Aphthous stomatitis

Aphthous stomatitis (also known as canker sores) is characterized by frequent recurrent mouth ulcers. The cause of these painful, mostly benign sores is unknown, but they commonly occur after minimal trauma (e.g., biting the tongue). There are several types of aphthae, all of which can only be treated symptomatically.

• Very frequent

Epidemiological data refers to the US, unless otherwise specified.

• There is no identifiable cause but aphthous stomatitis is likely multifactorial.
• May be associated with:
  • Certain disorders (e.g., Behcet disease, inflammatory bowel disease, celiac disease, systemic lupus erythematosus)
  • Dermatological disorders
  • Malnutrition; (e.g., vitamin B₁₂ deficiency, folate deficiency, iron deficiency)
  • Infections (e.g., HIV)
  • Drugs (e.g., methotrexate)
• Often triggered by minimal trauma (e.g., biting the tongue)
• Commonly occurs in individuals with HIV

• Painful mucosal ulcers in nonkeratinized areas of the mouth and throat
• Efflorescence: round to oval, crater-like appearance on yellowish-grey base and erythematous margins
• No systemic symptoms
• Recurrence is common

• Minor aphthous ulcers
  • Size: 5–10 mm
  • Heal within 1–2 weeks without scarring
  • Occur in 80% of affected patients
• Major aphthous ulcers
  • Size: bigger (20–30 mm) and deeper than minor aphthous ulcers
  • Prolonged healing over several weeks with scarring
• Herpetiform ulcers
  • Size: small (1–3 mm diameter)
  • Tendency to cluster
• Bednar aphthae
  • In infants, ulcer on the palate after trauma
  • Heals completely without treatment

See “Differential diagnosis” in “Acute tonsillitis.”

The differential diagnoses listed here are not exhaustive.

• There is no causal treatment
• Symptomatic treatment includes topical corticosteroids (e.g., dexamethasone, triamcinolone), antimicrobials (e.g., tetracycline) and anesthetics (e.g., lidocaine, benzocaine).

• Benign, often recurrent
• If ulcers persist for longer than 6 weeks, tests should be performed to rule out the possibility of malignancy.