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Signs and Symptoms of Recurring Aphthous Ulcers

Minor aphthous ulcers

Figure 1. Minor aphthous ulcer
Minor aphthous ulcers are small and cause the least discomfort. They are most prevalent in people 10–40 years of age. Usual locations include the floor of the mouth, buccal and labial mucosa, tip of the tongue, and ventral surface of the tongue. They are rare on the dorsum of the tongue and on keratinized mucosa. Patients may become aware of them when a tingling or burning sensation occurs. Within two days, a raised erythematous (red) papule or white spot appears. This ulcerates, resulting in a pseudomembranous grayish or yellowish center within the lesion. Minor aphthae are round or oval and measure up to 4 mm in diameter. They usually heal uneventfully seven to ten days after the first signs appear. Recurrence may take weeks or years.9,10

Major aphthous ulcers

Figure 2. Major aphthous ulcer
Major aphthae (Sutton’s ulcers) are more severe than minor aphthae — larger, slower to heal and more painful — and can lead to adjacent and facial edema. They are found in all regions of oral mucosa, including keratinized mucosa, and are often larger than a centimeter in size. While they typically heal in ten to forty days, in extreme cases healing can take months while new ulcers are developing. Major RAU heal with scarring. If long-lasting and frequently recurring, they can result in morbidity and poor quality of life, with poor nutrition and stress.11,12

Herpetiform aphthous ulcers

Figure 3. Herpetiform aphthous ulcers
Herpetiform ulcers occur as multiple lesions, up to 100 at a time, and can range from <1 mm to 3 mm in diameter each. Herpetiform RAU also coalesce into larger irregular lesions. Healing usually occurs in seven to ten days, without any scarring. Herpetiform ulcers do not exhibit a vesicle stage and are not infectious.

Etiology of Oral Ulcerations

The exact etiology of RAU is not known. Systemic and local factors, as well as infectious agents, have been proposed. Medications including nonsteroidal anti-inflammatory drugs (NSAIDs); hypertensive medications such as ACE inhibitors, beta-blockers with alpha-blocking activity and calcium channel blockers; and cyclosporine, interferons, penicillin, sulfonamides and nicorandil have all been implicated in oral ulcerations.13,14 ,15,16,17,18,19