Overview
Recurrent aphthous stomatitis—also known as canker sore or aphthous ulcer—is an epithelial ulceration on nonkeratinized mucosal surfaces of movable mouth parts, such as the tongue, floor of the mouth, soft palate, or the inside lining of the lips and cheeks. Rarely, ulcerations affect keratinized tissue such as the gingiva or the external lips (vermillion).
Epidemiology
- Recurrent aphthous stomatitis affects approximately 25% of Americans and has a recurrence rate of 50% within 3 months.
- Recurrent aphthous stomatitis usually begins in childhood or early adolescence. It declines in both frequency and severity in patients >50 years of age.
- The incidence of recurrent aphthous stomatitis is slightly higher in stressed than in nonstressed populations.
Etiology
- The cause of recurrent aphthous stomatitis is unknown in most patients. The most likely precipitating factors are stress and local trauma (e.g., chemical irritation, biting the inside of cheeks or lips, or injury caused by toothbrushing or braces).
- Additional precipitating or contributing factors may include food allergy and hormonal changes.
- A genetic component to the disease is possible, given that >42% of patients with recurrent aphthous stomatitis have first-degree relatives with the condition.
- Patients suffering from recurrent aphthous stomatitis usually are nonsmokers. Many smokers have reported recurrent aphthous stomatitis following smoking cessation, which may be a result of the stress of cessation or the changes that occur to the oral mucosa after cessation.
- Systemic conditions associated with recurrent aphthous stomatitis include Behçet’s disease, systemic lupus erythematosus, neutrophil dysfunction, allergy, nutritional deficiencies of B vitamins or iron, inflammatory bowel disease, and AIDS.
Signs and Symptoms
- Individual aphthous ulcers usually are round or oval in shape, flat or crater-like in appearance, and gray to grayish yellow in color. An erythematous halo of inflamed tissue usually surrounds the ulcer.
- Some patients may experience a pricking or burning sensation (prodrome) about 24–48 hours before the lesion actually appears.
- Recurrent aphthous stomatitis lesions can be very painful. The pain may inhibit normal eating, drinking, swallowing, and talking, as well as routine oral hygiene.
- Fever or lymphadenopathy usually does not
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