Oral aphthous ulcers are very common lesions that almost everyone has experienced once or more in a lifetime, showing up first in adolescence.
These are small, oval, or round superficial ulcers with confined erythematous margins that occur inside the mouth.
These are smaller in size but painful, interfering with normal functions like mastication and speech.
Types of Oral Aphthous Ulcers
- Minor aphthous ulcer
- affects 70-80% of patients
- Size: as tiny as less than 4 mm in size
- Shape: spherical in shape
- Appearance: yellowish membrane with reddish margins
- Site: mucosa of lips, mouth and floor of mouth
- Sex: Males and females equally affected
- No.: usually 1-5 ulcers
- Healing: 10-14 days
- Major Aphthous Ulcer
- affects 10% of patients
- Size: greater than 10 mm
- Site: oral mucosa, tongue, palate, pharynx
- Sex: equal in men and women
- No.: 1-10 in no.
- Healing: may take 6 weeks
- Herpetiform Aphthous Ulcer
- rarest of all, affects 1-10% of patients
- Size: 1-3 mm
- Site: lips, cheeks, tongue, palate, gingiva, floor of mouth
- Sex: females are affected more than males
- No.: 10-100
Causes of Oral Ulcers
Oral ulcers can occur alone or as a symptom of an underlying condition, so knowing the cause is critical to understanding the etiology.
- Local trauma like sharp teeth, braces or cheek bite
- Nutritional deficiencies like Vitamin B12, folic acid or iron
- Stress or hormonal changes
- sensitivity to spicy or citrus foods
- Malignant causes: oral squamous cell carcinoma, odontogenic tumors, and various neoplasms of bone, connective tissue, or melanocytes.
- Systemic causes: Behcet’s syndrome, Inflammatory Bowel disease, Crohn’s disease
Diagnosis of Oral Ulcers
History taking and clinical findings are the baseline for diagnosis.
A detailed history helps find out the underlying cause of the occurrence of oral ulcers.
An intraoral examination is important to find any local cause or check for appearance of oral ulcers
Oral ulcers usually heal in a few days to weeks, but if they persist for months or years, or grow in size, they are usually malignant.
Treatment of Oral Ulcers
Treatment involves both topical and systemic agents.
Symptomatic treatment, involving NSAIDs, is given to get rid of pain.
- Topical treatment
- Triamcinolone acetonide ointment is applied to the site of the ulcer 4 times a day.
- Triclosan-antibacterial mouth rinse
- Benzydamine mouthwash relieves pain
- Doxycycline Mouthwash
- Systemic treatment
- Dexamethasone [corticosteroid] + Azathioprine [immunosuppressant]
- Oral prednisolone
- Vitamin supplementation
Oral aphthous ulcers are a very common condition whose etiology can be as simple as a cheek bite or as serious as malignancy; careful assessment and history taking help us resolve these painful little lesions with the right treatment.
MBH/PS