Aphthous Stomatitis: It’s Causes, Symptoms And Treatment

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Aphthous stomatitis is a common shallow, painful disorder of oral mucosal lesion. Aphthous stomatitis is also named recurrent aphthous ulcers or canker sores and usually, it is caused by unknown etiology but involves T-cell mediation which is triggered by many factors. An individual ulcer lasts about 7-10 days and heals without scarring (having no mark), while the larger ulcers may last about several weeks to months and can scar (having mark or spot)when healing.

Etiology of Aphthous stomatitis:

The absolute or precise cause of this disease is not known or not clearly understood. Although, there are many combinations of factors that are involved in the development of canker sores,  the common cause which triggers ulcer is,

  • Weak immune system (immunodeficiency)
  • Allergies or hypersensitivity to food (such as coffee, chocolate, cheese, nuts, drinks, eggs, citrus fruits, any spicy food which leads acidity)
  • Due to emotional stress-(it is not caused directly by an ulcer, but it may increase the chances of developing ulcers and slow down the process of healing).
  • Any allergic viruses and bacteria
  • Any trauma or minor injuries in your mouth (such as any cuts, harsh type brushing, burning sensation)
  • Poor nutrition or deficiency of vitamins in the diet
  • Using tobacco or any addicted medications, while as well as quitting these drugs also lead to ulcers.
  • Certain medications
  • Aphthous stomatitis is mostly first seen in children, teens, and adolescents (from the ages of 10-25 years). 

Certain medications are also causing to the development of canker sore or ulcers, They includes,

  • Ibuprofen  or any other anti-inflammatory medicines
  • Nicorandil (medication used to treat angina pectoris)
  • Oral nicotine replacement therapy 
  • Illegal drugs (such as cocaine)

A rare cause of recurrent canker ulceration is caused by certain serious diseases, these are including:

  • Cohorn’s diseases- (inflammatory bowel diseases IBD which affected your digestive tract)
  • Celiac diseases- (reaction caused by eating gluten which is present in grains or cereals)
  • Behcet’s disease- (diseases caused inflammation of blood vessels in all your body)
  • HIV/AIDS- (serious disorder interferes with your body and leads cancer)

Sign and symptoms of aphthous stomatitis:

Aphthous stomatitis or ulcer generally begins with a round yellowish uplifted spot bordering a red halo and covered by loosely attached white, yellow or grayish type membranes. People can experience a single ulcer or multiple sore or ulcers. Aphthous stomatitis most common sign and symptoms are, Ulcers in the mouth, usually inside the lips, on the cheeks, or on the tongue

  • Ulcers or sores that are covered with a yellowish layer and have a red base halo.
  • Usually no fever present (in most cases)
  • Lesions generally heal at least 7-14 days

The less common sign and symptoms that cause to more serious underlying infection, it may include,

  • Fever
  • Swollen of lymph node
  • Sluggishness or insensitivity 
  • Weight loss
  • Thrush infection in your mouth or throat

Types of Aphthous ulcers:

Aphthous stomatitis is categorized  into three types because of its severity or duration and these are,

Minor aphthous ulcers:

Minor aphthous stomatitis ulcers are the most common type of ulcer. They are usually small in size less than 5 mm (2-3 mm)in diameter and it can form a single ulcer, sore, or maybe in a cluster. They usually do not cause severe types of pain.

Major aphthous ulcers:

Major aphthous stomatitis ulcers are a less common type of ulcer. They are usually 5 mm or larger than 5mm and it can form singularly or in a pair. They are generally painful, mainly when you are eating or drinking, and these ulcers last anywhere between two weeks and a number of months.

Herpetiform ulcers:

Herpetiform ulcers can occur when multiple pinpoint or precise lesions combine together and form large, irregularly shaped sores, or ulcers. These ulcers are so-called as herpetiform because of their resemblance in appearance to herpes, although, herpetiform aphthous ulceration is not caused by herpes (simplex virus).

What Do Aphthous mouth ulcers look like?

The ulcers which are named as canker sores, mouth sore, or these are usually shallow, flimsy and begin with a pale yellow in color, and turning grey as the condition develops. They may be circular with fully red when inflamed, depending on where the ulcers or sores are located.

In serious cases, aphthous stomatitis ulcers can result in swelling with inflammation of the lymph nodes, fever, and physical fatigue or lethargy but these are extremely rare, and the swelling of the lymph nodes is consequently unlikely to be the first sign of aphthous ulcers. 

What tests should be done in aphthous stomatitis ulceration?

Most people affected by minor aphthous stomatitis ulceration which does not require tests. They are assumed if there are recurrent or repeated attacks of multiple or severe oral sores, ulcers, or complex aphthosis. The blood tests that may include in aphthous stomatitis are,

  • Blood count, 
  • iron, 
  • B12 and folate studies
  • Gluten antibody tests for coeliac disease
  • Fecal calprotectin test for Crohn disease
  • Swabs to evaluate the presence of Candida albicans, Herpes virus.

What natural home remedies cure canker sores?

In most cases, aphthous stomatitis (mouth sores or canker sore) do not require any treatment, and there is nothing specified remedy you need to do to get rid of a canker sore because mostly it will heal on its own time period. Few home remedies can be used to relieve pain, irritation, and inflammation of aphthous stomatitis or canker sores that can help to speed up the healing.

  • Any topical anesthetic creams applied directly to the sore, while the mouthwashes and oral medications can also help to relieve pain or inflammation.
  • You may avoid acidic or spicy food that may aggravate your sores.
  • Allow ice cubes or ice chips to dissolve slowly in your mouth for relieving the pain.
  • If there is any vitamin inadequacy, you may take supplementation as prescribed by your doctor or dentist.
  • Use the toothpaste that doesn’t contain sodium lauryl sulfate..
  • Brush your teeth gently carefully and use a brush with soft bristles.
  • To get rid of sores, mix milk of magnesia with Benadryl liquid and use it as a mouth rinse. You may also apply milk of magnesia on your sores to get rid of inflammation, irritation with a cotton swab. 
  • Washes your mouth with salt water or baking soda. You may mix 1-tablespoon of baking soda per ½ cup water, and rinse it with plain water.
  • Other home remedy includes goldenseal (herbs that are used to soothe an upset stomach and kill the bacterias) mouth rinse, deglycyrrhizinated licorice (a herbal supplement that is used to treat ulcers) in warm water, and saltwater rinses.
  • By intake of vitamin C, vitamin B complex orally when lesions first appear and it may speed up the healing.
  • Carrot and celery juices may also be helpful to treat duodenal and gastric ulcers.

Treatment of canker sores:

Usually, canker sores are painful and for the treatment of aphthous stomatitis or canker sores are categorized in topical anesthetic cream, mouthwashes, oral medications, nutrition supplements, and cautery by the recommendation of the dentist.

What topical recommendation and over-the-counter (OTC) medications cure canker sores?

Topical gels, cream, or ointments that are used for ulcers and canker sores to relieve the pain, decrease the inflammation, and prevent infections are.

i. Topical pain medications: 

Gels such as benzocaine and lidocaine (an anesthetic work on numbing painful areas) are used directly on the canker sore to relieve the pain or inflammation. These gel are short term pain relievers for minor mouth sore and helps to cover and protect the sore as it heals. 

ii. Topical anti-inflammatory medications:

The steroid medications such as triamcinolone acetonide or fluocinonide can be used topically (applied on affected areas)to reduce the inflammation from aphthous stomatitis or canker sores. These medications generally require a recommendation and it should be used exactly as your doctor or health care professional has instructed.

iii. Topical antibiotics: 

These types of medications may be prescribed by your doctor or dentist if there are chances to develop a canker sore and it may become infected with bacteria. Redness, crusting, any pus discharge, and fever are signs of infection.


Several mouthwashes may be used to treat the mouth sores or  canker sore by the recommendation of your doctor, these are

  • Diphenhydramine suspension (Allergy liquid) can be used as a mouth rinse. It has topical anesthetic effects on the tissue of your mouth. Put the suspension in your mouth sores, rolling it around for 30 seconds to 2 minutes, then spit it out.
  • Anti-inflammatory steroid mouth rinses are also prescribed by your doctor to reduce the inflammation and redness of the sores.
  • Tetracycline antibiotic rinses may be recommended to relieve the pain and it can promote the healing of your mouth sores.
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Oral medications:

The ulcer and sores drug is sucralfate (Carafate) and colchicine (Mitigare) helps to treat the canker sores. Or your doctor might give you steroid pills.

Nutritional supplements: 

If you have a deficiency of nutrients or vitamins, then your dentist prescribes multiple nutritional supplements to fulfil your body requirement and healing the mouth sores. Cautery dental lasers can help you feel better right away. Your doctor can also cauterize sores with chemicals like silver nitrate.

Good To Know:

If you have mouth sores or you might face difficulty in eating or drinking it is necessary you should take care of proper hygiene and avoid the foods that irritate your mouth or make the resistance for the healing process. You should brush your teeth with a soft-bristled brush twice a day, which will keep your mouth free of food which triggers your sores. Usually, mouth sores or ulcers do not need any treatment; they heal on their own or by some preventions, while if they are not healing, you might treat your sores by natural home remedies or using mouthwashes by the prescription of your doctor.