Aphthous Ulcers

Aphthous ulcers, also known as canker sores, are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. They are one of the most common oral mucosal conditions.

Causes and Risk Factors

• Trauma to the mouth, such as biting the cheek or tongue, can trigger aphthous ulcers.
• Stress and anxiety may contribute to the development of aphthous ulcers.
• Hormonal changes during menstruation or menopause may also play a role in some cases.
• Certain foods, such as citrus fruits, tomatoes, and spicy or acidic foods, can trigger or worsen aphthous ulcers in some individuals.
• Deficiencies in vitamins B12, iron, or folic acid have been linked to an increased risk of developing aphthous ulcers.

Symptoms

• Painful sores or ulcers on the tongue, inside the cheeks, or at the base of the gums.
• Sores are typically round or oval and have a white or yellowish center with a red border.
• Size can vary from small (less than 1 cm) to large (greater than 1 cm).
• May be accompanied by swelling, redness, and inflammation of the surrounding tissue.

Types of Aphthous Ulcers

• Minor aphthous ulcers: Small (less than 1 cm), shallow, and heal within 1-2 weeks without scarring.
• Major aphthous ulcers: Larger (greater than 1 cm), deeper, and may take several weeks to heal, potentially leaving scars.
• Herpetiform aphthous ulcers: Numerous small, shallow ulcers that resemble a herpes infection but are not caused by the herpes virus.

Treatment and Management

• Topical anesthetics or pain relievers to reduce discomfort.
• Mouthwashes or oral gels containing ingredients like benzocaine, lidocaine, or chlorhexidine to help manage symptoms.
• Corticosteroid ointments or pastes may be prescribed for more severe cases to reduce inflammation.
• Good oral hygiene practices and avoiding irritants can help prevent recurrence.

Complications

In rare cases, aphthous ulcers can become secondarily infected with bacteria or fungi. If left untreated, these infections can lead to more serious complications such as cellulitis or abscesses.

Differential Diagnosis

Aphthous ulcers must be differentiated from other oral lesions that may have a similar appearance but different causes and treatments, including oral herpes, leukoplakia, lichen planus, and squamous cell carcinoma.