Aphthous Stomatitis

Aphthous Stomatitis Definition

Ulcers present inside mouth may manifest in various forms. Aphthous stomatitis refers to a specific type of mouth ulceration which causes pain and discomfort. This disease can afflict individuals of any age-group, from children to elderly. Also often referred to as “Canker sore”, it is an ulcerous mouth condition characterized by painful and superficial sores. Lips, cheek lining and tongue are the worst affected and they may extend up to the upper portions of the throat in some cases. It is basically the ulceration of the mucous lining inside the mouth which is not contagious in nature.

This form of mouth ulcer is known by several other names like:

Picture 1 – Aphthous Stomatitis

  • Aphthous ulcer (this name is obsolete now)
  • Recurrent Aphthous Stomatitis
  • Recurrent Aphthous Ulcer (RAU)
  • Sutton’s Disease (specially used for recurring, major ulcers)

Aphthous Stomatitis ICD 9

The ICD 9 code of this disease is 528.2.

Aphthous Stomatitis Incidence

Mouth ulcers of this type are found more in women than men. It is common in babies, toddlers and adults. Around 50% of the global population seems to be affected with this disease. Herpetiform recurrent aphthous ulcer and major recurrent aphthous ulcer are not so common. Almost 80% of the cases reported show prevalence of recurrent aphthous ulcer minor.

Aphthous Stomatitis Types

Classification of this mouth ulcer is done on the basis of the intensity and size of the lesions. Take a look at these forms:

Minor Ulcer

This ulcer is quite common in people. They may take around 2 weeks to heal.

Major Ulcer (Sutton’s disease)

They affect cheeks, tongue and lips of individuals, especially children after crossing pubertal stage. These lesions usually leave scars on healing.

Herpetiform ulcer

This is a severe type of ulcer that develops in a cluster and majorly affects females usually after they turn 18 years old. However, they lead to excessive pain.

Aphthous Stomatitis Causes

Elusive nature of the causes of a number of aphthous ulcers makes it difficult to state. However, some of the following factors may be held responsible for the development of ulcers in the mouth:

  • Vitamin deficiency, especially of Vitamin B 12
  • Anxiety
  • Stress
  • Lack of immunity, due to weak immune system
  • Drug formulations
  • Food allergies caused by citrus fruits, chocolate, coffee and nuts
  • Injury inside mouth caused by coarse food, toothbrush, sharp tooth, accidental biting and even dental braces
  • Chemotherapy
  • Reduced sleep
  • Weight loss

What does Aphthous Stomatitis look like?

There is redness in the site of ulcer in the beginning. This further develops into open ulcer which attains yellowish or white form and gets surrounded by a reddish circle. Lesions in minor ulcer are surrounded with grayish yellow halo. This coloration of the ulcer is caused by the deposition of fibrin which helps in blood clotting. The lesions of this form are somewhere around 3 and 10 mm in diameter. Both major and minor ulcers look about the same. However, the borders of these lesions may spread over keratinized regions. Their size is also bigger than the previous. They attain a diameter over 10 mm. Herpetiform types form lesions of diameter around 1to 3mm although they do not result in scars.

Aphthous Stomatitis Symptoms

Before the ulcer appears on the site, it shows signs like burning or itching. It takes a few days to develop into a red bump or spot. Painful sensations arise after the development of the sore. The lips often swell up in case of minor ulcers. This is doubled when the lymph nodes swell up and become painful. It is made worse by fever and painful gums. These sores are prone to secondary infections which lead to more symptoms. Lesions may occur again even after getting cured.

Aphthous Stomatitis Diagnosis

Visual examination is sufficient for the diagnosis of this condition. Doctors also try to get a detailed medical history for proper diagnosis. Some of the following tests can be conducted to ward off the possibilities of complications:

  • Biopsy
  • Blood tests
  • Lesion culture

Aphthous Stomatitis Differential Diagnosis

Several other diseases may lead to ulcers in the mouth. Gastrointestinal and oropharyngeal ulcers may be the cause for them. Doctors should conduct a differential diagnosis to rule out the possibility of the symptoms reported by a patient as effects of these disorders.

Aphthous Stomatitis Treatment

The aim of the treatment of this condition is to reduce the intensity of the symptoms. The lesions usually reduce by themselves. However, medication is required if the sores are big enough or the symptoms are severe. The following tips below may help cure RAU:

Picture 2 – Aphthous Stomatitis Image

  • Rinsing mouth with salt water, to reduce pain of the ulcers
  • Use of over-the counter mouthwashes, to eliminate painful sensations. Mouthwashes which contain benzydamine hydrochloride are known to be anesthetic which reduces pain. But these may be unsuitable for children.
  • Use of formulations of corticosteroid, which contains triamcinolone acetonide and hydrocortisone hemisuccinate
  • Using I-Lysine 500 mg, proven to be quite effective in curing herpetic ulcers.
  • Use of topical medicines, to reduce swelling and pain.
  • Avoiding spicy and acidic food, which is important to restrict further irritation in the sores.

Other than the abovementioned treatment options, some of these home remedies have also been found to yield good results:

  • Applying fresh aloe vera juice over the sores, for soothing effect.
  • Use of Licorice root, an effective natural treatment for the canker sores.
  • Eating garlic
  • Applying milk of magnesia on the sores
  • Consumption of yogurt, as a pain relief remedy
  • Tea tree oil, considered to be another useful natural cure.
  • Gargling with coconut milk, another effective remedy for recurring sores.

Aphthous Stomatitis Vs Herpetic Stomatitis

Herpetic stomatitis is an oral condition that develops when the mucosa of the mouth becomes acutely infected along with the development of vesicle. It is mainly the result of the Herpes simplex virus. These vesicles may rupture and cause tremendous local pain. Aphthous stomatisis, on the other hand, is caused by factors other than viral infection – as already explained.

Aphthous Stomatitis Prevention

Maintaining proper oral hygiene is important to save the mouth from several ailments. Although such measures might not be sure shot ways to avert this malady, some of the following steps can be adopted for preventing any occurrence of this nature:

  • Protecting dental braces with wax, to minimize abrasions in the mouth.
  • Use of non-alcoholic mouthwashes, for reducing the occurrence of the disorder and providing relief from pain.
  • Though using toothpaste without sodium lauryl sulfate doesn’t lessen the incidence of these ulcers, it can definitely help in easing the pain and facilitate healing of ulcers.

Aphthous Stomatitis Prognosis

Minor recurrent aphthous stomatitis and herpetiform ulcer seem to be limited over a certain period of time. Major ulcer can play havoc on the health of sufferers, However, proper medical intervention ensures a good prognosis like the other forms. The condition is not morbid unless the canker is associated with inflammatory bowel disease or Behçet syndrome.  Minor ulcers heal in about 10 to 14 days although the herpetiform ulcers may take even a month to heal.

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