Aphthous Stomatitis

Aphthous stomatitis is commonly defined as recurrent ulcerations of the oral mucosa. In layman's terms, an occurrence of aphthous stomatitis is often called a mouth ulcer. The most affected areas of the oral cavity are the labial mucosa, buccal mucosa, and tongue. Unlike for example cold sores, which develop on the outside of the mouth, these ulcerations are non-contagious. This is a critical point to get across to patients, who often carry misperceptions regarding the transmissibility of mouth ulcer.

Generally speaking, we distinguish three major clinical presentations of aphthous stomatitis based on the size and number of the wounds:

• Minor aphthae: Typically round and <10 mm in diameter.
• Major aphthae: Similar to minor aphthae but are larger (>10 mm in diameter) and therefore requiring a longer healing time.
• Herpetiform ulcers: Multiple ulcers of <1 mm in diameter, occurring in numbers up to 100.

Other mouth conditions that patients might confuse with aphthous stomatitis include:

• Burning mouth syndrome
• Oral candidiasis
• Recurrent intraoral herpes simplex virus or herpes varicella zoster virus
• Leukoplakia
• Oral lichen planus
• Hand-foot-and-mouth disease
• Infected salivary glands
• Dental abscess
• Behçet’s disease

Causes of Aphthous Stomatitis
As mentioned above, there is little known about causes and etiology of aphthous stomatitis, despite its high prevalence. This can be frustrating especially for patients who deal with it regularly.

With that said, there are a number of predisposing factors that you as dental professionals can discuss with your patients. These include:

• Physical damage to the gingiva, tongue, or other soft tissues within the mouth. This is perhaps the most common and easily explained factor. It can happen for a variety of reasons, including brushing too hard (or with overly hard bristle filaments), biting down on the inside of the mouth, or friction and wear from orthodontic appliances.
  
  
• Hematinic deficiencies (nutrition for formation of blood cells), such as iron, zinc, folic acid and important vitamins such as B12.
• Inheritance, since a large proportion of patients appears to have a positive family history.
• Negative reaction to toothpastes or other oral care products containing certain ingredients.
• Underlying systemic conditions, such as Crohn’s disease or HIV, increases the vulnerability of patients to develop aphthous stomatitis.
  
  
• Stress. This is rather ambiguous and can feel difficult for dentists to discuss with their patients, but the ties have been shown scientifically so it is certainly worth addressing as a possible contributor.

Whether or not they are using an oral care product to treat their mouth sores, remind patients to do what they can on their own to avoid irritating or worsening the wound (i.e., avoid biting down on it, and try not to eat spicy foods or drink alcohol).

Given what a painful experience recurrent aphthous stomatitis can be for those who deal with it, dental professionals that are able to help their patients overcome it will be highly valued and appreciated. It’s a common issue in oral mucosal health care, and while there may not be a cure, there are definitely ways to lessen the pain and reduce occurrences through smart measures.