Aphthous stomatitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 1, 2016
StartDiseasesAphthous stomatitis

Aphthous stomatitis is a common condition that causes the formation of non-contagious, benign mouth ulcers, or apthae (also called canker sore) in people who are healthy otherwise. With no clear cause, these mouth ulcers can be painful and unpleasant but are not a symptom of a more serious disease and the condition will correct itself over time.

Contents

Definition & Facts

Many people commonly refer to the mouth ulcers that develop in aphthous stomatitis as canker sores. The mouth ulcers themselves are triggered by a wide range of environmental factors triggering an immune response in the body that is mediated by T-cells. In general, the mouth ulcers characterizing this condition appear on the inside of the lips and cheeks, inside the mouth.

It is estimated that up to 20 percent of the population have the condition, which often begins in childhood or during the teenage years. Most people who do have this condition experience the mouth ulcers for a few years; however, the condition tends to disappear on its own gradually thereafter. 

Symptoms & Complaints

The main symptom of aphthous stomatitis is the development of the mouth ulcers themselves. There are no overall symptoms that are detectable outside the mouth. People with this condition may feel stinging or itching inside the mouth prior to the emergence of an ulcer or sore.

After the appearance of the ulcer, people with this condition will feel pain; this pain can be particularly severe when eating or drinking. The consumption of acidic or salty foods and drinks can particularly trigger pain, as can contact with the mouth ulcer itself. The mouth ulcers are most severe in the first few days following the development of the ulcer and will lesson as the ulcer itself begins to heal.

If a person has tongue lesions, chewing and even speaking may cause discomfort. For most people with aphthous stomatitis, ulceration in the mouth takes place three to six times annually. However, in more severe cases, mouth ulcers are nearly constant and additional ulcers develop prior to the disappearance of older lesions. In this case, aphthous stomatitis may lead to weight loss or malnutrition due to the severe pain caused by eating. 

Causes

There is not one clear cause of aphthous stomatitis. There may be different causes for the condition in different individuals, especially as nearly 20% of the population experience the condition at some point in their lives. The mouth ulcers are non-contagious and no infectious organism is related to their growth or development. There are several types of triggers that can help to provoke the immune response sparking the ulcers, meaning that the condition has different causes for different people.

A large plurality of at least 40 percent of those with this condition have others in their family with mouth ulcers. Most people with a family history of the condition develop the mouth ulcers at an earlier age and with a more severe impact. For some people, mouth ulcers emerge more frequently at stressful times, which may be exacerbated by behaviors like lip or cheek chewing.

Localized trauma from injections, dental work or tooth brushing is another primary trigger for the development of mouth ulcers. In other cases, hormonal fluctuations caused by the menstrual cycle or impacted by the use of the birth control pill trigger mouth ulcer formation. 

Diagnosis & Tests

Aphthous stomatitis is diagnosed based on the appearance of the mouth ulcers and the patient's experience with past mouth ulcers. The most relevant criterion for diagnosis is a medical history of recurring mouth ulcers that heal by themselves, over time, at ongoing intervals. Recurrent mouth ulcers caused by aphthous stomatitis are different from mouth ulcers that emerge as a symptom of a different disease, illness or condition.

In order to ensure that someone does not have another condition, blood tests may be conducted in order to rule out vitamin or mineral deficiencies, gastrointestinal disorders like Celiac disease or anemia. In general, if mouth ulcers are caused by another disease or disorder, that condition will cause other significant symptoms.

Aphthous stomatitis is distinguished because its only symptom and only effect are the mouth ulcers that characterize the condition. If a doctor is concerned that the ulcers are instead caused by dietary allergies, patch tests, and other skin allergy tests may be performed in order to rule out an allergic cause

Treatment & Therapy

For most people with aphthous stomatitis, the impact of the condition is minor and no particular treatment or ongoing therapy is required. In general, any treatment needed is provided on a case by case basis. For example, while a person has an active mouth ulcer, refraining from consuming spicy, salty or acidic foods and drinks will help to reduce pain and discomfort until the ulcer heals. There is no cure for the mouth ulcers associated with aphthous stomatitis, but various medications have been used in order to relieve the pain caused by the sores.

Some people use topical treatments in order to reduce pain, including lidocaine, glycerin and other creams, mouthwashes or toothpastes. Other substances that are used include topical antiseptic treatments for the mouth in order to speed the healing of the ulcer and ward off potential infection.

For more serious and severe cases of aphthous stomatitis, corticosteroids applied topically or taken orally may be prescribed in order to reduce inflammation and moderate the immune response sparking the development of the ulcers. For women with hormonally-induced mouth ulcers, a change in hormonal contraceptive options may be prescribed in order to lessen their development. 

Prevention & Prophylaxis

There is no clear means of preventing the development of aphthous stomatitis and it is not associated with a more serious underlying condition. The mouth ulcers are not infectious and cannot be transferred from person to person.

Individual changes like taking care during tooth brushing, correcting nutritional deficits or changing hormonal birth control can help to control outbreaks in some people with this condition; however, in general, it will clear up on its own within a few years of initial onset.