Diagnosis
Aphthous stomatitis
Common oral mucosal lesions with discrete, shallow, painful ulcers typically lasting 7-10 days.
Also known as: Aphthae, Aphthosis, Aphthous ulcer, Canker sore, Recurrent aphthous stomatitis, Recurrent aphthous ulcer, Recurrent oral ulcer
Etiology
Cause/associations [8as]
Unknown etiology
Autoimmune disorders: Behcet syndrome, systemic lupus erythematosus, Crohns disease, Ulcerative colitis, celiac disease, food allergies
Host factors: genetic, deficiency (iron, folic acid, vitamin B6/B12), immune dysregulation, physical/emotional stress
HIV infection
Infections: Bacterial, viral and fungal
Medications: NSAIDs, alendronate, nicorandil
Trauma: biting of the mucosa
Endocrine factors: progestogen level in the menstrual cycle
Stress
Smoking cessation
Deficiency: iron, folic acid, vitamin B12, and zinc
Pathophysiology [8as][jaa]
Genetic predisposition (family history)
Likely cell-mediated immunological reaction involving T-cells and TNF-α:
Lymphocytes infiltrate the oral epithelium --> edema --> vacuolization of the epithelium --> localized swelling --> later ulceration of the epithelium
Classification [8as]
Minor aphthous ulcers: shallow and diameter <1 cm (70%)
Major aphthous ulcers: diameter >1 cm (10%)
Herpetiform ulcers: clusters of ulcers (10%)
Complications [8as]
Severe pain --> dysphagia --> dehydration and nutritional deficiencies
Suboptiomal oral hygiene
Bacterial superinfection (prevented with chlorhexidine mouthwash)
Opportunistic fungal infections in the oral mucosa
Epidemiology
Prevalence per 100.000 [bdb][kqq][f32][ysw]
Symptoms & findings
Symptoms
None listed.
Clinical findings
None listed.
Anamneses
None listed.
Localized findings
Approach
Blood test (leukocytes, CRP, sedimentation rate, iron, ferritin, vitamin B6/B12)
Viral culture
Biopsy
Endoscopy
Treatment
Identify and avoid predisposing factors.
Symptomatic treatment: aims to alleviate symptoms [8as]
Topical anesthetic
Protective emollient
NSAIDs
Topical corticosteroids
Topical antibiotics
Chlorhexidine mouthwash to prevent added bacterial infection
Topical tetracycline
Short course of systemic steroids (prednisone) if major aphthous ulcers
Differential diagnoses
Behcet's disease, Bullous pemphigoid, Celiac disease, Crohn disease, Eczema, Erythema multiforme, Hand-Foot-and-Mouth disease, Herpes simplex, HIV, Iron deficiency anemia, Langerhans cell histiocytosis, Lichen planus, Linear IgA dermatosis, Oral cavity carcinoma, Pemphigus vulgaris, Reactive arthritis, Sweet syndrome, Syphilis, Systemic lupus erythematosus, Ulcerative colitis, Vitamin B12 deficiency
References
[1] Plewa MC, Chatterjee K. Recurrent Aphthous Stomatitis. [Updated 2023 Nov 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431059/
[2] http://emedicine.medscape.com/article/867080; [Medscape]
[3] Cebeci et al. Prevalence and distribution of oral mucosal lesions in an adult Turkish population. Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14(6):E272-7.
[4] Mumcu et al. Prevalence and distribution of oral lesions: a cross-sectional study in Turkey. Oral Dis. 2005 Mar;11(2):81-7.
[5] Shulman JD. An exploration of point, annual, and lifetime prevalence in characterizing recurrent aphthous stomatitis in USA children and youths. J Oral Pathol Med. 2004 Oct;33(9):558-66.
[6] Baş et al. Investigation of Behçet's Disease and Recurrent Aphthous Stomatitis Frequency: The Highest Prevalence in Turkey. Balkan Med J. 2016 Jul;33(4):390-5.
[7] http://emedicine.medscape.com/article/1075570; [Medscape]