What is Aphthous Ulcer? (Oral Ulcer) Oral Ulcers are also called as Recurrent Aphthous Stomatitis/ Aphthous ulcer/ Canker sores. It is char...
What is Aphthous Ulcer? (Oral Ulcer)
Oral Ulcers are also called as Recurrent Aphthous Stomatitis/ Aphthous ulcer/ Canker sores. It is characterized by the developing painful recurrent solitary or multiple lesions on the oral mucosa.
It may caused due to several reasons they are,
• Bacterial infection
• Genetic factor
• Vitamin B12 / folic acid deficiency
• Trauma
• Endocrine conditions
• Psychic factor
• Allergy
• Systemic diseases
BACTERIAL INFECTION
The causative organism is alpha-hemolytic streptococcus, streptococcus Sagunis is strongly associated with the disease. This is proved by injecting this streptococcus into the guinea pig and rabbit to produce a lesion in the skin and oral mucosa, which is clinically and histologically similar to humans.
GENETIC FACTOR
Subject with positive family history, recurrence of oral ulcers with HLA-B51 is these subject may develop an ulcer in the early stages of life.
IMMUNOLOGICAL ABNORMALITY
Another etiological factor was the autoimmune response of oral studies showing that IgG And IgM bind to the oral epithelial cells of the spinous layer in patients with an oral ulcer. This is due to the diffusion of bacterial food or any other substances that act as a hapten or which initiate the immunological response and react with epithelial cell's surface antigen and produce changes resulting in the adverse inflammatory response.
IRON OR VITAMIN B12/FOLIC ACID DEFICIENCY
Some of the studies show that nutritional deficiency may be a significant factor in recurrent oral ulcers. Patient with oral ulcer are screened and shows that iron and vitamin B12 / folic acid deficiency is associated with it.
TRAUMA
Traumatic incidences such as oral surgical tooth dental needle dental trauma, and self-inflicted bites may result in an oral ulcer.
ENDOCRINE CONDITION
Studies have correlated the relationship between the occurrence of the menstrual period and the development of an oral ulcer. An ulcer is maximum in a post-ovulation period which may be related to progesterone level. Also, during the time of pregnancy remission of the oral ulcer shows eruption sometimes very rapidly.
PSYCHIC FACTOR
The acute psychological problem may also precipitate oral ulcers.
ALLERGIC FACTOR
Many Patient with a recurrent oral ulcer has a history of asthma, drug allergy, hay fever, and food allergy like [shrimp]. the outbreak of ulcer following certain food/drugs be reported so allergy is one of the most important factors that cause a recurrent aphthous ulcer.
SYSTEMIC DISEASES
In various systemic diseases such as Behcet's HIV cyclic neutropenia, magic syndrome[ major aphthous and generalized inflamed cartilage], PFAPA syndrome[ periodic pharyngitis, and cervical adenitis Crohn's diseases, ulcerative colitis, and gluten-sensitive heterotrophy, in these diseases recurrent aphthous ulcer be common.
CLASSIFICATION OF ORAL ULCER
I) Recurrent aphthous minor (most common "Canker sore")
II) Recurrent aphthous major (Mikulizc scarring apthae/ Sutton's disease) - Severe form of Aphthous ulcer
III) Recurrent herpetiform ulceration consists of a cluster of ulcer that resembles herpetic lesion but lacks evidence of lack presence of a virus in the patient
Clinical Features of Aphthous Ulcers
RECURRENT APHTHAE MINOR
Recurrent oral ulcers mostly occur in women than in men in the age group of 10 to 30 years . in a general population, 20 percent of people are affected with this disease. Some of the clinical features are one or more small burning sensations, erythema, generalized edema in the tongue, paresthesia, malaise, and localized vesicles-like lesions. The oral ulcer is a single or multiple erosive lesion covered by a grey membrane. It is generally necrotic at the center with well-defined margins of 2 -3 mm in diameter surrounded by erythematous hallow. It is very painful and may interfere with speech and eating. These ulcers generally persist from 7 to 14 days and then heal gradually with no evidence of scarring.
RECURRENT APHTHOUS MAJOR
These are large and painful from 1 to 10 in number found on the soft palate, and tongue with severe pain and dysphagia. This type of ulcer is more common in HIV patients. these ulcers may persist for 6 weeks and leaves a scar on healing. patient with these major aphthae also occasionally show similar lesions on the vagina/rectum and
RECURRENT HERPETIFORM ULCER
These are multiple small ulcers up to 100 in occur in any site of the oral cavity. The lesion is pinhead-sized and more lesions may persist for 1 to 3 years and the patient may have temporary relief by 2 percent tetracycline mouthwash.
Differential Diagnosis
The lesion was mistakenly diagnosed as erythema erosive lichen planes, pemphigus , pemphigoid, and herpetic stomatitis.
Treatment for Aphthous Ulcer (Oral Ulcer)
There is no specific drug for this this may heal gradually .however some ointments may be used to relieve the pain and reduce the tetracycline mouthwash (250mg per 5ml) used 4 times daily for 5 to 7 days, steroid ointments , 1.5 percent cortisone acetate applied locally and hydrocortisone acetate-antibiotic lozenges may also be effective.
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