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{{Aphthous ulcer}}
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{{Aphthous ulcer}}  
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==Overview==
==Overview==
An ''' aphthous ulcer''' or '''canker sore''' is a type of [[mouth ulcer]] which presents as a painful open [[sore]] inside the [[mouth]], caused by a break in the [[mucous membrane]].  The condition is also known as '''aphthous stomatitis,''' and alternatively as "Sutton's Disease," especially in the case of multiple or recurring ulcers.   
An aphthous ulcer or canker sore is a type of [[mouth ulcer]] which presents as a painful open [[sore]] inside the [[mouth]], caused by a break in the [[mucous membrane]].  The condition is also known as aphthous stomatitis, and alternatively as "Sutton's Disease," especially in the case of multiple or recurring ulcers.   
 
==Historical Perspective==
The term aphthae was first used by [[Hippocrates]] at between 460-370 B.C., in relation to disorders of the mouth.
 
==Classification==
[[Aphthous ulcer]] may be classified into 3 groups: major aphthous stomatitis, minor aphthous stomatitis and herpetiform stomatitis.


The term '''''aphtha''''' means '''[[ulcer]];''' it has been used for many years to describe areas of ulceration on mucous membranes. Aphthous stomatitis is a condition which is characterized by recurrent discrete areas of ulceration which are almost always painful.  Recurrent aphthous stomatitis (RAS) can be distinguished from other diseases with similar-appearing oral [[lesion]]s, such as certain [[virus|viral]] [[exanthem]]s, by their tendency to recur, and their multiplicity and chronicity.  Recurrent aphthous stomatitis is one of the most common oral conditions. At least 10% of the population suffers from it.  Women are more often affected than men.  About 30–40% of patients with recurrent aphthae report a family history.[http://dental.huji.ac.il/course/oral_medicine/lectures/4/lesones/afta2.pdf][http://www.emedicine.com/ent/topic700.htm][http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=16390463&dopt=AbstractPlus]
==Pathophysiology==
The exact pathophysiology of aphthous ulcer is not [[fully understood]]. The pathogenesis of recurrent [[aphthous ulcer]] is varies based on underlying medical conditions.  
It is thought that aphthous ulcer is the result of ​the cross reactivity theory between [[antigens|microbial antigens]] and [[mitrocondrial]] [[heat shock protein]], dysembryoplastic theory, histopathogenesis of glandular cells in myxoma or the thrombotic theory​. Predisposing factors implicated so far in the development of [[aphthous ulcers]] are: [[trauma]], [[smoking cessation]], [[stress]], [[hormonal disorders]] and food hypersensitivities.


==Causes==
==Causes==
The exact cause of aphthous ulcers is unknown. Factors that provoke them include [[stress (psychology)|stress]], [[fatigue (physical)|fatigue]], [[illness]], injury from accidental biting, [[hormone|hormonal]] changes, [[menstruation]], sudden [[weight loss]], [[food allergy|food allergies]], the foaming agent in toothpaste ([[Sodium lauryl sulfate|SLS]]), and deficiencies in [[vitamin B12]], [[iron]], and [[folic acid]].<ref>{{cite journal |author=Wray D, Ferguson M, Hutcheon W, Dagg J |title=Nutritional deficiencies in recurrent aphthae |journal=J Oral Pathol |volume=7 |issue=6 |pages=418–23 |year=1978 |pmid=105102}}</ref> Some drugs, such as [[nicorandil]], also have been linked with mouth ulcers.  In some cases they are thought to be caused by an overreaction by the body's own[[autoimmunity|immune system]].
The exact cause of aphthous ulcers is unknown. Factors that provoke them include [[stress (psychology)|stress]], [[fatigue (physical)|fatigue]], [[illness]], injury from accidental biting, [[hormone|hormonal]] changes, [[menstruation]], sudden [[weight loss]], [[food allergy|food allergies]], the foaming agent in toothpaste ([[Sodium lauryl sulfate|SLS]]), and deficiencies in [[vitamin B12]], [[iron]], and [[folic acid]].
 
==Differentiating Gonadoblastoma from Other Diseases==
[[Aphthous ulcer]] must be differentiated from malignant ulcers, infections, [[rheumatic]] and cutaneous disease.
 
==Epidemiology and Demographics==
The prevalence of aphthous ulcer is estimated to range from 1,000 to 60,000 cases per 100,000 individuals annually among adult, and 1,000 to 60,000 cases per 100,000 individuals among children.
 
==Risk Factors==
Common risk factors in the development of recurrent aphthous ulcers are use of denture or braces, gender, age, family history, oral diseases and stress.
 
==Screening==
There is insufficient [[evidence]] to recommend routine [[screening]] for gonadoblastoma. However, patients with XY [[gonadal]] [[abnormalities]] should be followed using [[sonography]] starting at [[age]] 2, every six months, until the [[gonads]] are removed.
 
==Natural History, Complications, and Prognosis==
The natural history, complications and prognosis of recurrent aphthous ulcers varies with disease severity.
 
==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
There is no single diagnostic study of choice for the diagnosis of [[aphthous ulcers]].
===History and Symptoms===
Symptoms of aphthous ulcers include [[oral pain]], [[dysphagia]], and [[oral bumps]] that may have resolved spontaneously in the past.
===Physical Examination===
===Physical Examination===
====Skin====
Patients with [[aphthous ulcer]]s usually present with [[ulcer]]s that may be may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not. These characteristics help physicians to classify the disease.
=====Mouth=====
 
<gallery>
===Laboratory Findings===
Image:Apthae01.jpg|Apthae. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
There are no specific laboratory findings associated with [[aphthous ulcers]].
Image:Apthae02.jpg|Apthae. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
===Electrocardiogram===
There are no ECG findings associated with [[aphthous ulcers]].
 
===X-ray===
There are no X-ray findings associated with [[aphthous ulcers]].
 
===Ultrasound===
There are no echocardiographic and ultrasound findings associated with [[aphthous ulcers]].
 
===CT scan===
There are no [[CT-Scan]] findings associated with [[aphthous ulcers]].


</gallery>
===MRI===
There are no [[MRI]] findings associated with [[aphthous ulcers]].


==Medical Therapy==
===Other Imaging Findings===
Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good [[oral hygiene]] should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers. Strong mouthwash such as Listerine has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.
There are no other imaging findings associated with [[aphthous ulcers]].
 
===Other Diagnostic Studies===
There are no other diagnostic studies findings associated with [[aphthous ulcers]].
 
==Treatment==
===Medical Therapy===
The majority of cases of [[aphthous ulcers]] are self-limited and require only supportive care. Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral [[hygiene]] should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers and cause [[pain]]. Strong mouthwash such as [[Listerine]] has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.
 
===Surgery===
Surgical intervention is not recommended for the management of [[aphthous ulcers]].
 
===Primary Prevention===
There is no established method for prevention of [[aphthous ulcers]]. Dental hygiene and regular dentistry visits though are highly advised for improving bucal health and reducing the risk of aphthous ulcers.
 
===Secondary Prevention===
There is no established method for prevention of [[aphthous ulcers]]. Dental hygiene and regular dentistry visits though are highly advised for improving bucal health and reducing the risk of aphthous ulcers.


==Primary Prevention==
The best way to prevent Aphthous ulcers is to keep your mouth free of infection. This includes brushing and flossing your teeth, keeping your hands out of your mouth and visiting the dentist for regular cleanings.


==References==
==References==
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[[es:Afta]]
[[eo:Afto]]
[[fr:Aphte]]
[[gl:Afta]]
[[id:Sariawan]]
[[it:Afta]]
[[he:אפתה]]
[[la:Ulcus Aphthous]]
[[nl:Afte]]
[[ja:口内炎]]
[[pt:Afta]]
[[sq:Afta]]
[[fi:Afta]]
[[sv:Afte]]
[[th:แผลร้อนใน]]
[[uk:Афти]]
[[zh:口疮]]


[[Category:Oral pathology]]
[[Category:Disease]]
[[Category:Laryngology]]
[[Category:Up-To-Date]]
[[Category:Immunology]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[pl:Afta]]
{{WH}}
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Latest revision as of 22:34, 12 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

An aphthous ulcer or canker sore is a type of mouth ulcer which presents as a painful open sore inside the mouth, caused by a break in the mucous membrane. The condition is also known as aphthous stomatitis, and alternatively as "Sutton's Disease," especially in the case of multiple or recurring ulcers.

Historical Perspective

The term aphthae was first used by Hippocrates at between 460-370 B.C., in relation to disorders of the mouth.

Classification

Aphthous ulcer may be classified into 3 groups: major aphthous stomatitis, minor aphthous stomatitis and herpetiform stomatitis.

Pathophysiology

The exact pathophysiology of aphthous ulcer is not fully understood. The pathogenesis of recurrent aphthous ulcer is varies based on underlying medical conditions. It is thought that aphthous ulcer is the result of ​the cross reactivity theory between microbial antigens and mitrocondrial heat shock protein, dysembryoplastic theory, histopathogenesis of glandular cells in myxoma or the thrombotic theory​. Predisposing factors implicated so far in the development of aphthous ulcers are: trauma, smoking cessation, stress, hormonal disorders and food hypersensitivities.

Causes

The exact cause of aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid.

Differentiating Gonadoblastoma from Other Diseases

Aphthous ulcer must be differentiated from malignant ulcers, infections, rheumatic and cutaneous disease.

Epidemiology and Demographics

The prevalence of aphthous ulcer is estimated to range from 1,000 to 60,000 cases per 100,000 individuals annually among adult, and 1,000 to 60,000 cases per 100,000 individuals among children.

Risk Factors

Common risk factors in the development of recurrent aphthous ulcers are use of denture or braces, gender, age, family history, oral diseases and stress.

Screening

There is insufficient evidence to recommend routine screening for gonadoblastoma. However, patients with XY gonadal abnormalities should be followed using sonography starting at age 2, every six months, until the gonads are removed.

Natural History, Complications, and Prognosis

The natural history, complications and prognosis of recurrent aphthous ulcers varies with disease severity.

Diagnosis

Diagnostic Study of Choice

There is no single diagnostic study of choice for the diagnosis of aphthous ulcers.

History and Symptoms

Symptoms of aphthous ulcers include oral pain, dysphagia, and oral bumps that may have resolved spontaneously in the past.

Physical Examination

Patients with aphthous ulcers usually present with ulcers that may be may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not. These characteristics help physicians to classify the disease.

Laboratory Findings

There are no specific laboratory findings associated with aphthous ulcers.

Electrocardiogram

There are no ECG findings associated with aphthous ulcers.

X-ray

There are no X-ray findings associated with aphthous ulcers.

Ultrasound

There are no echocardiographic and ultrasound findings associated with aphthous ulcers.

CT scan

There are no CT-Scan findings associated with aphthous ulcers.

MRI

There are no MRI findings associated with aphthous ulcers.

Other Imaging Findings

There are no other imaging findings associated with aphthous ulcers.

Other Diagnostic Studies

There are no other diagnostic studies findings associated with aphthous ulcers.

Treatment

Medical Therapy

The majority of cases of aphthous ulcers are self-limited and require only supportive care. Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral hygiene should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers and cause pain. Strong mouthwash such as Listerine has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.

Surgery

Surgical intervention is not recommended for the management of aphthous ulcers.

Primary Prevention

There is no established method for prevention of aphthous ulcers. Dental hygiene and regular dentistry visits though are highly advised for improving bucal health and reducing the risk of aphthous ulcers.

Secondary Prevention

There is no established method for prevention of aphthous ulcers. Dental hygiene and regular dentistry visits though are highly advised for improving bucal health and reducing the risk of aphthous ulcers.


References

Template:Oral pathology


Template:WH Template:WS