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Aphthous ulcers: causes, frequency and tips

by Josephine Andrews
Published: Last Updated on 326 views

Aphthous ulcers (“mouth ulcers”) are damage to the oral mucosa. Rarely, they can also occur in the genital area. They are round or oval and have a yellowish to off-white coating with an inflamed border. Aphthae often cause severe pain, but in most cases they are harmless and heal without consequences. Occasionally, however, they can occur in connection with diseases, for example Behçet’s vascular inflammation. Read everything you need to know about the symptom of “aphthae” here.

Aphthae: description

Aphthae (wrongly spelled “aphthae”) are painful damage to the mucous membrane in the mouth . They can attack the gums, oral cavity, tonsils or tongue. Occasionally, aphthous ulcers also appear in the genital area. They can be round or oval, have a yellowish to off-white coating and are usually surrounded by an inflamed red border. The extent can vary from the size of a pinhead to three centimeters in diameter – then one speaks of the major form . A large number of small aphthae (up to 100 pieces, distributed throughout the oral cavity) can be a sign of herpes infection. Doctors speak of mouth rot. Pimples in the mouth occur particularly frequently on the edge of the tongue or on the inside of the lips.

Aphthae can occur once or repeatedly (medical: habitual or chronically recurrent aphthae). In most cases, they are harmless and will heal on their own within one to three weeks. It can sometimes take months for major aphthous ulcers to disappear. Then scars can remain.

Aphthous ulcers and canker sores

Mucosal defects in the mouth are colloquially referred to as mouth ulcers. However, the term “mouth ulcer” is medically imprecise. In the vernacular, for example, it describes small lesions of the mucous membrane (aphthae) as well as cancerous growths in the oral cavity. In order to make a distinction, the doctor makes the differential diagnosis by examining the mouth sore in detail and prescribing further tests if necessary.

aphthous ulcers and pain

Aphthae are painful and can significantly affect well-being. How severe the pain is varies from person to person. It depends primarily on the place where an aphthous ulcer appears and less on the size. It can be particularly uncomfortable if they are in places that are subject to high mechanical stress, such as the tongue. Speaking, eating or swallowing then trigger pain.

aphthous ulcers in children

Bednar’s aphthous ulcers are small injuries to the oral mucosa in infants that are caused, for example, by sucking on a bottle. They usually occur in the area of ​​the hard palate.

Also in small children, aphthous ulcers are sometimes caused by frequent coughing with the tongue stuck out, for example in whooping cough . That is why one speaks here of the whooping cough ulcer (medical: Fede-Riga’sche Aphthe).

frequency of aphthous ulcers

Aphthae are among the most common diseases of the oral mucosa. About two to ten percent of the population are affected by aphthae at least once in their lives.

Aphthae: causes and possible diseases

Aphthous ulcers are caused by a strong reaction of the immune system, causing tissue to die. Holes form in the oral mucosa and the nerve endings are exposed – which is why aphthae are often very painful. But the exact triggers for the immune reaction and thus for the aphthous ulcers in the mouth are largely unclear. The following factors will be discussed:

  • Diseases : Aphthous ulcers can occur as part of diseases such as chronic inflammatory bowel disease, celiac disease (chronic disease of the small intestine), Behçet’s disease (vascular inflammation), Sweet’s syndrome (rare skin disease), neutropenia (decrease in certain white blood cells), HIV infection, herpes infection , hand, foot and mouth disease
  • Autoimmune Response : The immune system attacks the body’s own tissues.
  • Immune deficiency : for example due to chronic diseases such as diabetes
  • stress
  • Chemical irritation : for example due to sodium lauryl sulphate (SLS) contained in the toothpaste
  • Injuries to the oral mucosa : caused by badly fitting braces or bite injuries
  • Nutritional deficiencies : vitamin B12, iron and folic acid deficiencies
  • Food intolerance : for example nuts, tomatoes, alcohol or citrus fruits; also through additives in foods such as preservatives or colorings.
  • Changes in hormonal balance
  • Genetic factors : Habitual aphthous ulcers tend to run in families.
  • Viruses and bacteria could possibly also be triggers.

Studies also show that smokers are less likely to be affected by canker sores than non-smokers. Smoking causes the oral mucosa to become horny over time (medical: hyperkeratosis), which may protect against aphthae formation.

Aphthae: When do you need to see a doctor?

Aphthae are usually harmless, non-contagious and heal on their own. But if they:

  • occur again and again
  • are particularly large
  • not disappear after one to three weeks,
  • trigger bacterial infections associated with inflammation,

you should see a doctor.

Aphthous ulcers: what does the doctor do?

The doctor makes the diagnosis based on a survey and the clinical picture. Specific laboratory tests are not available for canker sores. As a rule, the doctor recognizes the aphthous ulcers by their typical appearance. If the aphthous ulcers keep coming back or are particularly large, the doctor must check whether a disease might be the trigger. Then he can, for example, carry out an additional blood test.

If an ulcer-triggering disease such as Behçet’s disease or a mouth ulcer caused by cancer is diagnosed, the doctor initiates the appropriate treatment.

If there is no underlying disease, in severe cases doctors can prescribe glucocorticoid gels, pastes, rinses or medications with active ingredients such as prednisolone , triamcinolone or betamethasone or prescribe a cortisone ointment.

Aphthae: You can do this yourself

The inflammation usually goes away on its own after one to three weeks. A visit to the doctor is then not necessary. However, you can still fight the unpleasant pain with various means and also accelerate the healing process:

  • Painkillers : In the pharmacy there are various ointments, gels and rinses that contain numbing local anesthetics, for example with the active ingredient lidocaine. These have a purely pain-relieving effect and do not counteract the causes of the aphthous ulcers.
  • Herbal remedies : Healing can be accelerated with anti-inflammatory herbal remedies. You can make yourself a chamomile or sage tea and rinse your mouth with it after it has cooled down or rub the affected areas with tea tree oil or lemon balm extract. In the pharmacy there are also healing tinctures, for example with myrrh or rhubarb root. The caustic effect of the substances accelerates the healing process by repelling dead tissue.
  • Hydrogen peroxide : A solution containing hydrogen peroxide has an antibacterial effect, which means it kills germs in the mouth and disinfects the oral cavity. However, it is best to discuss this measure with your doctor, because hydrogen peroxide can also irritate the oral mucosa. In addition, there are other disinfecting mouthwashes in the pharmacy.
  • Diet : Avoid foods that increase pain, such as citrus fruits or hot spices. Alcohol may also have a similar effect.
  • Oral hygiene : To prevent bacteria from spreading in the irritated mouth, you should pay attention to particularly thorough oral hygiene with a germ-killing mouthwash.
  • Prevention : Avoid the substance sodium lauryl sulfate used in toothpastes. Studies have shown that you can significantly reduce your risk of aphthae in this way.

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