Aphthous stomatitis

The exact cause is unknown. However, experts are inclined to think that this disorder is the result of a combination of concomitant factors.

Symptoms of aphthous stomatitis are usually limited to ulcers on the oral mucosa; however, on rare occasions, the appearance of these lesions may also be associated with systemic symptoms such as fever or general malaise.

With their characteristic appearance, ulcers caused by aphthous stomatitis usually resolve spontaneously in 1 to 2 weeks.

As a general rule, the diagnosis of aphthous stomatitis is clinical, i.e. it is based on an objective examination and anamnesis.

At present, there is no definitive cure for aphthous stomatitis; however, patients can resort to various symptomatic remedies. With age, the disease tends to gradually reduce the frequency with which it produces oral lesions.

What is aphthous stomatitis?

Aphthous stomatitis is a common oral condition characterized by the repeated formation of painful but benign ulcers (aphthous ulcers) on the inner mucosa of the lips or cheeks, or on the mucosa of the tongue or pharynx.

Typical of youth and young adults, aphthous stomatitis is not a contagious disease, so the sufferer does not transmit it to healthy people who are in the vicinity or who have contact with him/her.

Meaning of the words stomatitis and aphthous stomatitis

In medicine, the term "stomatitis" designates any acute or chronic inflammation of the oral cavity; the word "aphthous", on the other hand, refers to mouth ulcers, which are benign ulcer-like lesions of the oral mucosa; "buccal mucosa" is the non-specific expression used to describe the mucosa lining the inside of the mouth.

Thus, according to the literal meaning of the above terms, aphthous stomatitis is the inflammation of the oral cavity characterized by the presence of aphthae on the oral mucosa.

Epidemiology

Statistics say that aphthous stomatitis affects between 5% and 66% of the general population; this figure places it at the top of the most common diseases of the oral cavity.

Aphthous stomatitis is widespread throughout the world; however, it is more easily observed in developed countries.

It usually appears at an early age, between 10 and 19 years; it is not predominantly of one gender, which means that it affects males and females equally.

Causes

The exact cause of aphthous stomatitis is unknown.

However, experts are inclined to think that this common oral condition has a multifactorial origin, that is, it is the result of a combination of factors.

What are the factors that favor aphthous stomatitis?

According to research, the factors whose combination appears to play a key role in the occurrence of aphthous stomatitis are:

• The weakening or malfunctioning of the immune system. Studies on the subject have shown that many cases of aphthous stomatitis are characterized by an inadequate immune response, whose protagonists are T lymphocytes and the cytokines IL-2, IL-10 and TNF-alpha.
• Food allergies to foods such as chocolate, coffee, nuts, almonds, citrus fruits, eggs, strawberries, cheese and tomatoes.
• Stress.
• Certain viruses and bacteria.
• Trauma to the mouth.
• Poor nutrition.
• Certain medications.
• The presence of systemic diseases, such as: systemic lupus erythematosus, inflammatory bowel disease, reactive arthritis, celiac disease, Behçet's disease, cyclic neutropenia, nutritional deficiencies, IgA deficiency, immunosuppression due to HIV, MAGIC syndrome, PFAPA syndrome, Sweet's syndrome or Lipschutz ulcer.
• Family history for aphthous stomatitis. Scientific studies have shown that, in a non-negligible number of cases, aphthous stomatitis sufferers have relatives affected by the same disease; this has led experts to think that aphthous stomatitis may have, at least in a certain percentage of patients, a hereditary character.

Symptoms

Aphthous stomatitis is usually characterized by a single symptom: the repeated formation of painful ulcers, or aphthous ulcers, inside the mouth, mainly on the mucosa of the tongue, lips, cheeks and pharynx.

Rarely, it may be associated with some other systemic symptom, such as malaise or fever.

What are canker sores? Canker sores in the mouth look like small round or ovoid sores, approximately 5 mm in diameter. These lesions are covered by a yellow-grayish pseudomembrane and surrounded by a thin red halo. They appear approximately 24 hours after the first tingling sensation. They may also cause halitosis and increased salivary secretion.

In particular, 3 types of mouth ulcers can be recognized:

• Minor aphthous ulcers: these are the most common and generally do not exceed 8 mm; they occur mainly on the inside of the lips or on the sides of the tongue, and may heal in 10 days.
• Major aphthous ulcers: they grow up to more than one centimeter, also affect the mucosa of the palate and pharynx and may be accompanied by episodes of fever.
• Herpetiform aphthous ulcers: these can be confused with herpes virus sores and are characterized by small sores that develop into a large sore; they can last up to 14 days.

In some patients, aphthous stomatitis may be an isolated case, while in others it may appear up to four times in a year.

Treatment

At present, people suffering from aphthous stomatitis can only resort to symptomatic therapy, as the medical community has not yet succeeded in developing a treatment that can definitively cure the condition in question.

Purpose

Symptomatic treatment of aphthous stomatitis is aimed at relieving the pain caused by ulcers while waiting for them to resolve naturally, since it should be remembered that aphthous stomatitis resolves spontaneously within 1 to 2 weeks in less severe cases and in more than a month in more severe cases.

What does it consist of?

Turning to the practical aspects, symptomatic therapy of aphthous stomatitis includes:

• Increase fluid intake, which promotes hydration of the oral mucosa and helps to relieve ulcer pain.
• Temporary exclusion of spicy and/or salty foods and acidic beverages from the diet because when they come into contact with aphthous ulcers, the pain associated with them becomes more acute and even more bothersome; with the suppression of these foods until the ulcers disappear, the patient avoids the discomfort just described.
• Perform adequate oral hygiene, adding to brushing the use of chlorhexidine rinses to reduce the risk of infections of the already altered mucosa.
• The application, directly on the wound, of a corticosteroid drug (topical corticosteroid) with anti-inflammatory effect.

This treatment is reserved for the most severe clinical cases, in which the pain is very intense and the ulcers are prolonged.

The use of any corticosteroid should only be by medical prescription, since it is a pharmacological category with many side effects (especially when its use is inappropriate).

It is important to note that most people with aphthous stomatitis manage to control ulcer pain only by temporary correction of diet and hydration of the oral mucosa.

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Prevention of aphthous stomatitis

For further prevention, it is important to know the causes of mouth ulcers and, consequently, what is best to avoid so that they do not form.

Why do mouth ulcers occur? Inflammation may be due to irritation caused by alcohol, tobacco smoke or frequent ingestion of foods that are too acidic, too spicy, salty or spicy; excessive consumption of vinegar, theine, caffeine or too hot beverages may also contribute to the formation of mouth ulcers.

The main prevention against the formation of inflammation of the oral cavity is undoubtedly to maintain good oral hygiene: because when aphthous ulcers are present, the nerve endings of the oral mucosa are exposed to the external environment and are therefore more prone to be affected by bacteria or other microorganisms.

Another useful tip is the practiceof yoga or any activity that helps to reduce stress, often associated with the onset of aphthous stomatitis, so it is essential to take care of psychophysical relaxation.