aphthous stomatitis; aphthous ulcer (canker sore)

Introduction

The most common oral mucosal ulcerative lesion.

Etiology

• oral mucosal ulceration
  • Behcet's syndrome
  • erythema multiforme
  • Crohn's disease
• predisposing factors (proposed)
  • Streptococcal infection
  • Herpes
  • minor dental trauma
  • stress
  • menstruation
  • nutritional deficiencies
  • food allergies
  • HIV1 infection
    • zalcitabine (ddC) therapy

Epidemiology

• most patients young
• most common cause of mouth ulcers
• prevalence is 20-50% of population
• usually begins in adolescence or early adulthood
• frequency decreases with age

Clinical manifestations

• recurrent (> 4 times per year), painful, round, shallow ulcers with a gray base
• found on buccal mucosa, rarely on oral mucosa attached to periosteum, i.e. hard palate, gums or tongue
• three forms of aphthous stomatitis
  • minor form (80%): solitary oval ulcer < 1 cm in diameter, duration 7-10 days
  • major ulcer (10%): multifocal, ragged, up to 2 cm in diameter, duration up to 6 weeks, may scar, often immediately recurring following resolution
  • Herpetiform ulcers: grouped papulovesicular lesions

* images

Laboratory

• diagnosis is generally clinical, but biopsy may be necessary to distinguish from Herpes simplex or CMV in AIDS patients

Management

• avoidance of hot or acidic foods
• saline rinses
• topical viscous lidocaine
  • 3 mL of 2% solution
  • hold in mouth 1-2 minutes before meals
• diphenhydramine solution - may mix with kaopectate
  • Magic mouthwash
• topical steroids
  • dry lesion
  • triamcinolone topical 0.1% every 4-6 hours
  • use with or follow with Orabase to affix steroid
• oral suspensions of lidocaine, corticosteroid & tetracycline
• Gelclair
• systemic or locally injected steroids in severe cases
• thalidomide in severe cases
• treatment of underlying etiology

More general terms

• stomatitis (includes oral ulceration)

Additional terms

• mucosal ulcer