APTHOUS ULCERATION

Aphthous ulcers or recurrent aphthous stomatitis (RAS) are painful recurrent mucous membrane ulcerations. Usually affect the non-keratinized oral mucous membrane

Clinical features

There are 3 types of aphthous ulcers

TYPE FEATURES
Minor
aphthous
ulcers
  • Small round/oval ulcers (2-4 mm)
  • Surrounded by erythematous ulcers
  • Occur in groups of only a few ulcers (i.e.,
    1-6) at a time
  • Mainly on the non-keratinized mobile
    mucosa of the lips, cheeks, floor of the
    mouth, sulci, or ventrum of the tongue
  • Heal spontaneously in 7-10 days
  • Leave little or no evidence of scarring
Major
aphthous
ulcers
  • Painful ulcers on non-keratinized oral
    mucous membrane
  • Large (1-3 cm) edged ulcers
  • Several may be present simultaneously
  • Marked tissue destruction, sometimes
    constantly present
  • Healing is prolonged often with scarring
Herpetiform
ulcers
  • Occur in a group of small (1-5 mm)
    multiple ulcers and heal within 7-10 days

MANAGEMENT

Goal of treatment: to offer symptomatic treatment for pain and discomfort, especially when ulcers are causing problems with eating.

  • Salt mouth wash for cleansing
  • Prednisolone 20 mg every 8 hours for 3 days; then taper dose to 10 mg every 8 hours for 2 days;
    then 5 mg every 8 hours for 2 days
  • Or topical triamcinolone paste applied twice a day
  • Paracetamol 1 g every 8 hours for 3 days
  • Refer to specialist if ulcers persist for more than 3 weeks apart from the treatment
Note
  • Oral gel containing an anti-inflammatory agent combined with analgesic and antiseptic is ideal
    treatment