Writer :

Dr. Tania Hafiz
2003-2004

APTHOUS ULCER :
It is an ulcer that forms on the mucous membrane. An apthous ulcer is typically a recurrent round or oval sore inside the mouth on an area where the skin not tightly bound to the underlying bone. Exam: Inside the lips, cheeks, underneath the tongue.

Synonym :

Apthae, Apthosis, Apthous stomatitis, Canker sores.

Types :

1. Recurrent minor Apthous ulcer
   => 80%, less than 5mm in size, heals within 1-2 weeks
2. Major Apthous ulcer
   => more than 10mm in size, take wks or moths to heal and leaves a scar.
3. Herpetiform ulcers
   => multiple pinpoints ulcers that heal within a month. Most commonly on tongue.

Causes/ triggers

1. Emotional stress
2. Mechanical trauma like self- bite, cut, burns while eating, dental work
3. Nutritional deficiency -Vitamin B, iron, folic acid
4. Toothbrushes=hard brushing, ill-fitting dentures
5. Hormonal changes=Menstruation, Pregnancy
6. Viral infection
7. Gastrointestinal diseases like Celiac diseases, Crohn’s disease
8. Weak immune systems=Immunodeficiency

Differential Diagnosis :

• Herpes simplex
• Herpangina
• Erythema multiforme
• FDE

Sign-Symptoms:

Can be Painful, if irritated by movement or eating certain types of food such as citrus or spicy foods.

Lab tests :

• CBC,
• iron,
• B12,
• Folate test

• Swab for microbiology evaluate the presence of Candida albicans, Herpes simplex virus or others organisms.

Treatment

1. Avoid spicy and sour foods until ulcers heal
2. Drink plenty of water
3. Regularly rinse mouth out with warm, slightly salted water
4. Keep mouth clean
5. Take Iron, Vitamin B complex containing foods
6. Avoid irritative/hard foods which may scratch like pineapple, Sugarcane
7. Reduce stress and sleep
8. Topical analgesics/antiinflammatory agents
9. Viodin gurgle mouthwash
10. Clean tongue after Breakfast and before sleep at night
11. If have any stress then antidepressant
12. In rare cases may need oral antibiotic

Edited By : Nahid Hassan.