Contents

Search

aphthous stomatitis; aphthous ulcer (canker sore)

The most common oral mucosal ulcerative lesion. Etiology: 1) oral mucosal ulceration a) Behcet's syndrome b) erythema multiforme c) Crohn's disease [4] 2) predisposing factors (proposed) a) Streptococcal infection b) Herpes c) minor dental trauma d) stress e) menstruation f) nutritional deficiencies g) food allergies h) HIV1 infection - zalcitabine (ddC) therapy Epidemiology: 1) most patients young 2) most common cause of mouth ulcers 3) prevalence is 20-50% of population 4) usually begins in adolescence or early adulthood 5) frequency decreases with age [7] Clinical manifestations: 1) recurrent (> 4 times per year), painful, round, shallow ulcers with a gray base 2) found on buccal mucosa, rarely on oral mucosa attached to periosteum, i.e. hard palate, gums or tongue [6] 3) three forms of aphthous stomatitis a) minor form (80%): solitary oval ulcer < 1 cm in diameter, duration 7-10 days b) major ulcer (10%): multifocal, ragged, up to 2 cm in diameter, duration up to 6 weeks, may scar, often immediately recurring following resolution c) Herpetiform ulcers: grouped papulovesicular lesions * images [6] Laboratory: - diagnosis is generally clinical, but biopsy may be necessary to distinguish from Herpes simplex or CMV in AIDS patients Management: 1) avoidance of hot or acidic foods 2) saline rinses 3) topical viscous lidocaine a) 3 mL of 2% solution b) hold in mouth 1-2 minutes before meals 4) diphenhydramine solution - may mix with kaopectate - Magic mouthwash [5] 5) topical steroids a) dry lesion b) triamcinolone topical 0.1% every 4-6 hours c) use with or follow with Orabase to affix steroid 6) oral suspensions of lidocaine, corticosteroid & tetracycline 7) Gelclair [3] 8) systemic or locally injected steroids in severe cases 9) thalidomide in severe cases 10) treatment of underlying etiology

Related

mucosal ulcer

General

stomatitis (includes oral ulceration)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 317-18
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17, 18 American College of Physicians, Philadelphia 1998, 2009, 2015, 2018
  3. Prescriber's Letter 9(7):41 2002
  4. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  5. Prescriber's Letter 20(1): 2013 COMMENTARY: Treatment of Canker Sores Detail-Document#: 290110 (subscription needed) http://www.prescribersletter.com
  6. Scully C, Meyers AD Medscape: Aphthous Ulcers http://emedicine.medscape.com/article/867080-overview - Scully C. Clinical practice. Aphthous ulceration. N Engl J Med 2006 Jul 14; 355:165. PMID: 16837680 https://www.nejm.org/doi/full/10.1056/NEJMcp054630 - Scully C, Porter S. Oral mucosal disease: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 2007 Sep 14; 46:198 PMID: 17850936
  7. NEJM Knowledge+ Question of the Week. April 30, 2019 https://knowledgeplus.nejm.org/question-of-week/388/