Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), commonly referred to as a canker sore or salt blister, is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals.
The cause is not completely understood but involves a T cell-mediated immune response triggered by a variety of factors which may include nutritional deficiencies, local trauma, stress, hormonal influences, allergies, genetic predisposition, certain foods, dehydration, some food additives, or some hygienic chemical additives like SDS (common in toothpaste).
These ulcers occur periodically and heal completely between attacks. In the majority of cases, the individual ulcers last about 7–10 days, and ulceration episodes occur 3–6 times per year. Most appear on the non-keratinizing epithelial surfaces in the mouth – i.e., anywhere except the attached gingiva, the hard palate, and the dorsum of the tongue. However, the more severe forms, which are less common, may also involve keratinizing epithelial surfaces. Symptoms range from a minor nuisance to interfering with eating and drinking. The severe forms may be debilitating, even causing weight loss due to malnutrition.
The condition is very common, affecting about 20% of the general population to some degree. It has been suggested that aphthous stomatitis is not a single entity, but rather a group of conditions with different causes. and there is also a correlation between habit duration and severity of the condition. Cessation of smoking is known to sometimes precede the onset of aphthous stomatitis in people previously unaffected, or exacerbate the condition in those who were already experiencing aphthous ulceration. Possible allergens include certain foods (e.g., chocolate,<!--
Systemic disease
{| class="wikitable" style="float: right; width:20em;"
! style="background-color: #CCEEEE;" | Systemic disorders associated with aphthous-like ulceration
|-
|
:Behçet's disease
:Celiac disease
:Cyclic neutropenia
:Nutritional deficiencies
:IgA deficiency
:Immunocompromised states, e.g. HIV/AIDS
:Inflammatory bowel disease
:MAGIC syndrome
:PFAPA syndrome
:Reactive arthritis
:Sweet's syndrome
:Ulcus vulvae acutum
|}
Aphthous-like ulceration may occur in association with several systemic disorders (see table). These ulcers are clinically and histopathologically identical to the lesions of aphthous stomatitis,<!-- It tends to be rare in other countries such as the United States and the United Kingdom. Hematinic deficiencies can cause anemia, which is also associated with aphthous-like ulceration. ]]
thumb|right|Blood is often taken to assess the [[hemoglobin, iron, folate and vitamin B12 levels]]
thumb|right|200px|A [[patch test is sometimes carried out. Areas of the skin on the back are stimulated with various common allergens. The ones which cause an inflammatory reaction may also be involved in recurrent oral ulceration.]]
Diagnosis is based on the clinical appearance and the medical history. A more common method of classifying aphthous stomatitis is into three variants, distinguished by the size, number and location of the lesions, the healing time of individual ulcers and whether a scar is left after healing (see below).
Minor aphthous ulceration
This is the most common type of aphthous stomatitis, accounting for about 80–85% of all cases. or herpes-like ulcerations) is a subtype of aphthous stomatitis so named because the lesions resemble a primary infection with herpes simplex virus (primary herpetic gingivostomatitis). Aphthous stomatitis occurs in individuals with no associated systemic disease. However, this definition is not strictly applied. For example, many sources refer to oral ulceration caused by anemia and/or nutritional deficiencies as aphthous stomatitis, and some also consider Behçet's disease to be a variant.
|-
| Topical analgesics / anesthetics / anti-inflammatory agents || Reduce pain || Benzydamine hydrochloride mouthwash or spray, viscous lidocaine,
Prognosis
By definition, there is no serious underlying medical condition, and most importantly, the ulcers do not represent oral cancer, nor are they infectious. However, aphthae are capable of causing significant discomfort. There is a spectrum of severity, with symptoms ranging from a minor nuisance to disabling. This makes it the most common disease of the oral mucosa. Aphthous stomatitis occurs worldwide, but is more common in developed countries.
History, society and culture
"Aphthous affectations" and "aphthous ulcerations" of the mouth are mentioned several times in the treatise "Of the Epidemics" (part of the Hippocratic corpus, in the 4th century BCE), although it seems likely that this was oral ulceration as a manifestation of some infectious disease, since they are described as occurring in epidemic-like patterns, with concurrent symptoms such as fever.
Aphthous stomatitis was once thought to be a form of recurrent herpes simplex virus infection, and some clinicians still refer to the condition as "herpes" despite this cause having been disproven.
The informal term "canker sore" is sometimes used, mainly in North America, either to describe this condition generally, or to refer to the individual ulcers of this condition, or mouth ulcers of any cause unrelated to this condition. The origin of the word "canker" is thought to have been influenced by Latin, Old English, Middle English and Old North French. In Latin, cancer translates to "malignant tumor" or literally "crab" (related to the likening of sectioned tumors to the limbs of a crab). The closely related word in Middle English and Old North French, chancre, now more usually applied to syphilis, is also thought to be involved. The lesions of several other oral conditions are sometimes described as aphthae, including Bednar's aphthae (infected, traumatic ulcers on the hard palate in infants), oral candidiasis, and foot-and-mouth disease. When used without qualification, aphthae commonly refers to lesions of recurrent aphthous stomatitis. Since the word aphtha is often taken to be synonymous with ulcer, it has been suggested that the term "aphthous ulcer" is redundant,<!-- Stomatitis is also a non-specific term referring to any inflammatory process in the mouth, with or without oral ulceration. It may describe many different conditions apart from aphthous stomatitis, such as angular stomatitis.
The current most widely used medical term is "recurrent aphthous stomatitis" or simply "aphthous stomatitis". Historically, many different terms have been used to refer to recurrent aphthous stomatitis or its sub-types, and some are still in use. Mikulicz's aphthae is a synonym of minor RAS, Sutton's syndrome and periadenitis mucosa necrotica recurrens.
Rembrandt Gentle White toothpaste did not contain sodium lauryl sulfate, and was specifically marketed as being for the benefit of "canker sore sufferers". When the manufacturer Johnson & Johnson discontinued the product in 2014, it caused a backlash of anger from long-term customers, and the toothpaste began to sell for many times the original price on the auction website eBay.
See also
- Acute necrotizing ulcerative gingivitis, also known as "trench mouth"—another painful, non-contagious mouth infection with similar symptoms
- CankerMelts (licorice)
- Mouth ulcer