Symptoms
Aphthae are usually small, approximately lentil-sized, white to yellow fibrin-covered, flat erosions and ulcerations of the oral mucosa. The marginal region is slightly raised and reddened. Aphthae occur in one or more locations and are particularly painful on contact with acidic or spicy foods. The so-called herpetiform aphthae are smaller and more numerous than the common lesions and have a vesicular structure. Aphthae usually develop rapidly but may persist for a long time. The duration of healing depends on the size and is one to two weeks for smaller lesions and two to four weeks or even months for larger ones. Often they occur recurrently. In a severe course, chronically many and large aphthae occur, which take weeks or months to heal with scarring and severely impair the quality of life.
Causes
The exact causes have not yet been elucidated. It is known that women are affected more often than men. Heredity also plays a role. Certain foods, such as nuts, dyes, chocolate, gluten, cheese, preservatives, sodium lauryl sulfate (SLS) in dental care products), allergies, poor oral hygiene, and minor injuries are thought to trigger aphthae. Stress, hormonal fluctuations in women, immunological disorders such as HIV, medications (e.g., NSAIDs), and vitamin or mineral deficiencies (iron, folic acid, vitamins B12, B1, B2, B6, and zinc) are also blamed in some cases. Whether certain bacteria or viruses have an influence is not precisely known. Some triggers are controversial. Smoking has a protective effect and increased aphthae may occur when quitting smoking. Aphthae may also disappear during pregnancy or with age.
Diagnosis
Differential diagnoses include viral infections (herpes simplex labialis or oralis oral thrush in children, cytomegalovirus, varicella, coxsackie, HIV), bacterial infections (ulcerative gingivitis, syphilis), fungal infections, neoplasms, hematologic disorders, and autoimmune diseases. Therefore, aphthae with accompanying symptoms such as fever, fatigue, diarrhea, halitosis, conjunctivitis, arthritis or ulceration of other organs should be clarified by a physician. A severe course with large lesions and long duration of illness may also indicate an underlying disease such as HIV.
Nonpharmacologic treatment
Known triggers such as nuts and aggravating factors such as acidic and spicy foods should be avoided and possible causes treated. Good oral hygiene can also have a positive effect.
Drug treatment
Since the actual cause is not known, local treatment of symptoms is the primary treatment. In practice, a variety of medications are used. Local anesthetics:
- Topical local anesthetics such as lidocaine in the form of gels, mouth rinses, sprays or lozenges can be used to numb the pain for some time.
Salicylates:
- Topical salicylates such as choline salicylate or salicylic acid are also used to treat pain. As a precaution, these should not be used in children with viral infections (Reye syndrome).
Analgesics:
- Oral analgesics such as paracetamol or ibuprofen are an alternative for severe discomfort. A disadvantage are possible adverse effects when administered systemically.
Herbal extracts:
- Plant tannins such as extracts of rhubarb, ratanhia, sage or myrrh have an astringent effect. Cloves are plant local anesthetics.
Micronutrients:
- For drug prevention, a therapy attempt with a vitamin and mineral preparation can be made for frequently recurring aphthae. A deficiency of iron, folic acid, vitamin B12, B1, B2, B6 (vitamin B complex) and zinc is thought to be responsible for the lesions in some patients.
Topical glucocorticoids:
- Such as triamcinolone acetonide have an anti-inflammatory effect. Chamomile and other herbal medicines are over-the-counter, but weaker-acting herbal anti-inflammatories.
Other options:
- Disinfectants such as chlorhexidine or octenidine.
- Oral contraceptives may reduce the recurrence rate in women with a hormonal cause.
- Caustic agents such as silver nitrate rods are mentioned in the literature.By locally destroying the nerve endings, they have a pain-relieving effect.
Finally, there are countless home remedies and alternative medicines that are said to be well effective according to manufacturers, patients or health professionals.