Approximately 5 to 21 percent of the population suffers from aphthae (colloquially also: aphthae, aften), a painful inflammation in the oral cavity. The small blisters that develop can occur once or chronically. If several aphthae occur at the same time, or if they appear more frequently than four times a year, we can speak of aphtosis (this is usually the case). Children can be affected as well as adults and also the sex does not play a role.
What are aphthae?
An aphthae can be very painful. Usually they come 3 days, stay 3 days and go away again in 3 days. Adhesive tablets can cover the aphtae for a few hours and reduce the pain. An aphtae is defined as damage to the oral mucosa in the area of the gums, palate, oral cavity, tongue, or tonsils. There is a painful, inflamed area (of average 3-4mm in size) in the oral cavity. Specifically, it is a vesicle that develops over time into a small, yellowish depression surrounded by a red, inflamed border. Two types of aphthae are distinguished: First, the “ordinary” aphthae, which occurs for a short time, and second, the “recurrent”, that is, the recurrent inflammation of the mucous membrane in the oral cavity.
Causes
The causes of aphthae are currently not clearly understood. On the one hand, bacteria and viruses are possible triggers. It is also known that Behcet’s disease (a vascular inflammation) may be responsible for the occurrence of aphthae. On the other hand, it is suspected that the vesicles can be caused by certain foods that are incompatible with the body (e.g. preservatives, dyes, etc.), or that nutritional deficiencies, such as an existing iron deficiency, could be the cause. Furthermore, the psychological state of the individual, as with many other diseases, plays a role. Certain ingredients, such as those found in toothpaste, are discussed by scientists as triggers. Furthermore, an autoimmune reaction of the body can be considered as a cause. In this case, the body’s own immune system fights the tissue of its own body. Doctors assume that this disease is not contagious and therefore not transmissible. In summary, it can be stated that there is most likely a multifactorial origin behind this disease.
Symptoms, complaints, and signs
Aphthae usually occur on the mouth or in the intimate area and are usually circular or oval in shape. They initially cause discomfort such as burning or a feeling of tightness in the affected area. After about 24 hours, redness develops and a kind of mucosal defect with a yellow or grayish-white coating forms. The apth itself is inflammatory red and surrounded by a bright red halo. Apthae can occur in a variety of locations, such as on the mucosa of the oral cavity, on the tongue, on the gums, or on the palate. Occasionally, the noticeable redness is localized to the mucosa in the genital area. The size of the aphthae can vary greatly – from the size of a pinhead to a diameter of up to two three centimeters. Depending on their type, aphthae can vary greatly in appearance. The minor type is characterized by isolated mucosal defects in the mouth or intimate area that are usually three to five millimeters in size and heal after five to seven days. In the major type, there are deeper skin lesions that can be up to three centimeters in size. Those affected usually feel ill and also suffer from swollen lymph nodes or fever. Herpetiform-type aphthae are very small and painful, and usually spread throughout the mouth.
Diagnosis and course
To diagnose aphthae, the physician examines the patient by taking a look inside his or her mouth and listening to a description of the patient’s symptoms. In rare cases, a blood test is also ordered to rule out other diseases. The first signs are usually the smallest inflammations in the oral cavity, which are barely visible to the naked eye, but which cause the patient pain. The often very small whitish to yellowish looking blisters form within a few hours. Within a very short time, round or oval depressions of the oral mucosa develop, whose edges are slightly raised and strongly reddened.Regarding the course of the disease, it should be noted that aphthae usually disappear after one to two weeks, but healing depends on the size (larger aphthae can take up to four weeks to heal).
Complications
In most cases, aphthae do not lead to further complications. They usually remain on the lips for about two weeks and disappear on their own if there is no further inflammation at the particular site. Due to the pain, the patient’s quality of life can be severely limited. As a result, normal food and liquid intake is no longer possible. The aphthae can also lead to stress in everyday life and to headaches and nausea due to the reduced fluid intake. Treatment is usually done by ointments or solutions and also leads to quick success. Complications usually do not occur if the aphthae are treated in time by a doctor. However, the affected areas should not be touched by the patient. The aphthae often cause small bleedings, so that the oral cavity might taste unpleasantly of blood and might hurt. Externally, the aphthae are hardly noticeable, but can lead to complications with the partner, as kissing is no longer possible. After a few weeks, however, the aphthae disappear on their own and do not lead to further problems or subsequent damage.
When should you go to the doctor?
In most cases, aphthae are harmless to health and heal on their own without further treatment. A visit to the doctor is recommended if the damage does not recede after one to three weeks at the latest or is associated with particularly unpleasant accompanying symptoms. If the aphthae are accompanied by pain, itching or bleeding in the mouth, a doctor should be consulted immediately. The same applies to particularly large lesions that may even be associated with inflammation. Recurring aphthae should also be medically clarified. Children suffering from inflammatory skin lesions should see a pediatrician after one week at the latest. If the affected child no longer wants to drink or eat because of the pain, an immediate visit to the doctor is recommended. People with pre-existing conditions of chronic periodontitis or oral mucositis should see a doctor as soon as possible with the symptoms. Likewise, pain patients, pregnant women and other risk groups, if the aphthae do not recede after a few days or other physical complaints are added.
Treatment and therapy
There are a variety of options for treating aphthae. Generally, painkilling agents, such as lidocin, in the form of gargle solutions, ointments, or even sprays are usually used by the treating physician. Corrosive agents, such as rhubarb root extract, or silver nitrate can also be used. The corrosive effect is intended to accelerate the healing process by rejecting dead tissue. If an infectious cause can be ruled out, triamcinolone acetonide, in the form of an ointment, is often prescribed. Popular wisdom has it that a use of home remedies such as tea tree oil, as well as chamomile and sage tea rinses, will bring about improvement. According to studies, avoiding sodium lauryl sulfate (found in toothpaste) caused a significant reduction in the development of aphthae. Also under discussion for the treatment of aphthae are so-called soft lasers, which are supposed to fight inflammation, relieve pain and heal the tissue.
Outlook and prognosis
The small inflamed areas in the mouth heal completely with or without treatment. The duration of healing for individual aphthae is one to two weeks. This depends on whether they receive medical care and what foods the sufferer eats. The healing process slows down if the consumption of acidic nutrients damages the protective layer over the affected area. Likewise, careless oral hygiene or stretching of the skin can cause cracks to form, which prolongs the healing process. Playing with the tongue in the affected region also leads to prolonged discomfort. Although individual aphthae heal completely within a few weeks, there is a risk that aphthae will recur throughout life. There is no lifelong freedom from symptoms.The triggering germs can attack the mucous membranes in the mouth again at any time and lead to inflammation. With a weakened immune system or the presence of other diseases, the likelihood of aphthae forming more frequently increases. If the patient also suffers from a chronic underlying disease, the painful inflammations occur more frequently than in normal cases. These diseases include Crohn’s disease or rheumatism in particular. In addition, a deficiency of vitamin B12 or iron is conducive to the development of aphthae.
Prevention
To prevent aphthae, recommended measures include avoiding intolerant foods, reducing stress, taking adequate vitamins, maintaining proper oral hygiene, and using a brine toothpaste.
Aftercare
In most cases, aphthae disappear on their own without complications. Therefore, no special aftercare measures are usually necessary. However, this depends greatly on the cause and size of the aphthae. In general, those affected should pay attention to conscientious oral hygiene and dental care. They should refrain from using dental care products containing sodium lauryl sulfate, as these can irritate the oral mucosa and thus impede healing. Special mouth rinses with tea tree oil can help to accelerate wound healing and prevent the recurrence of aphthae. This is especially recommended for frequently recurring aphthae. Especially in the case of large and long aching aphthae, alcohol, highly carbonated drinks, and hot and spicy foods should be avoided for a few days. In some sufferers, the development of aphthae is associated with certain histamine-containing foods. In such cases, it is recommended to consume the corresponding foods in moderation for a few weeks. If there is a suspicion that nutritional deficiencies or nutritional deficiencies are the reason for the disease, these should continue to be treated. Otherwise, new aphthae may develop. In the case of particularly large aphthae or also in the genital and anal area, scars may remain. In these cases, the wound should be examined by a physician.
What you can do yourself
The mucosal damage caused by aphthae, as well as the accompanying pain, can possibly be alleviated with proven home remedies. A high vitamin C supply is always recommended to strengthen the immune system. Vitamin C powders with a high bioavailability are very suitable. In addition, patients should also take zinc, which is also effective against infections and strengthens the immune system. Aloe vera has an analgesic and healing effect and promotes the supply of fluid to the mucous membrane. The natural and already pressed gel is applied to the aphthae several times a day. A rinse with Kaiser soda dissolved in water can kill the causative germs, helping the inflammation to heal faster. Manuka honey with a high MGO value often helps against aphthae because of its strong antiseptic effect. Also convincing can be the effect of dry coriander seeds, which need to boil gently in 250 ml of boiling water for five minutes. Then leave the seeds to infuse for 10 minutes. Now strain, cool and rinse the mouth with the decoction several times a day. Sea salt, in case of severe aphthous infestation combined with 3-percent hydrogen peroxide, has a high antiseptic and anti-inflammatory effect. Add this mix to lukewarm water and rinse the mouth with it several times a day. The family doctor should be consulted immediately if, for example, there is no improvement or the aphthae return.
