Aphthous Ulcer
Aphthous Ulcer
Aphthous ulcers or aphthous stomatitis or mouth ulcers are a common disease of the oral cavity characterized by the development of painful, recurrent, solitary, or multiple ulcerations of the oral mucosa (soft lining inside the mouth), with no other signs of any other disease.
Causes
There are many causes that predispose to aphthous ulcers.
Microbial organisms: one of the common causative organism of this disease is hemolytic streptococcus and streptococcus sanguis bacteria. Ulcers also occur due to viral infections caused by cytomegalovirus, varicella zoster, and adenovirus.
Systemic factors: recurrent aphthous ulcers are mainly due to nutritional deficiency. The other systemic diseases that cause oral ulcers are inflammatory bowel disease, celiac disease, sweet syndrome, cyclic neutropenia.
Trauma: local trauma such as toothbrush injury, self-inflicted bites, and oral surgical procedures, injections in the mouth and sharp cusp or fractured tooth cause aphthous ulcers.
Stress: stress and anxiety also cause aphthous ulcers. Aphthous ulcers are seen more frequently during exam periods.
Immunological abnormalities: mucosal destruction occurs due to T cell-mediated immunological reaction and may cause R.A.S
Genetic predisposition: there is a familial tendency for the occurrence of these ulcers. Increased susceptibility is seen in children with a history of recurrent aphthous ulcers parents.
Endocrine conditions: aphthous ulcers are more common during pregnancy, menstruation and menopause.
Allergic reactions: A history of drug allergy or asthma or hay fever precipitates the attack of this disease.
Cessation of smoking: Increases the frequency and severity of recurrent aphthous ulcers.
Types of Ulcers
Minor aphthae- also called as ‘canker sores’ where the ulcers are less than 1 cm in diameter and heal without scar.
Major aphthae– also called as ‘Sutton’s disease’ where the ulcers are more than 1 cm in diameter and heal with heal with scarring.
Aphthous ulcer with behcet’s syndrome: recurrent ulcers are associated with behcet’s syndrome.
Herpetiform ulcers: recurrent crops of dozens of small ulcers appears throughout the oral cavity.
Clinical features
Aphthous ulcers can occur at any age but more common in second and third decades of life. It is more common in women than men. Aphthous ulcers are mostly seen on the tongue, gingiva, buccal and labial mucosa, and pharynx. The lesions are very painful and so it interferes with eating for several days. It may appear as s single or multiple superficial round, symmetric and shallow erosions covered with a grey membrane. Most patients have 2 to 6 lesions at each episode and experience several episodes a year. The incubation period for ulcers is 7 to 14 days.
Treatment
The Dentist treats the aphthous ulcer by treating the underlying cause after taking the complete history of the patient and also according to the clinical appearance of the ulcers. If the ulcers are due to tooth injury or tooth related, the treatment for the tooth is the first priority. Cessation of causative agent in case of any allergy and also Physician’s treatment for underlying systemic disease are other treatment modules. The dentist prescribes mouthwash and oral hygiene measures depending on the oral status of the patient. The overall health and dental status has to be examined before treatment of recurrent ulcers.
