The following symptoms and complaints may indicate an aphtae:
Main symptoms
- Milky to yellowish spots on the oral mucosa surrounded by a red halo; they are usually roundish or oval and usually no larger than a lens
Secondary symptoms – major type (see below).
- Hypersalivation (synonyms: sialorrhea, sialorrhea or ptyalism) – increased salivation.
- Halitosis (bad breath)
- Significant subjective discomfort
- Disturbances in the intake of food
Recurrent aphthosis – clinical morphological manifestations.
| Minor type (Mikulicz) | Major type (Sutton) | Herpetiform aphthae (Cooke) | |
| Location | superficial | Deeper location (penetration into salivary glands/muscle layers; induration (hardening of tissue), deep ulceration (ulceration), tissue destruction) | Herpetiform arrangement/aphytes resembling herpes (may coalesce into larger erosive plaques (areal or squamous substance proliferation of skin))Note: not a vesicle stage |
| Localization | Area of vestibular (affecting the vestibule of the mouth) mucosa; usually nonkeratinized mucosa | Oral cavity (lat.cavum oris), oropharynx (oral pharynx), rarely genital mucosa (vulva) | entire oropharyngeal mucosa (including palate, gingiva); preferentially at the tongue margin |
| Number | 1-4 aphthae at the same time | several to many | multiple (50 to > 100) |
| Diameter | 2-5 mm; < 10 mm in diameter | > 1 cm (1-3 cm) | often only the size of a pinhead (1-2 mm) |
| Presence | 7-10 days | 2-4 weeks | 7-10 days |
| Painfulness (duration) | painful; 3-5 days | Very painful; lymphadenopathy (enlargement of lymph nodes) | 3-5 days |
| Quality of life | only slightly limited | very limited | Minor impairment of general condition |
| Healing | Scar-free | Healing in 10 days to 6 weeks (rarely longer); scarring is common (about 64% of cases) | 7-10 days; scarring is common in about 32% of cases |
| Occurrence (frequency) | Recurrent (3-6 times/year) | Consecutive or continuous | episodic |
| Percentage of all recurrent aphthae | approx. 85 % | approx. 10 % | approx. 5 % |
| Percent of population | 10-15 % |
Other special forms are:
- Solitary giant aphthae
- Bipolar aphthosis – in Behçet’s disease (synonym: Adamantiades-Behçet’s disease; a relapsing immunodeficiency disease of the rheumatic type); manifestation between the 20th and 40th year of life; men are more often affected than women; clinical picture: multiple, often very painful aphthae of the oral mucosa (100%); painful ulcerative genital lesions (90%); eye involvement (about 50%).
- HIV-associated aphthae