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Aphthous Ulcers

Aphthous Ulcers, Aphthous stomatitis, or Recurrent Aphthous Ulcers (RAUs) are painful lesions of the mouth also known as Canker Sores.

They are common in healthy persons but can be seen in Autoimmune Diseases and Inflammatory Diseases such as: Inflammatory Bowel Disease, Behcet's Disease, Crohn's Disease, Systemic Lupus Erythematosus (SLE), etc.


Types of Aphthous Ulcers

There are three distinct types of Aphthous Ulcers:
Minor Type Aphthous Ulcers / Mikulicz Ulcers
- Ulcers are Small (Less than 4 mm across)
- Ulcers Occur Singly or in Small Groups (6 or Less)
- Usually Not found on the Top of the Tongue or the Roof of the Mouth
- Outbreak Episodes Can Occur Each 1 - 4 Months
- Ulcers Heal in 7-10 Days
---- Healing Produces Little or No Scarring
Major Type Aphthous Ulcers / Sutton's Ulcers
- Ulcers are Large - 1 cm across or larger
- Tissue Surrounding the Ulcer is More Inflamed than in Minor Type Ulcers
- Ulcers Occur in Small Groups (6 or Less)
- Healing is Slow (10 - 40 Days)
- Healing May Produce Scarring
- Can Occur Anywhere in the Mouth (Including the Top of the Tongue or Roof of the Mouth)
- Ulcers Recur Very Often
- Blood Tests May Indicate Inflammation Such As:
---- Increased ESR (Erythrocyte Sedimentation Rate)
---- Increased Plasma Viscosity
Herpetiform Ulcers
- Ulcers Begin as Blisters and Quickly Form Multiple Tiny (Pinhead Sized) Ulcers. These Tiny Ulcers can Join Together and Form Large Ulcers
- Can Occur Anywhere in the Mouth
- Ulcers are Extremely Painful
- Ulcers Occur More often in Females
- Healing Takes 10 or More Days
- Ulceration can Occur Very Frequently / Patient May Have Continuous Ulcers from Overlapping Outbreaks.

Causes and Correlations with Aphthous Ulcers

Diseases and Conditions
  • Bacteria (Aphthous Ulcers may be due to Cross-Reactivity of Immune System with certain bacteria)
    -- Helicobacter pylori
    -- Mycobacterium tuberculosis
    -- Streptococcus sanguis / Streptococcus mitis
  • Crohn's Disease (CD)
  • Celiac Disease
    -- Aphthous Ulcers are associated with Celiac Disease even when Celiac GI Symptoms are not present.
    -- Gluten Free Diet can improve or induce Remission in Aphthous Ulcers.
  • Behcet's Disease (BD)
  • Sweet's Syndrome
  • Autoimmune Disease
  • Immunosuppression or Immune Deficiency
  • Cancer
  • Ulcerative Colitis
    -- Aphthous Ulcers are not common in Ulcerative Colitis
  • Virus
    -- Adenoviruses
    -- Cytomegalovirus (CMV)
    -- Human Immunodeficiency Virus (HIV)
    -- Varicella Zoster Virus (VZV)
Vitamins, Minerals and Medications
Injury and Other


  • Diet / Nutrition
    -- Diet Changes (patients with Celiac Disease or other Food Allergy)
    -- Nutritional Supplementation in patients with Vitamin and Mineral Deficiencies
  • Laser
  • Mouthwash / Mouthrinse
    -- Benzydamine Hydrochloride Mouthwash
    -- Chlorhexidine Gluconate (Periogard)
  • Topical Treatments
    -- Sodium Cromoglycate Lozenges
    -- Lignocaine gel
    -- Tetracycline
    -- Tetracycline / Amphotericin
    -- Triamcinolone acetonide
  • Systemic (Bodywide) Treatments
    -- Azathioprine
    -- Cyclosporin
    -- Deglycyrrhizinated Licorice (DGL) / Biogastrone / Carbenoxolone / Enoxolone[3][4]
    -- Oral Contraceptives (in Women with Menses-Associated Aphthous Ulcers)
    -- Steroids (Prednisone / Prednisolone)
  • Other
    -- Toothpaste / Mouthwashes containing Sodium Lauryl Sulphate (SLS) should not be used


1. Scully C. Aphthous Ulcers Clinical Presentation. Medscape Reference. Ed Meyers AD. Updated April 2012. Accessed June 2012.

2. Field EA, Allan RB. Oral ulceration aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. Alimentary Pharmacology & Therapeutics. 2003; 18: 949962. doi: 10.1046/j.1365-2036.2003.01782.x

3. Kaczor T. Deglycyrrhizinated Licorice (DGL) for Gastrointestinal Ulcers: How Can Something So Good Be So Poorly Proven? Natural Medicine Journal. 2009; 1(3):

4. Porter SR, Scully C, Pedersen A. Recurrent Aphthous Stomatitis. Critical Reviews in Oral Biology & Medicine. 1998; 9(3): 306-321.

Popular Threads Discussing Aphthous Ulcers

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01-12-2014, 02:51 AM   #1
Join Date: Jan 2014
Location: Dhaka, Bangladesh
I've recently found a solution for aphthous ulcer. At least it works for me. I mixed salt in drinking water( it should be very salty) and then gurgle with it. You have to do it at the very early stage of the ulcer, or it might not be helpful later. And try to gurle on night just before you go to sleep and don't eat or drink anything after the gurgle till the morning. So the salty taste remains. That's why I choose to do it just before go to sleep. Do this for 2-3 days in a row. I've try it everytime when the ulcer attacks, and it's working so far. I'll be happy if this could help anyone to lessen the pain of aphthous ulcer.
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