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Aphthous Ulcers
(Canker Sores, Aphthous Stomatitis)

Definition:
Aphthous ulcers are also known as canker sores. They are painful, temporary sores that may occur anywhere in the mouth except on the gums, lips, or roof of the mouth. They can occur one at a time or as a group of sores. Although these sores are not serious, other mouth sores may be. If you suspect you have this condition, make an appointment to see your doctor.

Causes:
No one knows what causes aphthous ulcers. It is a common misconception that they are a form of the herpes virus.

Unlike herpes, however, aphthous ulcers cannot spread from one person to another. Rather, they are thought to result from a reaction of the immune system. They tend to occur more often in women than men. They often occur for the first time between the ages of 10 and 40.

The following conditions may make certain people more prone to developing these mouth sores:

  • Stress or trauma in the mouth, such as biting the tongue
  • Certain foods (especially acidic foods, such as tomatoes and pineapples)
  • Family history
  • Changes in hormone levels
Risk Factors:
The following factors increase your chances of developing aphthous ulcers. If you have any of these risk factors, tell your doctor:
  • Deficiencies of iron, vitamin B12, or folic acid
  • Bacterial infections, such as stomach ulcers caused by the bacterium, H. pylori
  • Certain inflammatory bowel disorders, such as Crohn’s disease
  • Infection with the AIDS virus
Symptoms:
If you experience any of these symptoms, do not assume it is due to aphthous ulcers. Mouth sores similar to these may be caused by other more serious conditions.

Aphthous ulcers of various sizes typically occur on the inner surface of the cheeks and lips, on the tongue, and the soft palate. Usually they are an open, shallow sore with a slightly raised, yellowish-white border often surrounded by a red border.

Some people get aphthous ulcers two or three times per year, while others develop lesions continually one after another. Usually the most painful phase is the first three to four days, and then the sores begin to heal.

  • Minor ulcers (the most common form)
    • Less than one centimeter in diameter
    • Usually last 7-14 days
    • Heal without scarring
  • Major ulcers
    • Greater than one centimeter in diameter
    • Last several weeks or even months
    • Heal with scarring
Diagnosis:
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Looking at the sores is the only way doctors can tell the difference between aphthous ulcers, which have a typical appearance, and other more serious mouth sores.

It is especially important to examine mouth sores that do not heal within two weeks, since they may be a sign of cancer.

Treatment:
Aphthous ulcers usually resolve on their own within 1-2 weeks, thus treatments for aphthous ulcers are not usually necessary. However, treatment options for especially painful or persistent aphthous ulcers may include the following:

Oral Pain Relieving Rinses or Gels
An oral rinse, such as viscous lidocaine used every three hours or before meals, provides short-term relief from pain caused by aphthous ulcers. In addition, over-the-counter, anti-pain oral gels can be applied directly on the sores usually four times daily to numb the area and relieve pain temporarily.

Oral Antibiotic Rinse
For multiple sores, a liquid form of the antibiotic tetracycline can be used as an oral rinse four times daily for 10 days, which can coat the ulcers and prevent new ulcers from forming. Sometimes, as a side effect, this treatment can cause an oral infection called candidiasis, or thrush, which is easily treated.

Corticosteroids
For severe outbreaks of minor or major aphthous ulcers, steroids may be taken, usually in the form of a liquid oral rinse after meals and at bedtime. Steroids help reduce inflammation of the mouth caused by severe sores.

Prevention:
It is not always possible to prevent aphthous ulcers, since your genes and other medical conditions are out of your control. However, to help reduce your chances of getting aphthous ulcers, take the following steps:

  • Chew food carefully to avoid biting the tongue or cheek, which may cause mouth irritation that may lead to an aphthous ulcer.
  • Avoid acidic foods that may promote aphthous ulcers, such as tomatoes or pineapples.
  • If you do not get enough iron, vitamin B12, or folate in your diet, talk to your doctor about how to get enough of these nutrients to prevent aphthous ulcers. (Note that taking extra iron, vitamin B12, or folate does not prevent aphthous ulcers in people who are not deficient in these nutrients.)
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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