What are aphthous ulcers?
Aphthae occur mainly in the gums or in the oral mucosa, but also on the tip of the tongue, on the inside of the lips or in the palate. If the person looks at their oral mucosa in the mirror, they usually see a milky-yellowish spot surrounded by a reddish rim. In addition, the affected area hurts and burns. These symptoms mainly appear when the person eats something or drinks a sour orange juice, for example. Aphthae are among the most common diseases of the oral and pharyngeal mucosa and usually appear from the age of 20. Women are affected more often than men.
There are three forms of aphthous ulcers:
- minor aphthous ulcers
Minor aphthae (Mikulicz aphthae) are about the size of a lens and damage the mucous membrane more superficially. Therefore, this form heals without scarring. They usually last for a week and heal by themselves by the end of the following week. Minor aphthae account for around 80 to 90 percent of cases.
- major aphthous ulcers
Major canker sores (Sutton canker sores) affect far fewer people. This form can grow up to three centimeters in size and penetrates deeper into the mucous membrane. It can take weeks to heal. Since the tissue damage is more profound, this form heals with scarring.
- Herpetiform aphthae
Herpetiform aphthae (stomatitis herpetiformis) are very rare. They resemble cold sores and often appear on the edge of the tongue or on the inside of the lips. In this form, the aphthae can occur in large numbers. Their size is only a few millimeters (the size of a pinhead). They owe their name to their herpes-like appearance, but they are not caused by the herpes virus.
Aphthae can be recurrent, i.e. occur several times a year.
Symptoms: What are the symptoms of canker sores?
All forms of aphthous ulcers have in common that they cause pain. When chewing, swallowing, drinking, brushing your teeth and sometimes even when speaking. They are perceived as very annoying, but are almost always harmless.
A white, skin-like coating forms on the surface of the ulcer. The edge is often red. The formations usually burst open, which damages the sensitive oral mucosa. The sore becomes inflamed and causes a burning sensation and sometimes intense pain.
Oral aphthosis proceeds in several stages:
- Prodromal stage: burning, tingling, roughness and tightness
- Preulcer phase: redness and nodule formation (inflammatory erythema and indurated papules)
- Ulcerative stage: fibrin-covered mucosal defect with a raised edge (the fibrin is an endogenous substance that causes the milky-whitish appearance)
- healing phase
Depending on the form, the aphthous ulcers occur in different distributions and depths and have a characteristic appearance.
Minor aphthous ulcers:
Number: one to four aphthous ulcers at the same time, mostly in the oral cavity
Size: two to ten millimeters in diameter
Major aphthous ulcers:
Number: one to two aphthous ulcers at the same time
Size: 10 to 30 millimeters in diameter
Special feature: severely painful because the tissue defect is deeper. Scarred Healing
Herpetiform aphthae:
Number: 50 to over 100 aphthous ulcers at the same time, especially on the edge of the tongue and the inside of the lips
Causes: What causes aphthous ulcers?
Researchers do not yet know exactly what causes an aphthae. However, there are some factors that favor such a mucosal lesion. Mechanical stimuli – for example, a poorly fitting braces or prosthesis that constantly rubs against the gums or injuries caused by a toothbrush – are among them.
If a person has a lot of stress privately or professionally , he tends to develop aphthous ulcers. Likewise, if the immune system is weakened. Experts also suspect that a lack of vitamin B12 or zinc could play a role.
Since women suffer from aphthous ulcers more often than men, hormonal influences may also be a possible trigger.
Diagnosis: How does the dentist determine aphthous ulcers?
Diagnosis is based on medical history, symptoms, and oral inspection. Since aphthous ulcers have a characteristic appearance, they can usually be identified with certainty. However, non-professionals can easily confuse the herpetiform type with a herpes infection. Here the doctor must determine the cause of the symptoms.
If you get an aphtha for the first time, you should see a doctor to be on the safe side.
Even if the aphthous ulcers do not heal on their own, cause severe pain, recur frequently, cause very deep defects in the mucous membrane or other symptoms such as fever, a doctor should be consulted. In this way, other possible causes and diseases can be ruled out. Since every long-lasting ulceration (defect in the mucous membrane) can also be caused by cancer, it makes sense to see a doctor. If necessary, he can take a tissue sample ( biopsy ) from the changed area and arrange for further examinations of the material taken.
Therapy: How can aphthous ulcers be treated?
The treatment of aphthous ulcers is purely symptomatic, which means that care is taken to alleviate the symptoms. Aphthous ulcers hurt and burn. On the other hand, ointments or gels that contain a local anesthetic can help. Alternatively, herbal tinctures of myrrh, clove or rhubarb root can alleviate the symptoms.
Germicidal mouthwash solutions (if possible without alcohol) can reduce the risk of superinfection (multiplication of germs in an existing mucosal change), but do not accelerate healing.