Aphthae: Description
Aphthae (also incorrectly spelled “aphthae” or “afts”) are painful lesions of the mucous membrane in the mouth. They can affect the gums, oral cavity, tonsils or tongue. Occasionally, aphthae also occur in the genital area. They can be round or oval, have a yellowish to grayish-white coating and are usually surrounded by an inflammatory red border. The size can vary from the size of a pinhead up to three centimeters in diameter – then one speaks of the major form. A large number of small aphthae (up to 100 pieces, spread over the entire oral cavity) can be a sign of a herpes infection. Doctors speak of oral thrush. The pimples in the mouth occur particularly frequently on the edge of the tongue or on the inside of the lips.
Aphthae can occur once or recurrently (med.: habitual or chronic recurrent aphthae). In most cases, they are harmless and heal on their own within one to three weeks. In the case of major aphthae, it can sometimes take months for them to disappear. Scars may then remain.
Aphthae and mouth ulcer
Aphthae and pain
Aphthae are painful and can significantly impair well-being. How severe the pain is varies from individual to individual. It depends primarily on the location where an aphthae occurs and less on its size. It can be particularly unpleasant if they are located in areas subject to high mechanical stress, for example the tongue. Speaking, eating or swallowing then trigger pain.
Aphthae in children
Bednar’s aphthae are small lesions of the oral mucosa in infants, for example, caused by sucking on a bottle. They usually occur in the area of the hard palate.
Also in small children, aphthae are sometimes caused by frequent coughing with the tongue sticking out, for example in whooping cough. This is why it is also referred to as whooping cough ulcer (med.: Fede-Riga’s aphthe).
Frequency of aphthae
Aphthae are among the most common diseases of the oral mucosa. About two to ten percent of the population are affected by aphthae at least once in their lives.
Aphthae: causes and possible diseases
- Diseases: Aphthae can occur in the context of diseases, such as chronic inflammatory bowel disease, celiac disease (chronic disease of the mucous membrane of the small intestine), Behçet’s disease (vascular inflammation), Sweet syndrome (rare skin disease), neutropenia (reduction of certain white blood cells), HIV infection, herpes infection, hand-foot-and-mouth disease.
- Autoimmune reaction: the immune system fights the body’s own tissue.
- Immunodeficiency: for example, due to chronic diseases such as diabetes
- Stress
- Chemical irritation: for example due to sodium lauryl sulfate (SLS) contained in toothpaste
- Injuries to the oral mucosa: for example, due to poorly fitting braces or bite injuries
- Nutritional deficiencies: vitamin B12, iron and folic acid deficiencies
- Intolerant foods: for example, nuts, tomatoes, alcohol, or citrus fruits; also due to additives in foods such as preservatives or dyes.
- Changes in hormone balance
- Genetic factors: Habitual aphthae run in families.
- Viruses and bacteria could also possibly be triggers.
Studies also show that smokers are less likely to be affected by aphthae than non-smokers. This is because smoking causes keratinization of the oral mucosa over time (med.: hyperkeratosis), which may protect against aphthae formation.
