Definition:
Aphthae is a painful ulcerated sore that forms on the mucous membrane, most commonly in the mouth.
It is not contagious.
Aphthous ulcers are more common in younger individuals.
Complex aphthosis consists of constant multiple oral aphthae (≥3) or recurrent oral and genital aphthae after excluding Behcet’s disease.
Causes:
The cause of this disease is yet to be understood.
The eruption of aphthous ulcers is usually the result of predisposing factors:
1.Exogenous factors:
-Food or beauty products: Cause an allergic reaction.
-Trauma: While brushing your teeth, maladjusted prosthesis.
-Medication: Sedatives, antibiotics.
-Diseases: Inflammatory bowel disease, coeliac disease, Behcet’s disease.
2.Endogenous factors:
-Hormones: Aphthae erupt during puberty, pregnancy. In the case of pregnancy, they disappear after giving birth.
-Psychological: Anxiety, depression, stress. The canker sores disappear during resting periods, vacation.
-Hereditary: Not yet confirmed as a factor associated with aphthae.
-Hematological: Vitamin B12 deficiency, iron deficiency.
Types:
1.Minor aphthous ulcers:
Small ulceration, 8 to 10 mm in diameter, round or oval; it has a yellow or grey base, and is surrounded by a well-defined red outline.
The ulceration starts with a tingling or burning sensation.
The initial lesion is erythema. Then, it evolves into aphthous ulceration.
The necrosis spreads progressively. The pain is very intense in the beginning, then it decreases until the healing process is finished.
*Localisation: Buccal mucosa, tongue, gums.
*Prognosis: Without a treatment, minor aphthous lesions last 7 to 14 days.
2.Giant aphthous ulcer:
It starts with a small submucosal node. In a few days, it becomes an ulceration 2 to 3 mm in diameter. Its outline is irregular.
Giant and typical aphthous ulcers can be present simultaneously.
*Localisation: Labial commissure, inner side of the cheek.
*Prognosis: The healing process results in a retractile scar due to the loss of tissue.
If the giant aphthae affect the cheek, a limitation of the mouth opening is possible.
3.Herpetiform aphthous ulcers:
Small-sized ulcers erupt in crops. They can last from 10 to 100 days.
4.Major aphthous ulcers:
They are 6 to 10 mm in diameter, multiple, and affect both keratinized and non-keratinized mucosa. They can last up to a month.
5.Extraoral aphthous ulcers:
-Genital aphthae: In men, it is localized in the urethra. In women, it affects the labia majora, labia minora, vagina, or perianal region.
-Skin aphthae: Erupt in groups mostly on the neck, shoulders, back, etc.
6.Aphtosis:
-Complex aphthosis: Oral and genital aphthous ulcers. They can be associated with skin lesions.
-Touraine’s major aphthosis: The canker sores are associated with digestive, heart, neurological, vascular, ocular, joint problems, etc.
Complementary examination:
Biological: Rheumatoid serology ( Waaler-rose test), complete blood count ( CBC), renal and hepatic function tests.
Complete health check: To check cardiovascular, digestive functions, and detect thrombosis in the lower extremities.
Treatment:
1.Local:
-Antiseptic mouthwash:
Acetylsalicylic acid: 250 to 500 mg of aspirin is added to half a glass of water. It is used 4 to 5 times a day, before every meal.
Chlorhexidine: It limits the evolution of aphthous ulceration.
-Local anesthetic gel.
-Local anti-inflammatory agents: A local injection of corticoids can be used in the case of major aphthae.
The anti-inflammatory treatment can also be used as a cream ( Triamcinolone) or as a mouthwash.
They help speed the healing process and relieve the discomfort of canker sores.
-Antibiotics:
The dentist can prescribe topical or oral antibiotics such as tetracycline.
2.Systemic:
-Vitamin C by intravenous administration.
-Systemic corticosteroids.
-Hyaluronic acid.
-Phytotherapy.
