Recurrent oral ulcer or recurrent aphthous stomatitis is a disease that affects the oral mucosa.
In some cases, the ulcer is quick to disappear. In others, the ulcer persists, which makes eating, drinking, and talking uncomfortable.
Description and diagnosis:
Recurrent oral ulcers have three distinct clinical types: minor, major, and herpetiform.
Minor ulcers are the most common. These lesions can be individual or multiple. They affect exclusively non keratinized mucosa and the back of the tongue.
They are either oval or round; their diameter is usually 2 to 3 mm but can be larger with a grey or yellow base and an erythematous halo.
These ulcers heal spontaneously without scarring.
Major ulcers are a severe type of recurrent oral ulcers. Their diameter exceeds 1cm and their contour is irregular. They usually develop individually but can also merge.
These lesions can last weeks or months before healing and leaving a scar.
Herpetiform ulcers are the least common of the 3 recurrent oral ulcers. They resemble the ulcers caused by primary herpes.
Herpes ulcers can affect every region of the oral mucosa, while herpetiform ulcers spare the attached gingiva and the hard palate.
Cause of recurrent oral ulcers:
Recurrent oral ulcers are multifactorial.
Endogenous factors:
- Genetic predisposition
- Nutritional deficiency in iron, folic acid, or vitamin B12
- Pregnancy or menstruation: Progesterone injections can get rid of the ulcers
- Systematic diseases: Behçet’s disease
Anxiety exacerbates aphthous ulcers.
Exogenous factors:
- Trauma caused by the aggressive brushing of the teeth, food or dental treatment
- A certain number of patients develop ulcers after smoking cessation
How to manage recurrent oral ulcers:
Patients with minor ulcers can find relief with a chlorhexidine or benzydamine mouthwash.
The basic treatment consists of topical steroids.
An ulcer is announced by a tingling sensation. If dealt with at this stage, the emergence of the ulcer can be prevented.
Patients with major ulcers usually need systemic steroids as treatment.
In certain severe cases, thalidomide or immunosuppressors are used. These cases must be dealt with in a hospital.
