The aetiology is very diverse. The most common local factor favouring the formation of aphthous lesions is trauma caused by the use of dentures, the presence of sharp teeth or the consumption of hard foods. The lesions may appear without any identifiable cause or be associated with congenital predisposition, psychological factors, stress, bacterial or viral infections. Recent studies show that aphthous patients have an impaired immune response. They are also often associated with diseases of the digestive tract. Chocolate, nuts or citrus fruits can induce the formation of aphthous ulcers.

The primary lesion of recurrent aphthae has not been defined. It may be a spot, papule, vesicle or maculopapular eruption. Associated symptoms are a burning or tingling sensation 24 to 48 hours before the lesion appears. The secondary lesion is a limited, circular erosion or ulceration. They may be single or multiple. They occur on the mucosa covered by non-keratinising epithelium, i.e. on the cheeks, edge of the tongue, back wall of the throat, palate, lips, floor of the mouth.

Miculicz aphthae (small)

These are painful erosions that occur in multiples on the unaltered mucosa and heal within 7-14 days without leaving scars. Their diameter varies from a few millimetres to 1 cm.

Sutton's aphthae (large)

These are the most severe type of aphthous ulceration, with a diameter of more than 1 cm. They are very painful, often accompanied by general symptoms such as weakness, and lymph nodes may be enlarged. The lesions persist for several weeks and heal leaving scars.

photo: panthermedia

Herpes-like aphthae

They most often appear in the third decade of life, in women more often than in men. They are numerous and small lesions. They can number up to about 100, are 1-2mm in diameter and may fuse together. They heal from 7-21 days without leaving scars.

Behcet's syndrome

A multisystem disorder, it is rare, occurring more commonly in Mediterranean, Middle Eastern and East Asian populations. There is a triad of symptoms: recurrent oral mucosal aphthae, recurrent genital mucosal aphthae and recurrent iritis. The symptoms listed may be accompanied by neurological, gastrointestinal, renal and skin lesions.

Treatment of aphthous ulcers

Consists of maintaining good oral hygiene, removing traumatic factors and prescribing a mild diet. Superficial pain relievers are also used.