Summary
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.
Epidemiology
- Very frequent
Epidemiological data refers to the US, unless otherwise specified.
Etiology
- There is no identifiable cause, but are likely multifactorial
- May be associated with systemic or dermatological disorders, malnutrition, infections, or drugs; (e.g., Behcet disease; , Crohn disease, HIV; , vitamin B12 deficiency, folate deficiency, iron deficiency; , methotrexate)
- Often triggered by minimal trauma (e.g., biting the tongue)
- Commonly occur in HIV patients
Clinical features
- Painful mucosal ulcers in nonkeratinized areas of the mouth and throat
- Recurrence is common
- No systemic symptoms
- Efflorescence: round to oval, crater-like appearance on yellowish-grey base and erythematous margins
Subtypes and variants
-
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
Differential diagnoses
See “Differential diagnosis” in acute tonsillitis
The differential diagnoses listed here are not exhaustive.
Treatment
- There is no causal treatment
- Symptomatic treatment includes topical corticosteroids (e.g., dexamethasone, triamcinolone), antimicrobials (e.g., tetracycline) and anesthetics (e.g., lidocaine, benzocaine).
Prognosis
- Benign, often recurrent
- If ulcers persist for longer than 6 weeks, test should be conducted to rule out the possibility of malignancy.