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Diagnoses

Aphthous ulcers

About this diagnosis

Diagnoses are associated with common findings which are used to prescribe appropriate treatment.

Alternate terms: Canker sores.

An aphthous ulcer is a type of mouth sore (commonly referred to as a canker sore), which commonly arises on the unattached mucous membranes inside the lips and cheeks, on the sides of the tongue, and floor of the mouth. Apthous ulcers are not commonly found on the attached, "keratinized" gingival tissues that surround the teeth.

Aphthous ulcers are characterized by red borders with a yellow-grey center, and are typically very painful. Those that are smaller than one centimeter in diameter are considered "minor variant" apthae, while those greater than one centimeter are considered "major variant" subtypes.

Aphthous ulcers (canker sores) are a type of mucosal lesion seen in Behcet Syndrome

Figure 1: A large minor variant aphthous ulcer. This lesion was treated with Debacterol®, a dentist-dispensed sulfuric acid/phenolic compound, which helped alleviate the pain. After evaluating her diet, this patient switched to a toothpaste which did not contain the common foaming agent, sodium lauryl sulfate (SLS) and noticed that she stopped developing canker sores.

"Aphthous Stomatitis" is a term for multiple affected sites, is very painful, and can be temporarily debilitating, leading to problems with speech and eating. Aphthous ulcers have a tendency to recur (i.e. come back) in many patients, producing a diagnosis of "Recurrent Aphthous Stomatitis", or RAS. The term "Sutton's Disease" is also used for major variant apthae, which may take longer to heal (up to 30 days) and can produce scarring.

Aphthous ulcers may be of autoimmune origin—i.e. caused by the body's immune system. Deficiencies of certain vitamins, including B9 (folic acid) and B12 (cobalamin) have also been suspected. The foaming agent "sodium lauryl sulfate" (SLS), commonly found in toothpaste has also been implicated.

Apthae are one of the most frequently encountered mouth sores, especially in women. 15% to 20% of the population suffer from them. Generally, they are self-limiting, meaning they resolve on their own without treatment; however, the painful symptoms can be treated with over-the-counter or prescription medications.

Herpetiform aphthous ulcerations are simliar to minor variant apthae, but are generally smaller (2 millimeters or less) and more numerous (up to 100 may be present at any time).