of minor RAS (several). Would be nice to have pics of major RAS and herpetiforme RAS...lesion (talk) 13:28, 26 January 2013 (UTC)

I'm moving your request tag to the top of the page, where it's more likely to be seen. --BDD (talk) 21:32, 30 January 2013 (UTC)

Lead

"Aphthous stomatitis" is synonymous with "canker sores", currently we have a definition of aphthous stomatitis in terms of canker sores, does this make sense? Personally, I feel this would be better:

Aphthous stomatitis, also known as canker sores, is a common ..."

Lesion (talk) 14:42, 20 February 2013 (UTC)

That's fine. I think either way makes sense. It's what emedicine does. I was inspired by merriam-webster, FYI. Biosthmors (talk) 14:55, 20 February 2013 (UTC)

Merriam webster entry seems to treat canker sore as a synonym of oral ulcer. This is a popular medical dictionary, so it could be argued to follow it. There is an annoying lack of standardization of terms surrounding this topic. Lesion (talk) 16:47, 20 February 2013 (UTC)

I have again tweaked the first sentence...now it includes canker sores both as the first in the listed "also termed ..." and also we have at the end of the sentence "mouth ulcers (canker sores)." I think this is ok now, feel free to change if you think it can be better worded. Lesion (talk) 18:19, 25 February 2013 (UTC)

Recent revisions harmful?

This article went through a major "MEDRS" revision not long ago. It now has only 11 sources. Of these, only one is freely-available, and it is 13 years old. As someone who finds sources helpful on Wikipedia, I find this to be a step back from the previous article with 47 sources. According to WorldCat, one of the major sources [Oral and maxillofacial medicine : the basis of diagnosis and treatment is only available thousands of miles away . It is extremely hard to verify for independent editors. I also find the style of the rewritten article to be too narrative and perhaps lacking a little in WP:SUMMARY, which is probably partly a symptom of the fact that all the sources are UNAVAILABLE. I still don't think I can't find out anything about how effective the interventions actually are or what any of the major clinical trials have been recently. I guess this is the trend for medical articles on Wikipedia: the substitution of a relatively dynamic, living article with someone's relatively fixed graduate-school level essay (which, in my opinion, is not what the average reader is interested in). I'm not a fan. I'm not going to go away but I'm certainly going to voice my disagreement and I don't think all of our readers benefit as much as people think. We wonder why people are not editing while we have an article where the average reader's ability to VERIFY is basically shut down?

Incidentally, the revision seems to seriously conflate review articles and secondary sources, and primary sources and research articles. These are not identical. For example, the previous article had some mention of a zinc treatment based on a few small randomized clinical trials. If one cites the latest clinical trial, it is indeed a primary source about its own research but it is a secondary source for prior research. Now, it may not be a very good secondary source (and in reviewing it, I would agree that it is not), but this is an empirical question dependent on the circumstances. Secondary has a clear dictionary definition which is well-understood to mean a step removed. Not review article. And it's good to keep terms straight, for a variety of reasons.

In terms of helping our readers, What is the most effective way to treat recurrent canker sores? is likely a worthwile addition. UPDATE:I added the latter and Urban Legends Series: Recurrent Aphthous Stomatitis, which makes me feel a bit better. I was probably too harsh in my initial reaction although I still wonder about how much was lost in this transition. In re-reading, I think the style and information is OK but the lack of further information at a click is a serious disadvantage; I guess maybe it is common at this point despite all the open-access legislation (?). I also think the article is unnecessarily vague in some respects and that might be because it's channeling some 30,000 foot articles. It sounds contradictory to say it doesn't meet seem to be SUMMARY but also is too detailed narrative. I dunno. Just something...II | (t - c) 04:40, 23 March 2013 (UTC)

I agree that this article could do with more PMC references like those you have added. It relies too much on tertiary sources currently, but this has provided a good skeleton for future edits. Also please note that many of the new references will be available to read on google books. I have heard other editors talk about linking references to the relevant page in google books, but I don't know how to do this. I think this might improve access to the sources.

Previous article [3] did have more references, but most of these had to be removed as they were primary sources. I have done this responsibly, finding better sources to support the content rather than just deleting content like some editors would have done. Previous article also had unreferenced sections (imo, this is a much worse problem of verifiability) and UNDUE issues with regards sodium lauryl sulfate and zinc, for example. I therefore disagree that recent revisions have been harmful since the article was in such a poor state before, which was basically a link farm for (hopefully) well meaning editors to paste reals of primary sources about their own pet theory of "the cause" or "the cure". Actually I think the zinc thing was the only topic that could not be carried forward into the new article, I couldn't find a secondary source to support it. but I'm sure we can find a secondary source somewhere if it is notable. Also:

• Why was the url for the cochrane rv removed? Isn't this making it harder to access this source?

• The edit changing the wording of a sentence supported by the cochrane rv ... "but this type of oral ulceration is not considered to be aphthous stomatitis" to "...this type of oral ulceration may be not considered to be aphthous stomatitis" is questionable. The previous wording better reflects the wording of the cited source.

• Although the addition of the JFP source is beneficial, the wording of this sentence "Amlexanox applied topically is highly-studied and effective in healing" could be better.

• Re narrative, excessive detail and summary comments, it is hard to address these in a practical way without specific examples from the article.

• I would also point out that we should not be using primary sources, even if you are only using the "background" (i.e. secondary) section and not referencing the original research findings. A source may contain sections which could be considered a secondary source of prior research, but the fact that the same source also contains new research makes it a primary source and it should generally be avoided.

Thanks for your edits and comments. Lesion (talk) 13:06, 23 March 2013 (UTC)

The Cochrane review not freely-accessible, so to signal that for readers we remove the URLs if there is a DOI. People can click the DOI to get to the article. This was standard back when I was spending more time in medical articles (a few years back) and I think it is a good standard. As far as reflecting the sources and changing is to may, there are good reasons for not repeating very strict statements, even if a single source is highly strict. For one thing, the definition of systemic disorder is apparently defined quite broadly to include nutritional deficiencies and such. The lead notes that this is multi-factorial condition and there's a lot of mystery here, so I feel it is more appropriate to be a little vague on where a systemic condition is causing the ulcers and where it is RAS. In fact, that is one of the major issues that I felt when reading the article. My feeling is that you've written the article about RAS, which is (apparently) somewhat idiopathic, but the article is not entitled RAS - it is entitled aphthous stomatitis. My understanding is that few people regard idiopathic disorders as truly having no underlying cause, which is somewhat how you've ended up describing this. It's just that the true cause is a mystery. I realize that you have sources that seem to say this, but I'm suspicious that they use such strict terms or should use such strict terms. If you can provide quotes or copies of the articles, I would feel better. As far as the background and discussion mini-reviews, these remain secondary; I'll admit they have often problems (MEDRS says "these sections are often incomplete[6] and typically less useful or reliable than reviews"). Unfortunately, the open-access laws on the books here in the United States mainly apply to research articles and not to reviews. So most of open-access literature is research articles. This is a discussion that perhaps needs to be had at MEDRS sometime and not here, but there was a few people concerned about the stripping out of all research articles.

Could you tell me how many sources the tertiary sources cite, such as Scully, Neville et al, Treister et al, and Odell? I think that gives a decent indication of how ex cathedra their statements (Level III in the US; Grade D in the UK). Although I know there's some debate about this on Wikipedia, expert opinions without a citation typically do rank at the bottom of the evidence scale, regardless of whether they are in a review or not. Do these have electronic copies and DOI numbers? It is more common for book chapters to be published electronically these days.

This is an area I'm not all that familiar with and not likely to get real deeply involved in (haven't had a canker sore in long time), so forgive me if I'm not necessarily real up on the details. II | (t - c) 20:21, 23 March 2013 (UTC)

Agree that just like other classically idiopathic conditions, much more is now known about etiology. Really it's just another umbrella term for a bunch of processes we don't fully understand yet. Thank you for explaining the removal of the url and the tweaking to the wording in places. I will leave your changes but I just need to adjust the grammar in 2 places (without changing the meaning of your edits). Forgive me for stressing a point, but "Recurrent aphthous stomatitis" is synonymous with "aphthous stomatitis"...please provide evidence to the opposite. If it is not a synonym this should definitely be worked into the article...but I'm 100% sure that RAS = aphthous stomatitis...there is no non-recurrent form of aphthous stomatitis (by definition), unless its recurrent ulceration that slowly disappears over time as is the usual natural history. If oral ulceration is not recurrent then this is not the diagnosis. "RAS like stomatitis" or "RAS like ulceration" is oral ulceration with a systemic cause, but this is recurrent too unless the underlying condition is corrected. Would the mouth ulcer page be a better place to discuss oral ulceration that is not RAS?

Interesting what you say about using the background section of primary sources. I know that one of the recent never ending discussions about MEDRS and primary and secondary sources concluded that the use of background sections from primary sources was not desirable, however here we see that the wording of the policy is not so strongly against it.

Re reliability of the sources, these are all major textbooks...I wouldn't consider any of them expert opinion really. I will look for a way to make the sources more available via electronic copy as you suggest or a link to google books. Really this is the core of your concern I think, that (i) you cannot verify that the article reflects the content of the cited sources used and also (ii) you cannot assess the quality of the sources. Both these issues could be addressed if the sources were available, so I will try and sort this out. Lesion (talk) 21:24, 23 March 2013 (UTC)

In the real world things are often more messy than what is presented in a medical textbook, and here on Wikipedia we do have to flex somewhat to reflect the real-world, and we can't just take all sources completely at their word (not all reviews are equivalent or correct, etc). I'm not sure if we agree on this point yet, but I'm not sure that the term aphthous stomatitis is synonymous with idiopathic RAS; for example, first page of Google shows eMedicine saying "Behçet syndrome, systemic lupus erythematosus, and inflammatory bowel disease are systemic diseases associated with oral recurrent aphthous ulcers". Yes, it may commonly be used as a synonym, but in ICD K12.0 is RAS; there is also K12.1 which would feasibly fall under "aphthous stomatitis" as well. In many cases practitioners probably include the K12 code in addition to systemic codes when billing. Incidentally, I'm a little curious about this 20% figure for prevalence. Is this region-specific? Did they net out systemic conditions? How old is this estimate and where did it come from? I found an online source from the Surgeon General report which says 5 to 25 citing various old studies. Personally 20% seems high to me; apparently this is not in the National Health Interview Survey but apparently 2008 included some oral questions which could be dug up for more recent and accurate data. Also found an old 2001 review at UCLA which I may compare against the article. II | (t - c) 23:18, 23 March 2013 (UTC)

Under K12 it lists Aphthous stomatitis and Recurrent aphthous ulcer under recurrent oral aphthae. To me there is no suggestion that the categories under K12.1, Stomatitis not otherwise specified and ulcerative, represent a type of aphthous stomatitis. I think aphthous stomatitis is intended to be listed under K12, and that RAS = aphthous stomatitis. I have yet to find any evidence to disagree with this, but if someone highlights such evidence, it should be included if it is notable. Also, the phrase "idiopathic RAS" is not in common use...as per the Cochrane RV, RAS is by definition idiopathic and therefore this phrase might be considered redundant.

In my opinion the quoted content from emedicine is misleading and perhaps even poorly informed, but to not include it would be to cherry pick references, so I support its inclusion based on the fact that emedicine is generally considered minstream. The Cochrane position statement (paraphrasing) "where there is systemic cause for recurrent oral ulceration, this should be considered separately" might be intended to apply standardization in terms for researchers in this field, and to simplify future systematic reviews. As you pointed out, this review takes a broad definition of what constitutes a systemic condition, including anemia and nutritional deficiencies. This is contrasted with some other sources which discuss these as causes of RAS.

Re the prevalence, the Cochrane RV states "5% and 60%" and Neville et al states "5 to 66%". I included the 20% average figure from Neville because it seemed to me to be more precise than this large range in reported prevalence, although we also quote these. There are no details given as to how this figure was derived. If a source could be found that presented an average prevalence with more authority this would be good to include. Lesion (talk) 00:05, 24 March 2013 (UTC)

I'm not pressing for the use the eMedicine article or to completely change this to encompass systemically-caused canker sores, but I just presented that as an example that there are differing opinions as to whether RAS which occurs coincident to systemic disorders can still be referred to as RAS (or RA ulcers, as emedicine calls them). Certainly the presentation is likely to be the same and probably even completely identical in some cases. II | (t - c) 00:21, 24 March 2013 (UTC)

Update: I've asked on the help desk about integrating a link to the relavent page in google books with the references.

I think I took the Cochrane RV as universally representative of the classification of RAS to have no systemic cause. It is clear now that other sources are contradicting this. Perhaps a short discussion of this variance in definition of what is RAS and what is RAS-type ulceration would be good to add to the article, and better represent the evidence base as a whole. Lesion (talk) 15:33, 27 March 2013 (UTC)

Ok this issue was discussed on the help desk: WP:HD#How do I make a link to google books appear in the list of references?. I will add links to google books for any source that is available. FYI, one editor on help desk said that using a textbook for a source did not affect verifiability at all... Lesion (talk) 22:18, 27 March 2013 (UTC)

Update: the issue raised by the original comment about accessibility may be bogus. In WP:Verifiability#Accessibility it states "Other people should in principle be able to check that material in a Wikipedia article has been published by a reliable source. This implies nothing about ease of access to sources: some online sources may require payment, while some print sources may only be available in university libraries." On these grounds I therefore say that the changes I made to this article were strongly beneficial and not harmful at all. The reduction in number of sources is irrelevant because most did not meet policy and required removal, the content is now better worded and sourced with reliable references. Having said that, I think the additions of pubmed central articles were beneficial and have improved things further (although the wording could be better in places). Lesion (talk) 12:12, 9 April 2013 (UTC)

WP:PAYWALL is clear that there is no discrimination between which type of source is preferred (paywalled or not). If two sources are equal in content but one is a free for review, the free one should probably be used. However, we should not use a lesser quality source just because it is more easy for the layperson to access. Yobol (talk) 13:36, 9 April 2013 (UTC)

Re. your comment: "If two sources are equal in content but one is a free for review, the free one should probably be used.", I personally agree with this view, but it is not supported by this policy as far as I can see and therefore we should not enforce this on other editors. Lesion (talk) 13:43, 9 April 2013 (UTC)

You are correct, it is not part of policy, but seems a common sense compromise to these situations (or just use both sources). Yobol (talk) 14:04, 9 April 2013 (UTC)

I responded to this at User_talk:ImperfectlyInformed#Talk:Aphthous_stomatitis.23Recent_revisions_harmful.3F. Yes, this is certainly my personal opinion and not policy, and I'm sorry if that was misleading. If you search accessibility in the archives, you'll find that it has been the subject of discussion. The section title may have been an overreaction. However, in general, if you want others to be able to review your work, my experience says that accessibility is something you should think about. I would hope that this article doesn't get promoted to a Good article without at least one editor perusing the sources, which in this case may be difficult. If I can't access a source (and I can't always get an interlibrary loan) and it seems dubious or contradicts other sources, it may be deleted if no one steps in to address the question. We have had serious problems with negligent or fraudulent misrepresentations of sources as well (see Wikipedia:Jagged_85_cleanup) and sources with limited accessibility may substantially prevent editors from ferreting out these misrepresentations. Textbooks can also be very large (which means there's a lot of "factual" statements in them, which are not always truly factual or well-footnoted) and not quite so clearly peer-reviewed. If I felt so inclined, I'm pretty sure I could add some fairly fringey claims from recent medical textbooks published by CRC Press or Wiley, which may be presented by the authors as facts. That doesn't mean that these statements are appropriate. II | (t - c) 14:10, 9 April 2013 (UTC)

It is lazy in some respects to rely 100% on textbooks... all the info is already summarized for you and there is no pubmed crawling involved. It might take longer to add the same content supported by several peer review publications, but this might reduce the chances of including the opinions of the textbook's editors which might not be representative of the mainstream expert opinion worldwide. However, I think we are making very broad statements here, not all textbooks are compromised sources, some are considered authoritative in their fields with their lists of contributing authors running into the hundreds. For this article I probably overused textbooks as sources, and this has been balanced a bit by addition of PMC articles. We can anticipate future edits to add many more secondary sources to this framework in time...

I did not know Cochrane Rvs were not freely available in US, this is strange... Lesion (talk) 14:36, 9 April 2013 (UTC)

Unsourced content

In [[South Korea]], Albothyl, an active ingrediate [[Policresulen]], is gaining popularity to numb and heal canker sores. When used, Albothyl gives tremendous pain for couple seconds, then it numbs the canker sores. Moreover, it hastens the healing process.

Need a source for this please. Also please make sure the source conforms to WP:MEDRS. TY, Lesion (talk) 10:26, 16 July 2013 (UTC)

Lysine

@173.35.108.2201: An edit has added Lysine to the top of the table. It is certainly not considered first line treatment, let alone mentioned in any of the systematic reviews. The citation was drugs.com http://www.drugs.com/npp/lysine.html#ref13 which stated "Treatment for recurrent aphthous ulcers was also evaluated in this study. Only 1 of 28 patients did not benefit from lysine therapy." based in turn upon this 1994 study http://www.ncbi.nlm.nih.gov/pubmed/?term=Clinical+effectiveness+of+lysine+in+treating+recurrent+aphthous+ulcers+and+herpes+labialis.

Comments:

• if included should not be at the top of the table, this would suggest that this is a common, first line treatment.
• what kind of study is this? Was there a control group? 28 subjects ... v small... why no other scientific studies? How commonly is this actually used for aphthous stomatitis? How much evidence is there?
• is lysine a notable enough treatment with any evidence of efficacy for aphthous stomatitis to be included on the wikipedia page? Lesion (talk) 14:39, 4 August 2013 (UTC)

OK, never mind... someone else just removed it. Would comment that "drugs.com" does appear to have a list of references, but not sure if it is MEDRS compliant or not. Lesion (talk) 14:42, 4 August 2013 (UTC)

• MEDDATE is a valid reason not to include the 1994 primary source, but arguably drugs.com is a secondary source, just potentially not a reliable one as it's not published in a peer review journal. Had a quick search on pubmed, no more modern papers cite the primary source in question, and an brief look for "lysine" + "aphthous" yields no more modern results [4] and "lysine" + "ulcer" yields no obviously relevant results for aphthous stomatitis, although some research has been conducted on decubitus ulcers and peptic ulcers. Lesion (talk) 15:59, 4 August 2013 (UTC)

(copied from User talk:Scray) Hi. I had made the addition to the Aphthous stomatitis post (https://en.wikipedia.org/wiki/Canker_sore) about the use of lysine. I appreciate your editing of the article. Could use some more clarification from you. Read the WP:MEDDATE. Your identification that source material citations should be no less than 5 years old seems problematic. This would invalidate several other cited references in the article that provide no secondary citation at older than 20o8. Plus none of the current items in the table I had added to provide any citation reference. Could you please assist in how the content I am trying to add to improve this article could be added without creating an issue that would require your prompt removal? As you are clearly far more experienced in understanding how to make correct additions to medical articles...could you offer some guidance to a newbie on how to introduce my content without jeopardizing the accuracy of wikipedia? Am trying to be professional by providing sourcing. If attempting to provide reliable sourcing for this content is impossible given wikipedia policy, what other option is available to include this content without going against wiki policy? Would greatly appreciate your help. Thanks. — Preceding unsigned comment added by 173.35.108.220 (talk) 15:49, 4 August 2013 (UTC)

That other stuff exists is not a reason to relax our current standards, though I agree that improvements can be made. I am not aware that drugs.com is compliant with WP:MEDRS, and suspect that it is not (issues of WP:COI and peer review, for example). If a recent high-quality peer-reviewed secondary source states that L-lysine is an effective treatment for aphthous stomatitis, then an older primary source would be appropriate support. Do we have such a secondary source? -- Scray (talk) 16:11, 4 August 2013 (UTC)

I'll add that it seems highly unlikely that an amino acid supplement would have such an effect. Lysine is in virtually every protein we eat. -- Scray (talk) 16:15, 4 August 2013 (UTC)

In this particular situation lysine does not seem well-supported (I do not have access to the source, but the 17 sources citing don't show much promise), but the interpretation that WP:MEDDATE prohibits sources that are more than five years old is problematic, and not in-line with the language of the guideline or the drafting history. It depends on the situation and the language "look for" is a recommendation, not a bright-line rule. Also, amino acids can have profound physiological impacts, including a relatively well-known role for lysine in suppressing herpes cold sores (other examples include a remarkable effect of tyrosine when stressed and arginine and human growth hormone). II | (t - c) 18:00, 4 August 2013 (UTC)

There are 2 WP:MEDDATE issues in the existing refs, and these are my fault. If anyone has the new editions of these texts, it would be good to check this content can still be supported and also update the references for this article.

1. Neville BW, Damm DD, Allen CM, Bouquot JE. (2002). Oral & maxillofacial pathology (2. ed. ed.). Philadelphia: W.B. Saunders. pp. 253–284. ISBN 0721690033.
2. Cawson RA, Odell EW, Porter S (2002). Cawson's essentials of oral pathology and oral medicine. (7. ed. ed.). Edinburgh: Churchill Livingstone. pp. 192–195. ISBN 0443071063.

Note that the following 2 references are older than 5 years, but they are used to support content in the history section only, which tends not to follow WP:MEDRS but rather WP:RS generally. For content about history, it is natural to include some older sources imo...

1. Fischman, SL (1994 Jun). "Oral ulcerations.". Seminars in dermatology 13 (2): 74–7. PMID 8060829.
2. Burruano, F; Tortorici, S (2000 Jan-Feb). "[Major aphthous stomatitis (Sutton's disease): etiopathogenesis, histological and clinical aspects].". Minerva stomatologica 49 (1-2): 41–50. PMID 10932907. Lesion (talk) 17:39, 4 August 2013 (UTC)

I can see why you thought that the rest of the content in the table was unreferenced, but it is all referenced:

"Many different topical and systemic treatments have been proposed (see table),[1][2][10][7]"

Maybe this could be improved to put inline citation into the table. Lesion (talk) 17:47, 4 August 2013 (UTC)

Wikipedia does not require that all references older than 5 years be removed, and while I understand that some people are particularly rules-focused, this is a really bad rule that you should not be following strictly. Using a 2002 high-quality source is not really a big deal. II | (t - c) 18:02, 4 August 2013 (UTC)

MEDDATE can be difficult to comply with strictly, especially for people who tend to be paywalled out of sources. As you stated the 5 years is more of a guide than an absolute line, but I would still encourage people to follow it wherever more modern sources are available. In this case, the 1994 isn't the main problem, it is the nature of the source itself. Not encountered drugs.com before. Appears to be written by pharmacologists and claims to be up to date. It is referenced throughout which is better than many sites, but it is not a reliable source from a peer review journal.

Not supported by any policy, but I tend to look for adverts on a website when it is used as a source, as a rule of thumb, if there are adverts, then the website may not be reliable. If they are willing to make money from advertising, you have to question their motivation and the neutrality of the information they provide. Lesion (talk) 18:17, 4 August 2013 (UTC)

I was originally looking at the PubMed source that was put up which dates from 1994. The drugs.com source seems OK (probably on-par with WebMD, which altho not ideal has been discussed and generally people say there shouldn't be a strict rule against) and has a lot of citations. The issue here is that the source itself (drugs.com) doesn't really say much about lysine and canker sores. CTRL-F for canker sores or stomatitis. As far as I can tell there was just an uncontrolled survey. If there was an RCT or two, it would be a different story. II | (t - c) 18:33, 4 August 2013 (UTC)

Agree that MEDDATE is not a policy, but the consensus at WP:WPMED is that we should adhere to it when feasible, and I think there would be a consensus against the ref in question but if someone feels strongly about using it we could take this to that larger audience. Regarding the plausibility, I know of no convincing evidence (e.g. large well-run study) showing lysine is effective for HSV prevention or treatment, and the most recent high-quality review I see PMID 16209859 is in line with that impression (as is our Herpes simplex article). So, the plausibility question stands. Of course other amino acids present different mechanisms - tryptophan can regulate translation when properly delivered to a cell - but dietary amino acid supplements remain alternative medicines (i.e. outside the scientific mainstream, lacking conclusive support). In the current case, we still lack a sufficiently-reliable source. -- Scray (talk) 18:43, 4 August 2013 (UTC)

Well, I said "well-known". I don't know about canker sores, but lysine and herpes has been studied for around 50 years with an enormous number of peer-reviewed publications; herpes requires arginine which competes with lysine, and there's a fair amount of basic science to support the idea. Sure, no n=300 multicenter trials. This 2007 lysine monograph is a good summary: of the 6 small trials, one found no effect, and in this one something odd was going on in the subjects had lesions nearly half the time (41% for lysine, 46% for placebo) over 4-5 months, which is way more lesions than most people have. II | (t - c) 19:53, 4 August 2013 (UTC)

@Scray RE: Inclusion of Herpetiform ulceration in the article in error? - There are numerous studies showing that l-lysine is a well-supported drug for use with herpes sores. It is sold as such and labelled as such. Herpes seems very closely related to aphthous stomatitis, but is an STD, unlike canker sores. For obvious reasons herpes is of much more interest to medicate, than canker sores. Hence there aren't many studies of canker sore, but lots of studies and medical trials for herpes sores...which, this article indicates is a variant of aphthous stomatitis. In my opinion having information that l-lysine is a drug that can be used for canker sores would be of value to suffers of canker sores. And it was not present in the original article. Plus, given that this article covers "Herpetiform ulceration" as a variant of aphthous stomatitis...I think the inclusion of a drug that is used to heal herpes sores as a potential drug for aphthous stomatitis isn't too outrageous a leap. Plus, given that l-lysine is a dietary supplement sold in every drug store over the counter...it's not a dangerous drug. If there is no connection between herpes and aphthous stomatitis...then the reference to Herpetiform ulceration should at least be removed as it is not relevant to the article. Is there anyway to include that l-lysine is commonly used for treating herpes sores, which are a form of aphthous stomatitis, and that older studies have indicated that l-lysine could be used to treat canker sores?

Oh sod it, I looked at the herpes article and they are even more non-commital about l-lysine listing it as an "alternative medicine" and a not very effective one at that. Please disregard my comments. Was just trying to offer some help to others, after having found immediate success with l-lysine...and little presence on the web of information about it...aside from review comments continuous referring to it as having been of great help. Thanks for your help. Clearly this is not the right forum for this information. Please disregard my comments. At least I know it works for me and helped me a great deal. Everyone else can fend for themselves. — Preceding unsigned comment added by 173.35.108.220 (talk) 23:41, 5 August 2013 (UTC)

@173.35.108.220: Herpetiforme ulceration is not the same as herpes. Misleading medical jargon strikes again. As the article currently states:

"Herpetiforme ulceration: Also termed stomatitis herpetiformis,[4] herpetiform ulcers,[1] or herpes-like ulcerations, this type of aphthous stomatitis is so named because the lesions resemble a primary infection with herpes simplex (primary herpetic gingivostomatitis).[3] However, herpetiform ulceration is not caused by herpes viruses. As with all types of aphthous stomatitis, it is not contagious."

Confusing, and if it were up to me I would change it to something else, especially with others using terms like "herpetic ulceration" which does refer to ulceration caused by herpes and is not a type of aphthous stomatitis. However, herpetiforme ulceration is definately a recognized subtype of aphthous stomatitis. Translated to non medical jargon it might read something like "a type of canker sores which look like herpes but is not herpes".

If there are MEDRS compliant sources saying that Lysine works for herpes labialis, herpetic gingivostomatitis etc, then please feel free to add content ... just because Lysine is currently mentioned under alt med, doesn't mean that is correct... just need a source. But as far as aphthous stomatitis goes, there is no cure, and most treatments are at best partially effective at reducing the frequency of ulceration and reducing the pain associated ... the main reasons for reverting the addition of lysine to this page was concerns over the quality of drugs.com, which did not come from a peer review journal (try PubMed or google scholar rather than regular google, which usually gives loads of sites which are not suitable sources), and also that this source was basing the claim on a uncontrolled trail of only 28 people. In evidence-based medicine, multiple, large cohort randomized control trials are usually required to create evidence, which then are systematically reviewed before any firm assessment of efficacy can be made, and there just isn't any research like that for lysine as a treatment of aphthous stomatitis. Lesion (talk) 23:54, 5 August 2013 (UTC)

GA Review

This review is transcluded from Talk:Aphthous stomatitis/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: LT910001 (talk · contribs) 06:19, 1 September 2013 (UTC)

Hello! I would be honoured to take this review, and haven't had any part in editing or creating this article. I have previously collaborated with Lesion and would be therefore happy if another person wanted to be the main reviewer.

Overall I found this article very readable, tight and packed full of content. I would support its promotion to GA status.

More specific comments:

Lede

Lede  Done

Always the hardest section to get right, because it's the most imporatnt. Could be split into two paragraphs for readability, maybe at "The cause is not completely understood."  Done I personally don't think "recurrent aphthous stomatitis, RAS, recurring oral aphthae and recurrent aphthous ulceration" need to be provided. You state RAS is a subtype, not a synonym, and "recurrent" here is adjectival. To clarify, RAS is a synonym, not a subtype. All aphthae are recurrent, there is no non recurrent form. If a mouth ulcer occurs only once, heals and then never comes back, then this diagnosis is not appropriate. Recurrent oral aphthae, and recurrent aphthous ulceration are also commonly enough used that we should list them in the first list of synonyms imo. Any less commonly used term, historic term or term for a subtype, I have not listed here but instead discussed in the History section for want of somewhere better to put it. See also the section above Talk:Aphthous_stomatitis#Requested_move. Lesion (talk) 12:05, 1 September 2013 (UTC) This is a good point. LT90001 (talk) 07:35, 3 September 2013 (UTC) "and non-contagious mouth ulcers (canker sores)". Possibly could remove (canker sores) here, as you state above that canker sores are a reference to this disease and not all mouth ulcers. I see that you read the discussion between myself and Biosthmors (who rightfully is concerned about readability for readers) above Talk:Aphthous_stomatitis#Lead. Appears that "canker sores" is not an exact term, it is used both as a synonym of individual mouth ulcers (not necessarily even mouth ulcers associated with this condition), and also other sources use it as a synonym for this condition as a whole. Difficult to say without making its own sentence. Lesion (talk) 12:05, 1 September 2013 (UTC) Oh! Actually I hadn't read that. Perhaps you could reword from "is a common cause of benign and non-contagious mouth ulcers (canker sores). " to "is a common cause of benign and non-contagious mouth ulcers, which are also occasionally called canker sores" or something similar, to remove the ambiguity. LT90001 (talk) 07:35, 3 September 2013 (UTC)  Done "oral cavity (the lining of the mouth)" and several terms below could use the [[oral cavity|the lining of the mouth]] to enhance readability and decrease the feeling that this article has been 'translated' from medicine. In the lead, OK agree. Per WP:LEAD, we should be using clear and simple language. However, in the rest of the article, we should not shy away from using jargon. We should use it as the sources do, but all meaning should be derived from the article to explain the jargon. Many editors think it is enough to throw in some jargon as long as it is wikilinked. This is not the case per the MOS. Wikilinking a term is optional and desirable, but explaining it in parentheses is mandatory. The gold standard imo is giving an explanation in brackets AND wikilinking. I have just simplified the end of this sentence to "in the mouth". Can't get more clear than that. When you say, "and and several terms below" I assume you mean throughout the rest of the article, and not in the lead. Please advise if any other wikilinking issues in lead. Lesion (talk) 12:05, 1 September 2013 (UTC) Hi, yep I made a comment below in 'classification' about this wikilinking. LT90001 (talk) 07:35, 3 September 2013 (UTC) Overall this lede is really clear! Suggested reworked lead based on this feedback: Aphthous stomatitis (also termed canker sores, recurrent aphthous stomatitis, RAS, recurring oral aphthae and recurrent aphthous ulceration) is a common cause of benign and non-contagious mouth ulcers (canker sores). This condition is characterized by the repeated formation of ulcers in the mouth, in otherwise healthy individuals. These ulcers occur periodically and heal completely between attacks. Symptoms range from a minor nuisance to interfering with eating and drinking. The cause is not completely understood, but may involve a T cell mediated immune response which is triggered by a variety of factors. Different people may have different triggers, including nutritional deficiencies, local trauma, stress, hormonal influences, allergies, and a genetic predisposition. The condition is very common, affecting about 20% of the general population. There is no cure, and treatments are aimed at reducing pain and speeding the healing process. Often, the onset of the condition is during childhood or adolescence and usually lasts for several years before gradually disappearing, with or without any form of treatment. Looks great and reads well. LT90001 (talk) 07:35, 3 September 2013 (UTC)

Classification

Classification  Done

Given there's a picture in the lede, I think it would be better to move the picture to the symptoms section to illustrate what's written in the text.  Done Major I think it would enhance readability to change instances of "major apthae" to "major apthous ulcers"  Done Remove "(major apthous ulcers)" All GAs and FAs have a unique style and on reflection I think that these parentheses in moderation don't detract from the quality of the article, so I've got no further objections to these. LT90001 (talk) 07:35, 3 September 2013 (UTC) Again, [[fauces|back of throat]] may enhance readability for that one. Herpetiform You state "also known as herpatiform ulcers". That could be removed as it's the title of that subsection. "As with all types of aphthous stomatitis, it is not contagious." I like... very reassuring. Move "Recurrent oral ulceration associated with systemic conditions is termed "RAS type ulceration", "RAS like ulceration" or "aphthous-like ulcers".[3] " up one sentence to improve flow  Done "However, this definition is not strictly applied. " I think you could leave it at that: "E.g., many sources would refer to oral ulceration caused by anemia and/or nutritional deficiencies as aphthous stomatitis. Some consider Behçet's disease to be a variant of aphthous stomatitis.[4]" is not of the same quality as the article and I think it could be removed or rephrased. If you decide to keep it, perhaps "This definition is not strictly applied. For example, as many sources refer to oral ulceration caused by anemia and/or nutritional deficiencies as aphthous stomatitis, some also consider Behçet's disease to be a variant."  Done

Signs and symptoms

Signs and symptoms  Done

Could do with a picture, particularly when you say " An erythematous "halo" surrounds the ulcer" the halo picture would be good here.  Done "Persons with aphthous stomatitis have no clinically detectable systemic symptoms or signs." Not too sure I agree, as there is a visible physical ulcer there should be at least one symptom. Perhaps you could add "Apart from presence of one or more ulcers, " "(i.e. outside the mouth)" could be removed, as from my understanding a sign is something that can be elicited or noticed by a medical practitioner, but not necessarily a patient. Hang on, you state "Signs are limited to the lesions themselves." I guess that ties in with my first comment. Comment: in oral medicine and dentistry as a whole, "systemic" is often used to mean "not in the mouth". I have realized this could be confusing for many readers. Maybe "constitutional symptoms" or something would be better here? Lesion (talk) 13:48, 1 September 2013 (UTC) Looks good. Your inclusion of 'systemic' makes all the difference. Suggest change the next sentence "Generally, symptoms " to "Generally, localised symptoms" to highlight this separation. LT90001 (talk) 07:35, 3 September 2013 (UTC) "virtual" -> "virtually"  Done "reddened, flat area of mucosa". Wikify link to remove the erythematous tag (too many parentheses) "which develops" -> "which develop"  Done "which can"->"that can" not too sure about the exact grammar on this one but "that can" feels better  Done Remove "(see the classification section)." as this precedes the Signs and symptoms section.  Done

Causes

Causes  Done

Very clear Remove "(T lymphocyte)," that's not mentioned anywhere else in the article. Well, we do say CD4+ T lymphocytes ... I just thought it would be helpful to say that we mean the same thing ... Lesion (talk) 13:03, 1 September 2013 (UTC) That's a good point, and it also helps disambiguate when you refer to the collective group 'lymphocytes'. I also can't help but notice you alternate in referring to "T cell" and "T lymphocyte". I think "T cell" is easier to read and you could probably stick to that for consistency. LT90001 (talk) 07:35, 3 September 2013 (UTC)  Done "the generation of T cells" I'm not sure if it's standard terminology to describe T cells as "generated" by an immune response. Maybe "stimulated T cells"?  Done good point. Just removed entirely since we begin this sent saying T cell-mediated. Kind of implied that T cells are involved by this imo. Lesion (talk) 12:19, 3 September 2013 (UTC) "altong " -> "along"  Done "Persons with aphthous stomatitis have circulating lymphocytes which react with peptides 91-105 of heat shock protein 65-60.[3] " could do with a little bit of context. Beyond removing it entirely, not sure what is best. I've checked the source, it doesn't give any more detail. Suspect that it is in turn based on primary sources, in vitro studies etc. Lesion (talk) 13:03, 1 September 2013 (UTC) All right, I guess somebody will know what this means. LT90001 (talk) 07:35, 3 September 2013 (UTC) "Furthermore, the ratio of CD4+ T lymphocytes to CD8+ T lymphocytes in the peripheral blood of individuals with aphthous stomatitis is decreased.[4]" Not a comment but a thought, does that have implications for HIV/AIDS or EBV sufferers? Yes, HIV is associated with aphthous-like ulceration. Not heard of any link with EBV, but I could be wrong. Lesion (talk) 13:03, 1 September 2013 (UTC) "the common " -> "common"  Done "meaning that aphthous stomatitis is not a classical autoimmune disease" remove. This implication is clear from what you state in the sentences prior.  Done Rephrased this whole paragraph in a more structured way. Lesion (talk) 13:03, 1 September 2013 (UTC) "T cell mediated " -> "T cell-mediated"  Done Primary immunodysregulation "aphthous stomaitits " -> "apthous stomatitis"  Done "(see Effect of stress on the immune system)" could be silently wikilinked. Done I think Would prefer "E.g." replaced by "For example," in all circumstances, as I think it's more suitable not to use this shorthand.  Not done is this personal preference or supported by policy? I'm not sure, but I see e.g. and i.e. used very commonly in articles and I've never seen it get corrected. Happy to correct if this is policy. Lesion (talk) 13:03, 1 September 2013 (UTC) Yep, just a personal preference. I think it makes an article flow more if there aren't too many abbreviations or parentheses but I don't think it detracts from overall quality. LT90001 (talk) 07:35, 3 September 2013 (UTC)  Done In this instance. Lesion (talk) 12:19, 3 September 2013 (UTC) This statement "although this would be by the decreased mucosal barrier mechanism described below" should be stated or removed as original research  Done I wanted to talk about stress all in the same place, but the theories to explain this correlation do not neatly fit into any single mechanism alone. Lesion (talk) 13:03, 1 September 2013 (UTC) Decrease of the mucosal layer "The thickness of the mucosa ...thickness of the oral mucosa (atrophy)." is uncited.  Done both these short paragraphs were supported by Neville 2008, but the refs were hidden. I think I must have felt that Neville was cited too much, but it is a great source and I've not found a more complete or well structured discussion of the etiology of RAS to date. Lesion (talk) 13:03, 1 September 2013 (UTC) "all can " -> "can all"  Done "In a small subgroup of females with aphthous stomatits, there are " reads a little strange. Suggest reword to "In one study, a small group of females with apthous stomatitis had fewer occurences of apthae..."  Done Suggest apthae -> apthous ulcer.  Done for readibility sake, but technically "aphthous ulcer" means "ulcerous ulcer", but it is a widely used term nonetheless. Lesion (talk) 13:03, 1 September 2013 (UTC) Hah, well what about 'blue nevus'? I'm sure there's a lot more. LT90001 (talk) 07:35, 3 September 2013 (UTC) Don't understand. "Nevus" = mole/birthmark? You mean it's not actually blue? Lesion (talk) 12:19, 3 September 2013 (UTC) Increase in antigenic exposure/Heightened antigenic sensitivity Suggest " e.g"-> "with implicated triggers including "  Done Systemic disease I'm liking the table! (I like tables too. Lesion (talk) 13:03, 1 September 2013 (UTC)) Table "Systemic disorders Associated with aphthous-like ulceration" -> decapitalise "associated"  Done Table "immunocompromise" -> "Immunocompromised states"  Done " (e.g., the conjunctiva or the genital mucous membranes)" -> "such as the conjunctiva... membranes."  Done "a decreased frequency" remove "a"  Done "Silk Road, (i.e. " -> "Silk Road (between..."  Done Suggest integrate " (inflammation of the lymph nodes in the neck-- cervical lymphadenitis)." as a wikilink. (tidied a bit. Lesion (talk) 13:03, 1 September 2013 (UTC)) Lately noticed " (often they accompany each other)," is given it's own clause. Suggest remove parentheses, or commas. LT90001 (talk) 07:35, 3 September 2013 (UTC) Only just noticed because it is a new addition.  Done Lesion (talk) 12:19, 3 September 2013 (UTC)

Diagnosis

Diagnosis  Done

Suggest split into two or three paragraphs for readability, perhaps at the "blood tests" and "histology" areas of the paragraph.  Done "(e.g. to exclude anemia / deficiencies of iron, folate or vitamin B12 or celiac disease)." remove parentheses and "eg."  Done "conenctive tissue " -> connective tissue  Done my bad, Lesion (talk) 13:43, 1 September 2013 (UTC) I feel "Many of the systemic diseases cause other symptoms apart from oral ulceration, e.g. genital ulceration in Behçet's syndrome, which is in contrast to aphthous stomatitis where there is isolated oral ulceration. " has by now been mentioned a few times. Distinguishing isolated oral ulceration from oral ulceration with systemic signs and symptoms is one of the key points in the differential diagnosis of recurrent oral ulceration ... rm at least mention of Bechet's again. Lesion (talk) 13:43, 1 September 2013 (UTC) Looks good. LT90001 (talk) 07:35, 3 September 2013 (UTC) One small thing, "anemia / deficiencies of iron" is not the same style as your other common language/med language separations, which use parentheses. LT90001 (talk) 07:35, 3 September 2013 (UTC)  Done Used a comma instead. Anemia and hematinic deficiency closely related but not equivalents. Lesion (talk) 12:25, 3 September 2013 (UTC)

Treatment

Treatment  Done

Suggest removal of parentheses " (the pain is tolerable with simple dietary modification during an episode of ulceration)" and addition of ", with the pain tolerable..."  Done Table - suggest you add a title and put the citations there. (OK, this is a big task so pending, Lesion (talk) 13:43, 1 September 2013 (UTC)) After the first line that says "wikitable", you can add a "|+ caption here", that will change the table to display with a caption. LT90001 (talk) 07:35, 3 September 2013 (UTC)  Done But, I'm sorry, I'd definitely call that a title rather than a caption. Lesion (talk) 12:31, 3 September 2013 (UTC) You list "prednisolone" as a systemic agent and not a corticosteroid. (will look into this, Lesion (talk) 13:43, 1 September 2013 (UTC)) Comment, the categories are "Topical mild potency corticosteroids", "Topical moderate potency corticosteroids" and "Systemic agents". Because of the topical qualifier, predisolone correctly belongs in the systemic group. Lesion (talk) 13:47, 1 September 2013 (UTC) Fair enough. It's perturbin' my bones to think of prednisone as a systemic agent. Could you put it in its own column? LT90001 (talk) 07:35, 3 September 2013 (UTC) Renamed the "systemic agents" row "orally administered drugs" since all the other categories are topical therapies, this actually makes more sense to me now. Lesion (talk) 12:31, 3 September 2013 (UTC) In paragraph, "Amlexanox " should probably be wikilinked.  Done

Prognosis

Prognosis  Done
I think very readable. No comments.

Epidemiology

Epidemiology  Done
"racial epidemiologic variation" reword to "ethnic variation"; "epidemiologic" has no utility.  Done Lesion (talk) 13:43, 1 September 2013 (UTC) "e.g. in the United States of America, " -> new sentence, wikilnk to "USA".  Done "white skinned" -> "white-skinned" and same for "black skinned"  Done

History

History  Done

No comment. Would be interested to know where "canker sores" came from, but Wikipedia isn't all about what LT910001 wants. Added some info on this, but it is not an easy word to pin down etymologically I sense. Lesion (talk) 13:43, 1 September 2013 (UTC) Hmm! interesting. This part " In Latin, cancer translates to "malignant tumor" or literally "crab", and in Middle English and Old North French, chancre which now is more usually applied to syphilis. When the word canker is used in the phrase "canker sores", this does not imply that it is a cancerous condition, but rather canker is used to describe the appearance of the sores." is uncited. LT90001 (talk) 07:35, 3 September 2013 (UTC) The last sentence was OR. Reworded to "Despite these terms, aphthous stomatitis is not a form of cancer but rather entirely benign." This sentence is also uncited "Stomatitis is also a non specific term meaning inflammation of the mucous membrane of the mouth, and again may describe many different conditions." LT90001 (talk) 07:35, 3 September 2013 (UTC) This is akin to asking for a reference to say "the sky is blue". I went to Stomatitis (which I have been working on a bit recently) but to no avail. These terms are so commonly used it is difficult to find a basic definition in a source even though you already know it. Similar situation on cheilitis, you wouldn't believe how long I had to search for a definition. Lesion (talk) 12:36, 3 September 2013 (UTC) This source [5] was in the ELs of stomatitis (questionable whether this passes MEDRS, referenced but not a publication in a peer review journal...) but it might serve as an indicator that we are not far off with such a definition. Inflammation of mucous lining of any of the structures in the mouth, cheeks, lip, tongue, gingiva, and floor or roof of the mouth. I'll definitely "finish" stomatitis at some point, and I'm assuming I'll have to find a better source then anyway. Lesion (talk) 12:40, 3 September 2013 (UTC)

Citations

Citations  Done
Tight with no problems

Overall comments

In conclusion a tight, well-written article. LT90001 (talk) 06:19, 1 September 2013 (UTC)

Thanks for detailed review. Agree that table in treatments section needs inline citation. I will do this soon. Lesion (talk) 13:45, 1 September 2013 (UTC)

Table now has inline citation.  Done Lesion (talk) 17:38, 2 September 2013 (UTC)

• @LT910001: Just to be clear, are you saying that you are not comfortable being the main reviewer for this GA? If so, I'm not sure anyone else knows to take it, because it appears as though the review has already been taken on the GA nominations page. I wonder if there is a way to mark it as needing a reviewer again? Lesion (talk) 17:38, 2 September 2013 (UTC)

Hey, sorry for any confusion. I'm quite happy to be the main reviewer. I'll get back you on the commentary today (thought I'd leave a day to space things out a bit). It would be nice if at least one other person lent their support before this article goes to GA, but I think this article's quality stands on its own. LT90001 (talk) 22:41, 2 September 2013 (UTC)

Done. LT90001 (talk) 07:35, 3 September 2013 (UTC)

OK I'll action the rest of these points. I'll also post on WT:MED to see if anyone else will offer the second opinion that you asked for above. Lesion (talk) 11:28, 3 September 2013 (UTC)

Hi folks; I read through this yesterday after I heard that you'd like a second opinion. I'd like to point out that the image File:Behcets_disease.jpg appears to have an incorrect license. The image is taken from a paper that the source URL indicates is copyrighted. It is unclear why the image is tagged at Commons as CC BY-SA. It doesn't appear that the uploader (who self-identifies on a subpage of his userpage here) is one of the paper's authors. I think the image should be removed unless we can get some source for the purported licensing status.  Done -- It looks very similar to the other pictures of ulcers we have here already anyway. Lesion (talk) 14:43, 4 September 2013 (UTC)

I'd like to point out a few very minor, not-actionable-for-GA quibbles that I noticed because I mostly review at FA:

Further comments  Done

No need to link United States of America.  Done Please use a consistent style when listing page numbers (we have 323–8 but 53–56, for example).  Done Seems to have definitely been an error here "pp 220–224195" let me recheck that. Lesion (talk) 14:43, 4 September 2013 (UTC) Please make an effort to link on first use of a term (see for example systemic, systemic condition/disease, Behçet's disease). I personally feel that sometimes the first occurrence of a term is not always the best place for the link, but this view is probably against MOS. I have partially corrected this issue for Behcet's, but it is still linked twice in both the table and the article, which is probably wrong too. Also corrected for systemic disease. The table in Treatment could use some punctuation attention (lists currently end with either no punctuation, comma, or full stop but should be consistent; there should be a comma not a full stop after sulodexide).  Done We try not to use full stops after incomplete sentences, but I notice you've used them in the table names; do you feel that the bolded name is insufficient on its own? Perhaps put them in a table row instead, to clarify?  Done -- I think I put in a period just to separate the title from the reference. Lesion (talk) 14:43, 4 September 2013 (UTC) The {{Commons category}} link goes to a nonexistent category; should it go to Category:Aphthous ulcer instead?  Done

I would be happy to support promotion to GA after resolving that single image issue. Nice work. Maralia (talk) 14:15, 4 September 2013 (UTC)

Thanks for feedback. Lesion (talk) 14:43, 4 September 2013 (UTC)

No problem. I haven't done a GA review in many years so I'll leave the technical aspects of closing to LT (or you). Well done! Maralia (talk) 00:09, 5 September 2013 (UTC)

I have concluded this review and promoted to GA. Well done! LT90001 (talk) 03:05, 5 September 2013 (UTC)

Adding oralmedic, garlic and gangigel to "treatments"?

I'm not sure where to add these two, but they are very significant:

1. oralmedic: (can't find a study on it, but personal experience showed me it is VERY effective, so there is probably non-subjective testimonies out there to fine)
   1. http://www.oralmedic.co.uk/faqs.html

1. Garlic:
   1. http://the-indonesian-jdr.fkg.ugm.ac.id/wp-content/uploads/Renny_Ayu_Novianty.pdf
   2. http://www.sciencedirect.com/science/article/pii/S0306987708003666

1. hyaluronate (gangigel)
   1. http://informahealthcare.com/doi/abs/10.1517/17425255.4.11.1449

Thoughts?

Tal Galili (talk) 21:29, 22 November 2013 (UTC)

Thank you for making these searches. I agree the treatment section could do with a lot more work. We need to acknowledge the full range of the treatments available, and wherever possible should be accompanied by a source which meets WP:MEDRS to support if the treatment is effective or not. We should not say that something is effective for any medical condition without a MEDRS source. I would support 3 subsections of the treatment section to help readers and to help us to organize these treatments:

1. Mainstream treatment approach-- Note that not all therapies for aphthous stomatitis used by doctors and specialists have evidence, but they are widely used anyway. Would be good to clearly delineate these from the sections below. MEDRS sources needed to support that each is mainstream medicine, and ideally other MEDRS sources to describe what is known about the effectiveness.
2. Alternative and complimentary medicine-- includes all non mainstream treatments which are used in modern times. Sources in this section should support that a particular therapy is used for aphthous ulceration in alt med, but if we make any comment about how effective or ineffective any of these treatments are, we need MEDRS sources.
3. Historic treatments / Traditional remedies-- includes all historic treatments which do not tend to be used nowadays. Sources in this section should meet WP:RS. We do not need MEDRS sources to say that something was used historically.

I am not yet able to comment on which group your suggested treatments fall into, because I have not looked at the sources right now. I suspect that the 3 treatments you have placed here might fit into different groups. Not sure what others think. Lesion (talk) 21:44, 24 November 2013 (UTC)

@Bluerasberry: might have an example of a such a section in another article... Lesion (talk) 21:44, 24 November 2013 (UTC)

I do not see any place for the first three sources. The first is an advertisement and the second two are primary research papers. This paper

• Buchsel, P. C.; Murphy, P. J. (2008). "Polyvinylpyrrolidone–sodium hyaluronate gel (Gelclair®): A bioadherent oral gel for the treatment of oral mucositis and other painful oral lesions". Expert Opinion on Drug Metabolism & Toxicology. 4 (11): 1449. doi:10.1517/17425255.4.11.1449.

is a review article which comes to the conclusion that there is not enough research on which to make a valid medical claim, so that could be cited. In Wikipedia is it better to start with a source and then try to summarize it rather than to start with an agenda and try to bolster it. The taboo here especially in health is in saying incorrect things from poor sources, and not from harming the encyclopedia by failing to integrate good information. Here is another source -

• Brocklehurst, P.; Tickle, M.; Glenny, A. M.; Lewis, M. A.; Pemberton, M. N.; Taylor, J.; Walsh, T.; Riley, P.; Yates, J. M. (2012). Brocklehurst, Paul (ed.). "Systemic interventions for recurrent aphthous stomatitis (mouth ulcers)". The Cochrane Library. 9: CD005411. doi:10.1002/14651858.CD005411.pub2. PMID 22972085.

That last source is Cochrane and they are saying that not enough research exists to back any treatment. I suspect that is the state of the field. Like Lesion, I would support other treatments being mentioned but without secondary sources stating otherwise, I would not want any of them presented as having evidence of efficacy. Blue Rasberry (talk) 03:05, 25 November 2013 (UTC)

@Talgalili: + Blue

Thank you for looking at those sources.

The review [6] about Gelclair does mention aphthous stomatitis, but I think it is mostly about mucositis, which is a different topic. Happy to use this source to say it is sometimes used, but unless the sources says it is effective we should not suggest this.

The Cochrane review is about systemic medications. To my knowledge there is no review about topical treatments, but we badly need one.

I am planning to organize the treatments section into these 3 groups I described above. Bluerasberry I was wondering if you had any example of another article which I could use as a template? Lesion (talk) 09:47, 2 December 2013 (UTC)

Thanks Lesion, I do not. I still have self doubt about what I do myself. Right now there is a table in the treatment section, and I am fond of these, but some other users have noted that these might not be accessible for users with vision difficulties and that whenever possible, text without tables are preferable. Tables such as this one, with few columns, are universally accepted as appropriate so far as I know, but sometimes over time tables grow to include more columns and then become inappropriate. If you wanted to expand this table, then I would like that. I also like putting summary boxes on the sides, such as I did here to note safety concerns or here to make a comparison chart. If it gives you more confidence, then I would share my opinion that there is not solid standardization in how Wikipedia presents treatments. I am sensitive to reporting safety concerns and side effects more than I am to reporting what a treatment actually is supposed to do, and I often see that lacking. I like sectioning articles and if you section this treatment section as you propose, then ping me and I will come back and comment. It seems like a reasonable idea but I would not know where this has been done or described before. Blue Rasberry (talk) 16:02, 2 December 2013 (UTC)

Alum treatment

There is one folk remedy that works in our family. Moisten a Q-tip(tm) dip it in alum powder, and then dab some alum onto the apthous ulcer. It hurts when applied but the ulcer immediately starts to dry up and heal. In rare cases, if the ulcer is quite deep and still seems to be wet & open a few days later, repeat the treatment. I guess that the clotting ability of the alum stops erosion and lets the ulcer start to heal, but whatever the mechanism, it works. It would be nice to find some research about it.

Another aluminum-based treatment uses sucralfate. There's a mention here in the journal Cutis: Add Sucralfate to List of Apthous Ulcer Treatments (Comment on "Selecting Topical and Systemic Agents for Recurrent Aphthous Stomatitis"). Cutis. 2001;68:201-206)[letter] (Cutis. 2002;70:275). The author, Craig G. Burkhart, M.D., uses sucralfate (Carafate® suspension). This is "the aluminum subsalt of sucrose-8-sulphate, which has been used since 1968 as a mucoprotector for peptic ulcers." Monado (talk) 23:38, 5 December 2013 (UTC)

Patch test

Epeefleche, re patch test img, I have been thinking about this and it is perhaps not representative of the real world if we include the pic. In all the cases of oral ulceration I have seen or been involved with, a patch test has never been ordered. This test is reserved for sudden, acute swelling of the lips, and only then rarely (in my experience-- i.e. "original research"). Not sure it is accurate to give the image of patch test considering how often it is actually utilized in relation to this topic? I would not have any issue with the image if we had some pictures of other diagnostic methods, but as it is the implication to the casual reader is that a patch test is the most routine test. Regards, Lesion 19:37, 9 April 2014 (UTC)

• Hi. That's interesting; I have experience in this area, and it is the opposite of yours. Plus, I believe that our referring to our own experience, as you agree I believe, as the basis for the inclusion or exclusion of RS-supported material is not in keeping with wp:OR. wp:OR guards against editors putting their own personal experience above what the RSs say. And in the case what the RSs say accords with my experience. I have no issue with the inclusion of other diagnostic tests for which there is RS support.Epeefleche (talk) 19:44, 9 April 2014 (UTC)

IMO, the only routine investigation is bloods to check iron, vit B and hemoglobin. That gets done most of the time in my experience. What about some kind of image of that to give due weight, or at least the suggestion that there is no fixed approach to the diagnosis? Best not to show an actual needle as many people would be squeamish... Lesion 23:39, 9 April 2014 (UTC)

Great idea ... and your call on the squeamish issue.... (some may not like the patch test either).Epeefleche (talk) 05:13, 10 April 2014 (UTC)

OK, Lesion 08:18, 10 April 2014 (UTC)

Concern re Balsam of Peru refs

• Stomatitis does not necessarily equal aphthous stomatitis. Stomatitis= inflammation of mouth. You could say, aphthous stomatitis is a particular type of stomatitis.
• Stomatitis does not necessarily equal ulceration. Again, could say, that ulceration is one form stomatitis, but aphthous stomatitis is not only cause of oral ulceration

Just as on denture-related stomatitis, do the sources about Balsam of Peru explicitly state that it causes aphthous stomatitis (aka canker sores, aka recurrent aphthous stomatitis). Many thanks, Lesion 19:28, 19 April 2014 (UTC)

Fair question -- I thought that the refs that connect the two specifically had been added, and of course they should be. As you know, we have refs that point to BOP causing stomatitis generally, but the issue you raise is whether they point to the subset specifically. Perhaps you can see and check this source (I can't see what it says). I believe I have an article that is not on-line, but I will have to find it to cite to it. Interestingly, a century ago people tried treating these with Balsam of Peru (reminiscent of the effort to treat anal itching with Balsam of Peru products today). For not, I'll strike it, and only restore if I can turn up the proper RS ref. Good point. Tx.Epeefleche (talk) 08:07, 20 April 2014 (UTC)

Questionable use of term "toxin" to refer to SLS

Suspect misguided use of term toxin in this instance is influenced by lack of understanding about what is the true scientific definition of a toxin, and how this differs from what alternative medicine terms a "toxin" (see toxin (alternative medicine)), i.e. basically anything, including things which don't actually exist. Please use a reliable medical source to support inclusion of the term "toxin" for aphthous stomatitis topic. SLS is a synthetic chemical, it is not released from bacteria or other living cells. It causes mouth ulcers by acting as an antigenic stimulus, which is why SLS is discussed in the section describing states of heightened antigenic sensitivity. Also please use reliable medical sources not primary sources WP:MEDRS. This is an FA nominated article and all content should be at FA standard, and since this is a medical article, the standard is MEDRS. Adding primary sources at this stage may cause more work during the FA nomination as such content based on primary sources would need to be removed, and there may be an appearance of edit warring to the reviewers, when one FA criterion stipulates a stable edit history without edit warring. Thank you for your understanding. 188.30.202.119 (talk) 00:31, 25 June 2014 (UTC)/188.29.81.119 (talk) 14:30, 26 June 2014 (UTC)

Edit warring on format

Pls don't edit war on format -- when there is an acceptable first-chosen format you don't like. --Epeefleche (talk) 23:29, 5 July 2014 (UTC)

It is my understanding that the 2 column reflist causes display errors on many mobile devices, while the 30em is more reliable. Doesnt really matter to me, just trying to be helpful. 92.40.89.201 (talk) 07:59, 6 July 2014 (UTC)

With regards the format of the references, I am making them all a consistent style throughout the article per FA criteria. A thankless but necessary task. 92.40.89.201 (talk) 08:01, 6 July 2014 (UTC)

It's a bad idea to edit war on format -- when there is an acceptable first-chosen format you don't like. The em format causes one (rather than 2) columns on my pc and on my mobile device, and others have said as much as well. It's like edit-warring on date formats, where 2 are acceptable. Leave it to the first-chosen format. --Epeefleche (talk) 20:22, 7 July 2014 (UTC)

The FA reviewer also requests not to use the fixed column number [7], which is why I changed it back today. TY for getting page number anyway. 188.28.135.125 (talk) 21:31, 7 July 2014 (UTC)

That individual editor has a view that is disagreed with by many other editors. See, e.g., comments by seasoned sysop user:SlimVirgin here. I would also note that this issue has been raised on Nikki's talkpage (and other talkpages) a number of times. By various editors. Including here and here and here. Epeefleche (talk) 21:39, 7 July 2014 (UTC)

There is local agreement here, and it does generally perform better on mobile devices so there really is no need to pointlessly keep reverting. Thank you. 92.41.84.184 (talk) 22:37, 7 July 2014 (UTC)

• My view -- matching that of SlimVirgin and the others indicated in the comments linked to, is that the 2 col format, initially chosen, should be adhered to. You assert that the 2 col format has been deprecated, but see SlimVirgin's comment to Nikki linked to above that "There's no consensus to deprecate columns; it is something that was suggested but not agreed upon yet, so if people want to use them, it's okay.". And as you can see from the links above, User:Ssilvers also told Nikki that "that's just a proposal that met substantial disagreement. It does *not* actually seem to be deprecated -- there does not seem to be a widespread consensus." There are editors who feel as Nikki does, but by the above-indicated comments by a series of seasoned (100,000-plus-edits) you can see that Nikki's view is not a consensus view .. there is simply no consensus support for his position.

And that the 2-column format performs better on the mobile device I've seen, and on the PC I've seen, than the em format.

So there is no need to pointlessly revert (which I see you've now done once again) to a format other than that previously chosen. That's the sort of "let's change the original format chosen to one I like, because ILIKEIT", that leads to silly and fruitless edit wars. And we address that, as with dates and the like, by not changing the first acceptable format chosen, where there are two acceptable formats. Epeefleche (talk) 22:50, 7 July 2014 (UTC)

This stupid argument sums up everything I hate about WP. There are almost infinite ways we could be building the encyclopedia instead of this. Firstly, in all likelihood I was the one who chose the original format. Secondly, it is not a case of "I like it", there is a valid, logical reason to favor the other one. One patient today had this article already opened when they came in to see me. I don't know how many people look at wp on their mobiles, but they should be able to see a well laid out reflist if they choose to read wp in this way. I think we should use the more stable version since there is absolutely no difference to display on larger screens. Finally, I object to you calling any instance where someone disagrees with you an edit war. Anyway, I see you have not reverted and this must have been a bit difficult for you but you have my respect for this. 92.41.87.238 (talk) 02:04, 8 July 2014 (UTC)

• I also need to standardize all the dates to one format, as stipulated in the FA review, so if there is going to be any argument over this then I would prefer it were agreed before I do the work as it will take a little bit of time and I do not want it to be reverted. July 7 2012 OK? 92.41.87.238 (talk) 02:08, 8 July 2014 (UTC)

Surgical excision

I want to hear more about this. I'm guessing it does not work because the lesion is equivalent to any other mouth injury that would lead to another canker sore. B137 (talk) 03:52, 4 October 2014 (UTC)

Mainly it doesn't work because mouth ulcers will be forming at different locations on the skin inside the mouth and you can't cut out all the skin inside the mouth, and even if you did, when it healed the condition would continue anyway. It would be a useless surgical intervention. — Preceding unsigned comment added by 188.29.82.88 (talk) 00:44, 7 October 2014 (UTC)

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