What do aphthae look like?
Usually a day before the ulcer appears, a burning and tingling sensation occurs. Then a mucosal defect is formed with smooth edges, a gray-yellow coating on the bottom and a red inflammatory rim. Small aphthae, up to 1 centimeter in size, are most common, heal in 7–14 days and do not leave scars. Large aphthae are deeper, more painful, and can take several weeks to heal with scarring. Less common is the herpetiform variety - many small ulcers merging into foci. The general condition of aphthous stomatitis usually does not suffer, there is no temperature.
- Burning and tingling a day before the ulcer
- Round sore with a gray-yellow bottom and a red rim
- Small aphthae up to 1 cm heal in 1–2 weeks
- Large aphthae are deep, heal with a scar
- Herpetiformis - many small ulcers
- Localization on mobile mucosa
Why do they appear
There is no single reason; we are talking about a combination of predisposition and provoking factors. The most common trigger is a mechanical injury: a cheek bite, a sharp edge of a filling or tooth, a denture or braces rubbing, or a hard toothbrush. Stress and lack of sleep, hormonal fluctuations in women, and smoking cessation play a role. Deficiencies of iron, vitamin B12, folic acid and zinc are important. Some people note a connection with specific foods: nuts, chocolate, citrus fruits, tomatoes, spicy foods. Separately, we consider situations where aphthae is a manifestation of systemic diseases.
- Trauma to the mucous membrane: bite, sharp edge of the tooth, denture
- Stress, lack of sleep, overwork
- Deficiency of iron, vitamin B12, folic acid, zinc
- Hormonal fluctuations
- Food triggers for some people
- Some components of toothpastes
- Hereditary predisposition
What can be confused with
Herpetic stomatitis begins with blisters that open and form erosions, often on the keratinizing mucosa - gums and hard palate, often with fever and enlarged lymph nodes. Candidiasis produces a white cheesy coating, not ulcers. A traumatic ulcer has an uneven shape and is associated with a specific sharp edge or prosthesis, healing after its removal. Lichen planus appears as whitish mesh lines. A single non-healing ulcer with dense edges is of particular concern; it must be shown to a doctor to rule out a malignant process.
- Herpetic stomatitis
- Oral candidiasis
- Traumatic ulcer
- Lichen planus
- Manifestations of Behçet's disease
- Malignant mucosal ulcer
When is an examination needed?
A single episode after biting a cheek does not require examination. It’s worth looking into when canker sores appear more than several times a year, take a long time to heal, or are accompanied by other symptoms. Basic checks include iron and ferritin, vitamin B12 and folic acid, and a complete blood count. When mouth ulcers are combined with abdominal pain, diarrhea, blood in the stool, and weight loss, inflammatory bowel disease and celiac disease are ruled out. Aphthae, along with ulcers on the genitals and eye damage, require consultation with a rheumatologist. A non-healing ulcer must be examined by a doctor.
- Serum ferritin and iron
- Vitamin B12 and folic acid
- General blood test
- Blood glucose
- Examination of the intestines for accompanying complaints
- Examination by a specialist for a non-healing ulcer
Treatment and prevention
There is no specific treatment that completely eliminates the tendency to aphthae: therapy is aimed at reducing pain and accelerating healing. Local anesthetic gels, protective pastes that form a film, and antiseptic rinses prescribed by a doctor help. Hormonal agents for topical use are used only for their intended purpose in severe forms. It is important to remove the traumatic factor: polish the sharp edge of the tooth, adjust the prosthesis, change the brush to a soft one. During the healing period, avoid spicy, sour, salty and very hot foods. If there is a confirmed deficiency of iron or vitamins, they are replenished according to the doctor’s regimen.
- Local anesthetics and protective agents
- Antiseptic rinses as prescribed
- Removal of sharp tooth edges and correction of dentures
- Soft toothbrush, toothpaste without irritating ingredients
- Avoid spicy, sour and hot foods during healing
- Replenishment of iron and vitamin deficiency
- Dealing with stress and sleep patterns