Major RAS Diagnosis — ORE Part 1 MCQ

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ModerateOral MedicineMajor RAS DiagnosisORE Part 1

A patient presents with a deep, painful, cratered ulcer on the soft palate that has been present for 3 weeks. It is approximately 15 mm in diameter with a yellowish slough. The patient reports a history of similar large ulcers that heal with scarring over 4–6 weeks. What type of recurrent aphthous stomatitis is this?

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Correct answer: A — Major recurrent aphthous stomatitis (Sutton disease)

The diagnosis is major recurrent aphthous stomatitis (Sutton disease). The 15 mm ulcer diameter (>5 mm threshold), 3-week duration (consistent with major ulcer onset; major ulcers heal over 6+ weeks), yellowish slough (fibrinous pseudomembrane), deep cratered appearance, and critically, the documented history of healing with scarring in previous episodes are pathognomonic for major RAS. Minor RAS ulcers are smaller (<5 mm), heal without scarring in 10–14 days, and do not cause deep destruction. Herpetiform RAS presents as multiple pinpoint (1–3 mm) clustered lesions lasting 7–10 days without scarring. Behçet disease requires systemic features (genital ulcers, skin and ocular involvement); isolated recurrent oral ulcers do not meet criteria. Primary herpetic gingivostomatitis is acute viral infection in primary infection, not a recurrent pattern of large destructive ulcers.

Reference: Ship JA. Recurrent aphthous stomatitis. An update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(2):141–7. https://pubmed.ncbi.nlm.nih.gov/8665304/