Oral Aphthous Ulcers
Related Subjects:
|Macroglossia
|Microstomia
|Glossitis
|Medical Teeth
|Gum hypertrophy
|Angular Stomatitis - Cheilitis
|Oral Aphthous Ulcers
|Oral Leukoplakia
👄 Oral Aphthous Ulcers: Recurrent, painful oral ulcers are usually benign, but ulcers persisting >3 weeks require referral to exclude oral malignancy. ⚠️
📖 About
- Relatively common (10–20% of population).
- Often recurrent, self-limiting, and benign.
- More common in females than males.
🧪 Aetiology
- Immune dysregulation (most likely mechanism).
- Seen across all age groups.
- No proven viral or infectious cause.
🔗 Associations
- Local trauma (dentures, biting).
- Iron, B12, folate deficiency; malnutrition.
- Stress and perimenstrual flares.
- IBD (Crohn’s), coeliac disease, SLE.
- Behçet’s disease (oral + genital ulcers, uveitis).
- Lichen planus, erythema multiforme.
- HIV infection.
- Drugs — particularly Nicorandil.
🧠 Clinical Features
- Painful, shallow ulcers (tongue, buccal mucosa).
- Usually heal within 1–2 weeks.
- Check for associated genital ulcers → consider systemic disease.
📊 Classification
- Minor: <10 mm, oval, yellow base, mild pain, heal without scarring.
- Major: >10 mm, deeper, last weeks–months, painful, may scar, interfere with eating.
- Herpetiform: 1–2 mm, occur in clusters, may coalesce; not caused by herpes virus.
🔍 Investigations
- Only if severe, persistent, or systemic features.
- Bloods: FBC, ferritin, folate, B12, ESR, glucose.
- HIV testing in at-risk patients.
- Anti-endomysial antibodies for coeliac disease.
💊 Management
- ⚠️ Avoid spicy/hard foods; use soft diet and soft toothbrush.
- 🧴 Chlorhexidine mouthwash (Corsodyl) reduces pain/infection (warn about staining).
- 💊 Hydrocortisone lozenges (hold against ulcer for best effect).
- 🔹 Topical analgesics: Difflam, choline salicylate gel (⚠️ avoid aspirin gels in <16s → Reye’s risk).
- 💊 Severe/refractory: systemic agents (Colchicine, oral prednisolone, Azathioprine; rarely Thalidomide).
- 👥 All deliberate or accidental overdoses/complex presentations → consider psych/specialist review.
🌍 Clinical Pearls
- 📌 Any single, persistent, non-healing oral ulcer in an older smoker/drinker → assume SCC until proven otherwise.
- 📌 Always examine for genital ulcers, skin lesions, or GI symptoms to guide systemic work-up.
