Author: Vanessa Ngan, Staff Writer, An aphthous ulcer is an ulcer that forms on the mucous membranes. They are also called aphthae, aphthosis, aphthous stomatitis and canker sores. An aphthous ulcer is typically a recurrent round or oval sore or ulcer inside the mouth on an area where the skin is not tightly bound to the underlying bone, such as on the inside of the lips and cheeks or underneath the tongue. Aphthous ulcers can also affect the genitalia in males and females.
Differentials Behcet syndrome Malignant ulcer Folate deficiency Full details. Cold sores primarily affect the corners of the mouth, the lips, the nostrils and the philtrum, the area between the upper lip and the nose. Other viral, bacterial, treponemal Oral aphtous ulcers fungal agents have Oral aphtous ulcers potential to cause mouth ulcers. Retrieved April 12, Other names for aphthous ulcers include aphthous stomatitis and canker sores. Apply to dried ulcer two to four times daily.
Treated oral swabs. Who is at risk of aphthous ulcer?
The informal term canker sores is also used, mainly in North Oral aphtous ulcers, although this may also refer to any mouth ulcers. Before ulceration occurs, some individuals may begin to feel a burning or itching sensation inside the mouth, which can Oral aphtous ulcers painful. Hepatitis Australia. Differentials Behcet syndrome Malignant ulcer Folate deficiency Full details. Rembrandt Gentle White toothpaste did not contain sodium lauryl sulfate, and was specifically marketed as being for the benefit of "canker sore sufferers". They may also affect the tongue, the inside of the cheeks, and the inside of the lips. Ullcers used without qualification, uulcers commonly refers to lesions of recurrent aphthous stomatitis. Please always consult your physician for medical advices and treatment. There is a lack of accepted safety for use under medical supervision. This risk can be reduced if the receiving partner wears a condom or if a dental dam is used. Although stress does not directly cause mouth ulcers, it does increase the chances of Biggest slut swallow them and can affect their healing process. In aphtoue projects Wikimedia Commons. Aphttous recurrence may vary from days to months or even years between each attack of ulcers.
See related patient information handout on aphthous ulcers , written by the author of this article.
- The informal term canker sores is also used, mainly in North America, although this may also refer to any mouth ulcers.
- Clinically, 3 forms of recurrent aphthous ulceration exist: major, minor, and herpetiform.
See related patient information handout on aphthous ulcers , written by the author of this article. Aphthous ulcers are a common and painful problem. Benign aphthae tend to be small less than 1 cm in diameter and shallow. Aphthous ulcers that occur in conjunction with symptoms of uveitis, genital ulcerations, conjunctivitis, arthritis, fever or adenopathy should prompt a search for a serious etiology.
The lack of clarity regarding the etiology of aphthous ulcers has resulted in treatments that are largely empiric. These treatments include antibiotics, antiinflammatories, immune modulators, anesthetics and alternative herbal remedies. Aphthous ulcers can be classified into three different types: minor, major and herpetiform. They can be singular or multiple, and tend to be small less than 1 cm in diameter and shallow 3 Figure 1. Major aphthae are larger and involve deeper ulceration.
Patients with benign aphthous ulcers should have no other findings such as fever, adenopathy, gastrointestinal symptoms or other skin or mucous-membrane symptoms. The pathophysiology of aphthous ulcers is poorly understood. Histologically, aphthae contain a mononuclear infiltrate with a fibrin coating. Systemic T- and B-cell responses have also been reported as altered in patients with recurrent aphthae.
Infectious agents such as Helicobacter pylori and herpes simplex virus have been investigated but have not been consistently found in aphthous ulcers. Several conditions should be considered in the differential diagnosis when evaluating patients with recurrent aphthae. Major aphthae can be associated with human immunodeficiency virus HIV infection; clinicians should consider HIV testing when aphthae are large and slow to heal. Table 1 outlines the differential diagnosis of aphthous ulcers, with distinguishing features.
Cryptosporidium, mucormycosis, histoplasma. Cyclic neutropenia. Infection-causing ulceration in the mouth should be considered when evaluating patients with oral symptoms. A common infection, particularly in patients with HIV infection and aphthae, is herpes 5 Figure 3. When Tzank staining is available, a sample from a herpetic lesion will reveal inclusion-bearing giant cells.
Other viral, bacterial, treponemal and fungal agents have the potential to cause mouth ulcers. Biopsy alone or in conjunction with a culture of lesions or blood testing may aid in distinguishing the causative agent. Herpes stomatitis, found primarily on the alveolar mucosa. Tzank stain of a lesion scraping revealed inclusion-bearing giant cells. Several autoimmune diseases may mimic benign aphthous ulcers.
Lupus erythematosus, bullous pemphigoid and pemphigus vulgaris are other diseases that may involve ulceration of the mouth. In all of these conditions, the associated symptoms should be elicited to make a differentiation from benign recurrent aphthae. Hematologic etiologies should be considered when evaluating recurrent or slow-healing mouth ulcers. Cyclic neutropenia is associated with mouth ulcers during neutropenic periods.
Consideration may be given to blood count measurement if fever and mouth ulcers regularly occur together. Finally, a neoplasm such as squamous cell carcinoma must be ruled out when evaluating patients with persistent, nonhealing mouth ulceration. Office punch biopsy or surgical biopsy may help make this distinction.
Evaluation of the head and neck for adenopathy is particularly important in this situation. Treatment for oral aphthae can be divided into five categories: antibiotic, anti-inflammatory, immune modulatory, symptomatic and alternative Table 2. The lack of predictability of the efficacy of a particular treatment mirrors the mystery surrounding the etiology of the condition. Randomized, controlled studies 1 support use. Randomized, controlled studies 1 show decreased pain.
Studies in HIV-infected patients only 7. Randomized, controlled studies 9 , 10 show decreased symptoms and faster healing. Topical and systemic antibiotic treatments are empiric and are used because of a belief that some as-yet-undiscovered infectious agent is causing the aphthous ulcer. Reduction of pain and duration of ulcerations may result. Tetracycline suspension, mg per 5 mL, can also be used in a similar fashion, with 5 mL swished four times per day. In children and in women who may be pregnant, tetracycline should be avoided because of its tendency to discolor teeth.
Minocycline can also be used this way, with a mg tablet dissolved in mL water and swished twice per day. In addition, minocycline use can cause fetal harm. Therefore, women who are pregnant or who become pregnant while taking the antibiotic should be informed of the potential for harm to the fetus. Triamcinolone 0. The paste can be applied until the ulcer is healed. Aphthous ulcers in HIV-infected patients may have extremely protracted healing times, up to months.
Thalidomide in a dosage of mg once to twice daily for three to eight weeks yields a faster healing rate than placebo. Amlexanox 5 percent paste Aphthasol has been examined in several studies of the treatment of aphthous ulcers. The paste was applied to ulcers two to four times a day. In one large study, 21 percent of patients achieved complete healing at three days compared with 8 percent of untreated patients.
Other strategies exist for local and systemic symptom relief in patients with aphthous ulcers. Pain relief may be achieved with 2 percent viscous lidocaine applied with a cotton swab several times daily, as needed. Over-the-counter agents such as Orabase or Zilactin-B coat aphthous ulcers and provide local protection. Finally, the combination of over-the-counter magnesium hydroxide antacid and diphenhydramine hydrochloride 5 mg per mL , mixed half and half, will bring about some symptom relief.
Systemic nonsteroidal anti-inflammatory agents or acetaminophen may provide some analgesia when ulcers are very painful. Sucking on zinc gluconate lozenges is anecdotally reported to provide local relief and speeding of healing time for aphthous ulcers. Vitamin C, vitamin B complex and lysine may speed healing when taken orally at the onset of lesions. Sage and chamomile mouthwash, created by infusing equal amounts of the two herbs in water, may be helpful when used four to six times a day.
Echinacea is reported to speed healing, perhaps through its immune modulatory effect. Carrot, celery and cantaloupe juices also have been reported as helpful complementary agents. Aphthous ulcers are a poorly understood clinical entity that cause significant pain in otherwise healthy patients. Several agents are helpful in the management of aphthous ulcers, including antibiotics, antiinflammatories, immune modulators, anesthetics and alternative products.
When ulcers are slow to heal or if associated systemic symptoms are present e. Already a member or subscriber? Log in. He is also a clinical instructor in the departments of family medicine at Boston University School of Medicine and Tufts University School of Medicine.
McBride received his medical degree from the University of Pittsburgh Pa. School of Medicine and completed a residency in family practice at York Pa.
Address correspondence to David R. McBride, M. Reprints are not available from the author. Pharmacological management of recurrent oral mucosal ulceration. Freedberg IM. Fitzpatrick's dermatology in general medicine. Vol 1.
New York, N. Robbins pathologic basis of disease. Philadelphia: Saunders, Lack of association between aphthous ulcers and Helicobacter pylori [Letter]. Arch Dermatol. Bartlett JG. Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. N Engl J Med. Thalidomide for treatment of oral aphthous ulcers in patients with human immunodeficiency visus: case report and review. Am J Gastroenterol.
J Oral Maxillofac Surg. Amlexanox oral paste: a novel treatment that accelerates the healing of aphthous ulcers. Compend Cont Educ Dent. Strohecker J, ed. Alternative medicine: the definitive guide. Fife, Wash. Richard W. Sloan, M. Hospital and clinical associate professor in family and community medicine at the Milton S.
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy and there is no evidence of risk in later trimesters. Possible triggers of aphthous ulcers include: . Agnathia Alveolar osteitis Buccal exostosis Cherubism Idiopathic osteosclerosis Mandibular fracture Microgenia Micrognathia Intraosseous cysts Odontogenic : periapical Dentigerous Buccal bifurcation Lateral periodontal Globulomaxillary Calcifying odontogenic Glandular odontogenic Non-odontogenic: Nasopalatine duct Median mandibular Median palatal Traumatic bone Osteoma Osteomyelitis Osteonecrosis Bisphosphonate-associated Neuralgia-inducing cavitational osteonecrosis Osteoradionecrosis Osteoporotic bone marrow defect Paget's disease of bone Periapical abscess Phoenix abscess Periapical periodontitis Stafne defect Torus mandibularis. World Health Organization. The diagnostic process may involve the ruling out of these conditions through blood tests or, less often, using a gastroscopy or colonoscopy, possibly also obtaining tissue samples.
Oral aphtous ulcers. Topics under Aphthous Ulcer
Aphthous stomatitis - Wikipedia
Aphthous mouth ulcers aphthae are a common variety of ulcer that form on the mucous membranes, typically in the oral cavity mouth. Other names for aphthous ulcers include aphthous stomatitis and canker sores. Aphthous ulcers are generally round in shape and form in the soft areas of the mouth such as the inside of the lips, the cheeks or the underside of the tongue.
They are small in size — usually less than 5 mm in diameter — and can form as a single ulcer or in a cluster. They typically do not cause much pain. These are less common, are generally 5 mm or larger and form singularly or in a pair. They can be painful, especially when eating or drinking, and last anywhere between two weeks and a number of months. These can occur when multiple pinpoint lesions fuse together and form large, irregularly shaped ulcers.
Herpetiform ulcers are so called because of their similarity in appearance to herpes, however, herpetiform ulceration is not caused by the herpes simplex virus. Aside from the ulcers aphthae themselves, the condition has very few symptoms. Before ulceration occurs, some individuals may begin to feel a burning or itching sensation inside the mouth, which can be painful. Once the ulceration occurs, localized pain of various degrees is often present. The ulcers aphthae, canker sores or mouth sores are normally shallow and begin as pale yellow in colour, generally turning grey as the condition develops.
They may be ringed with red or appear fully red when inflamed. Depending on where the ulcers are located, eating, drinking and talking may become uncomfortable. Good to know: In severe cases, aphthous ulcers can result in swelling of the lymph nodes, fever and physical fatigue or lethargy. If you are concerned that you may have aphthous mouth ulcers, you can do a free symptom check with Ada at any time. The precise cause or causes of aphthous ulcers canker sores are unknown, however, it is thought that ulceration is brought about by one or a combination of external triggers.
It may also be partly genetic, with 40 percent of people who experience ulcers having a family history of the condition. Possible triggers of aphthous ulcers include: . Stress is a common cause of mouth ulcers. Although stress does not directly cause mouth ulcers, it does increase the chances of developing them and can affect their healing process.
Good to know: Dentists are able to advise on ways to reduce the risk of developing aphthous mouth ulcers, for example recommending toothpastes and mouthwashes that do not contain sodium lauryl sulfate or advising on correct brushing equipment and technique to reduce the chance of injury to the inside of the mouth.
Some medications are also linked to the development of ulcers , however, they may not always cause the aphthous variety of ulcers. They include:  . The ulcers that are symptomatic of these disorders, however, are technically not aphthous but closely resemble aphthous ulcers and are therefore called aphthous-like ulceration.
If you or someone you know has recurrent mouth ulcers or ulcers that do not heal, you can do a free symptom check with the Ada app at any time. The diagnostic process may involve the ruling out of these conditions through blood tests or, less often, using a gastroscopy or colonoscopy, possibly also obtaining tissue samples.
This usually only happens in severe cases, where the ulcerated area is extensive. In the case of a secondary bacterial infection, an antibiotic mouthwash and a means of managing the pain and discomfort may be prescribed. In some cases, oral antibiotics may also be needed see the section below on treatment. There is no cure for aphthous ulcers, aphthae or canker sores, but there are ways to manage the symptoms. In the majority of cases, the ulcers will disappear without treatment and avoiding hard or irritative foods, like e.
These pastes should be applied between two and four times per day, please follow the specific recommendations of your pharmacy or doctor. The use of an antiseptic mouthwash e.
They are typically administered in mouthwash form, with the antibiotic being dissolved in water, swilled around the mouth and spat out. This may be necessary several times per day for a number of days. There are a number of popular home remedies for aphthous ulcers, including: . Nutritional supplements such as Vitamin B capsules, Vitamin D capsules, folate tablets, or zinc tablets can also reduce the risk of developing canker sores. To lessen the likelihood of an ulcer outbreak, especially for those with a history of recurrent aphthous ulcers aphthae , a number of measures can be taken.
Aphthous ulcers aphthae are generally non-serious and will go away without any particular treatment. Ulcers that heal on their own within a few weeks are not an indication of oral cancer and are non-infectious. The ulcers, however, can be very painful and inconveniencing, especially if they are recurrent.
Many people will find that they stop getting aphthous ulcers as they get older. Good to know: If an ulcer or group of ulcers does not heal within three weeks, or lasts for longer than three weeks, the affected person should see a doctor as soon as possible for a proper diagnostic workup. In some cases, a persistent ulcer may indicate oral cancer.
Q: Are there any home remedies for aphthous ulcers aphthae? A: There are a number of popular home remedies for aphthous ulcers, including:  . Q: Can I get aphthous ulcers aphthae in the genital region? Q: Is it safe to have oral sex if the performing partner has mouth ulcers? A: Mouth ulcers, because they are breaks in the skin inside the mouth, increase the risk of contracting sexually-transmitted infections such as herpes, gonorrhea, syphilis and chlamydia.
This risk can be reduced if the receiving partner wears a condom or if a dental dam is used. Q: Can smoking cause mouth ulcers? A: Smoking can make mouth ulcers worse. The nicotine in cigarette smoke may reduce the amount of blood that flows to the mouth and gums, which may then slow down the healing process for any ulcers, cuts or scrapes inside the mouth.
At the same time, it seems to be the case that smoking may reduce the chance of developing mouth ulcers, because it hardens the surface of the epithelial cells in the mouth.
Q: What is recurrent aphthous stomatitis RAS? A: Recurrent aphthous stomatitis RAS is the name given to the condition of experiencing frequent bouts of aphthous mouth ulcers aphthae. Although a single bout of aphthous stomatitis is possible, recurrent episodes are the norm. Q: What is complex aphthosis? When complex aphthosis is suspected, medical attention should be sought for diagnosis and treatment.
Q: Can systemic lupus erythematosus cause mouth ulcers? A: Mouth ulcers can affect about half of all people with systemic lupus erythematosus , an autoimmune disorder. Lupus-related ulcers are not aphthous mouth ulcers, and while they may be painful in some people, they are often not painful for many others. They commonly affect the roof of the mouth, but can also appear on the gums, lips and inside of the cheeks. If acid enters the mouth, GERD can cause the erosion of tooth enamel and an acidic taste.
Mouth ulcers can develop. GERD may also cause a feeling of a sore throat and, in some cases, throat and esophageal inflammation and ulcers may develop. Q: Can chemotherapy cause mouth ulcers? A: Yes, chemotherapy often causes mouth ulcers. Chemotherapy can cause inflammation of the mucosal lining of the throat and mouth, leading to sores in the mouth. Q: Can Hepatitis C cause mouth ulcers? A: Yes, Hepatitis C or its treatment can sometimes cause mouth ulcers and other mouth conditions, such as tooth decay or a sensitive mouth by e.
Q: Are mouth ulcers a sign of cancer? A: A mouth ulcer that does not clear up is sometimes a sign of oral cancer. However, very few mouth ulcers are a sign of cancer.
Mouth ulcers associated with cancer are generally solitary rather than in clusters and appear without any apparent cause. Other symptoms of oral cancer may include: .
Q: Can aphthous mouth ulcers occur on the gums? A: Yes, mouth ulcers can affect the gums. They may also affect the tongue, the inside of the cheeks, and the inside of the lips. Q: What are the differences between cold sores and canker sores? A: Cold sores, also known as herpes labialis , are caused by Herpes Simplex Virus 1 or 2. Aphthous mouth ulcers are not caused by viruses. Cold sores primarily affect the corners of the mouth, the lips, the nostrils and the philtrum, the area between the upper lip and the nose.
DermNet New Zealand. Accessed July 13, Mayo Clinic. Acta clinica Croatica. June Accessed 24 October International Journal of Oral and Maxillofacial Surgery. March Accesed 24 October Nicotine and Tobacco Research. August BMJ Best Practice. American Family Physician. Accessed 21 September