Recurrent mouth ulcers (oral aphthosis): tests
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Occasional, mildly troublesome mouth ulcers
- No laboratory tests: local treatment and removal of local factors.
Recurrent or disabling aphthosis
Laboratory tests
- FBC
- Serum ferritin
- Vitamin B12
- Folate
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)
- Total IgA
- HIV serology (giant ulcers, recent-onset aphthosis or risk factor)if needednon-French guidelineHIV is among the infectious causes of recurrent mouth ulcers to be ruled out before accepting idiopathic aphthous stomatitis [2].
- Syphilis serology (atypical ulceration or risk factor)if needednon-French guidelineSyphilis is among the bacterial causes of mouth ulcers in the differential diagnosis [2].
- Herpes simplex PCR on a swab of an ulcer (herpetiform ulcers, always recurring at the same site, or unidentified)if neededHerpetiform aphthosis is confused with herpetic gingivostomatitis: a viral sample (PCR) rules out herpes [2]. For unidentified mouth ulcers, dermatology advice to rule out herpes infection (PCR) or a bullous disease (biopsy) [5]. Procedure reimbursed in atypical mucocutaneous involvement [6].
Also consider
- Coeliac disease suspected? If coeliac disease is suspected, see the Coeliac disease page.
Do not order
Sources (10)
- Mousavi T, Jalali H, Moosazadeh M. Hematological parameters in patients with recurrent aphthous stomatitis: a systematic review and meta-analysis. BMC Oral Health. 2024;24(1):339.
- Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: a review. J Clin Aesthet Dermatol. 2017;10(3):26-36.
- Randall DA, Wilson Westmark NL, Neville BW. Common oral lesions. Am Fam Physician. 2022;105(4):369-376.
- DermNet (Nouvelle-Zélande). Aphthous ulcer. V. Ngan, 2003 ; mise à jour par A. Oakley, janvier 2016 ; révision d’avril 2021.
- Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CeRéMAIA), filière FAI2R. Protocole national de diagnostic et de soins (PNDS) : maladie de Behçet, décembre 2019 (HAS, janvier 2020).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1828 (anticorps anti-transglutaminase IgA) et 4506 (détection du génome de l'herpès simplex).
- Bhargava S, Dubey SP, Haldipur D, et al. Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus. Indian J Otolaryngol Head Neck Surg. 2023;75(3):2672-80.
- National Institute for Health and Care Excellence. Coeliac disease: recognition, assessment and management. NICE guideline NG20, septembre 2015 ; chapitre Recommendations (1.1.1, 1.2.2).
- Haute Autorité de santé. Maladie cœliaque : diagnostic chez l'enfant et l'adulte. Recommandation de bonne pratique, validée par le Collège le 16 juillet 2026.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : acte 1684 (calprotectine fécale).