Aphthous stomatitis (mouth ulcers).

Aphthous stomatitis, also known as recurrent aphthous ulcers or mouth ulcers, is among the most common oral mucosal diseases noted by doctors and dentists.

Aphthous stomatitis is an idiopathic disorder that may cause significant morbidity. One or more separate, shallow, painful sores appear on the separated mucous membranes of the mouth.A single ulcer usually lasts 7 to 10 days and heals without scarring. Large sores may last from several weeks to months and may scar upon healing.

Types of aphthous stomatitis.

There are three types:

1. Slight aphthous ulcers are the most common (8 out of 10 cases).

They are small, round or oval and have a diameter of less than 10 mm. It looks pale yellow but the surrounding area may appear swollen and red.Only one ulcer may develop but up to five ulcers may appear at the same time. Each sore lasts 7 to 10 days and then passes without leaving a scar. It is usually not very painful.

2. Major aphthous ulcers occur in about 1 in 10 cases.

They tend to be 10 mm or larger across. Usually only one or two appear at a time. Each sore lasts from two weeks to several months, but will heal and leave a scar. It can be very painful and eating may become difficult.

3. Herpetic sore occurs in about 1 in 10 cases.

These are small pinhead-sized sores, about 1-2 mm in diameter. Multiple problem occurs at the same time. Every sore from a week to two months.Despite the name, they have nothing to do with herpes or the herpes virus.

_ What causes aphthous mouth ulcers?

The cause is unknown. They are not contagious and you cannot catch aphthous mouth sores. In most cases, an ulcer develops for no apparent reason in healthy people.

In some cases, ulcers are related to other factors or diseases.

These include:

1. Ill-fitting dentures, scratches from a hard toothbrush, etc.

2. Changes in hormone levels. Some women find that mouth sores occur just before their period. In some women, the ulcers do not appear until after menopause.

3. Quit smoking – some people find that they develop ulcers only after they stop smoking.

4. Iron deficiency or deficiency of certain vitamins (such as vitamin B12 and folic acid) may be a factor in some cases.

5. Rarely, a food allergy is the cause.

6. Mouth sores run in some families. Therefore, the genetic factor may play a role in some cases.

7. Stress or anxiety is said to cause aphthous mouth ulcers in some people.

8. Some medications can cause mouth ulcers.

_ Mouth sores are more common in people with certain conditions – for example, Crohn’s disease, celiac disease, HIV infection and Behçet’s disease.

However, this ulcer is not of the aphthous type. You should inform your doctor if you have any other symptoms in addition to mouth ulcers.

Other important symptoms may include sores on the skin or genitals, or joint pain and infections. Sometimes a blood test or other investigations are advised if other causes of mouth ulcers are suspected.

What are the treatments for aphthous mouth ulcers?

Treatment aims to relieve pain when an ulcer occurs and help it heal as quickly as possible. There is no treatment that prevents aphthous mouth ulcers from recurring.

Treatment may not be needed The pain is often dull, especially with the common type of ulcer.

_ Includes general measures.

1. Avoid spicy foods, acidic fruit drinks, and very salty foods, which can increase pain and tingling.

2. Use a straw to drink to avoid fluid coming into contact with the sores at the front of the mouth.

3. If you suspect a medication is causing the ulcer, a change of medication may be possible.

4. Mouthwash with salt.

Dissolve half a teaspoon of salt in a cup of warm water, rinse around your mouth, and spit it out. This can be done as often as needed and may be sedative. Do not swallow the salt mouthwash.

Some medications may ease your mouth sore symptoms.

1. Chlorhexidine mouthwash (Corsodyl® or Chlorohex®)

It may reduce pain. It may also help the sore heal more quickly. It helps prevent ulcers from getting infected. Unfortunately, it does not reduce the number of new ulcers.

2. Steroid emulsions (Corlan® granules).

It may also reduce pain and may help the sore heal more quickly. With your tongue, you can hold the emulsion in contact with the ulcer until the lozenge dissolves. The steroid emulsion works best the sooner it is started, once an ulcer appears.

3. Soothing protective pastes.

These products, such as Orabase®, help to temporarily cover the sore to protect them. Mouthwash, gel, or mouth spray may help relieve the pain.

Unfortunately, the effect of these painkillers is short-lived. It can be purchased at pharmacies. For all of these products, follow the directions on the packaging very carefully.

References :

Ginat W Mirowski (21-3-2017), “Aphthous Stomatitis”، medscape

Dr Mary Harding (31-8-2016), “Mouth Ulcers”, patient

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