Generality
Aphthous stomatitis is the common disease of the mouth, typical of young people and young adults, which involves the repeated appearance of benign ulcers on the oral mucosa.
The precise cause of acute stomatitis is unknown; experts, however, are inclined to think that this disorder results from the combination of a set of concomitant factors.
In general, the symptoms of aphthous stomatitis are limited to ulcers on the oral mucosa; rarely, however, the appearance of these lesions can also be associated with systemic symptoms, such as fever or malaise.
Equipped with a completely characteristic appearance, ulcers produced by aphthous stomatitis undergo spontaneous resolution usually within 1-2 weeks.
As a rule, the diagnosis of aphthous stomatitis is clinical, ie based on physical examination and medical history.
For the moment, there is no definitive cure for aphthous stomatitis; however, patients can rely on several symptomatic remedies; moreover, with aging, the disease tends to gradually reduce the frequency with which it produces oral lesions.
What is aphthous stomatitis?
Aphthous stomatitis is a common condition of the mouth, characterized by the repeated formation of painful, but benign (ulcers) ulcers, on the internal mucosa of the lips or cheeks, or on the mucous membrane of the tongue or pharynx.
Typical of young people and young adults, aphthous stomatitis is not a contagious disease, therefore those affected do not transmit it to healthy people in the vicinity or who have contact with it.
Meaning of the words Stomatitis and Aphthous
In medicine, the term "stomatitis" means any acute or chronic inflammation of the oral cavity ; the word "aftosa", on the other hand, is a reminder of mouth ulcers, which are benign lesions of the ulcerative type of the oral mucosa ("oral mucosa" is the non-specific expression used to describe the mucous membrane that covers the internal components of the mouth) .
According to the literal meaning of the aforementioned terms, aphthous stomatitis is the inflammation of the oral cavity characterized by the presence of aphthae on the oral mucosa.
Epidemiology
Statistics say that aphthous stomatitis affects between 5% and 66% of the general population; this numerical figure places it at the top of the list of the most common oral cavity diseases.
Aphthous stomatitis is widespread throughout the world; however, it is easier to observe it in developed countries.
For reasons that are still unclear, aphthous stomatitis most often affects people from a high socioeconomic background.
Aphthous stomatitis usually arises at a young age, to be precise between the ages of 10 and 19; this condition does not favor a particular sex, which means that it affects males and females equally.
According to what has been observed in the United States - a strongly multi-ethnic country - aphthous stomatitis would have a predilection for white people.
Did you know that ...
According to some statistical research, in 80% of the people who are affected, aphthous stomatitis would arise before the age of 30.
Causes
The precise cause of aphthous stomatitis is unknown.
Experts, however, are inclined to think that this common condition of the mouth has a multifactorial origin, ie it is the result of a set of factors.
What are the favoring factors of aphthous stomatitis?
Based on the research carried out, among the factors whose combination would seem to have a key role in the onset of aphthous stomatitis, include:
- The weakening or malfunctioning of the immune system. Studies on the subject have shown that many cases of aphthous stomatitis are characterized by an improper immune response, whose protagonists are the T lymphocytes and the cytokines IL-2, IL-10 and TNF-alpha;
- Food allergies to foods such as chocolate, coffee, nuts, almonds, citrus fruits, eggs, strawberries, cheese and tomatoes;
- The stress;
- Some viruses and some bacteria;
- Mouth traumas;
- The bad diet;
- Some drugs;
- The presence of systemic diseases, such as: systemic lupus erythematosus, inflammatory bowel diseases, reactive arthritis, celiac disease, Behçet's disease, cyclic neutropenia, nutritional deficiencies, IgA deficiency, immunodepression due to HIV, MAGIC syndrome, PFAPA syndrome, Sweet's syndrome or Lipschutz's ulcer;
- Familiarity for aphthous stomatitis. Scientific studies have shown that, in a non-negligible number of cases, those suffering from aphthous stomatitis have relatives affected by the same condition; this has led the experts to think that aphthous stomatitis may have, at least in a certain percentage of patients, a hereditary nature.
Did you know that ...
From some scientific studies on aphthous stomatitis it has emerged that the state of pregnancy, the use of oral contraceptives and nicotine have a protective function against the formation of new canker sores.
Symptoms and Complications
Aphthous stomatitis is usually characterized by a single symptom: the repeated formation of painful ulcers (or canker sores) inside the mouth, mainly on the mucosa of the tongue, lips, cheeks and pharynx.
Rarely - but it really happens to a few patients - can it be associated with some systemic symptoms, such as malaise or fever.
Characteristics of Ulcers (or Afte)
The ulcers (or canker sores or canker sores) produced by aphthous stomatitis are generally small (of the order of a few millimeters), although in some cases they may be up to more than a centimeter; they can be round or ovoid; in most circumstances, they are isolated, but it could happen that they also occur in multiple mode; normally, they have a necrotic center, covered by a yellow-gray pseudomembrane and surrounded by a thin red halo; they can be raised at the edges; especially in the early days, they are responsible for a very annoying pain, which is sharpened when eating; they are always benign lesions; finally, they are temporary: in fact, except for some sporadic cases in which they persist for over a month, they disappear in a natural way within 7-14 days.
TYPES OF ULCERS
To be more precise, aphthous stomatitis can produce three different types of canker sores in the mouth:
- Minor aphthous ulcers . They represent the most common type: they are observed, in fact, in 85% of cases of aphthous stomatitis.
Generally, they measure 2-3 millimeters; in any case, they are never larger than 8 millimeters.
They have a predilection for the inner mucosa of the lips, for the lateral and ventral portions of the tongue, and for the mucosa of the pharynx.
As a rule, they recover in about 10 days.
- Greater aphthous ulcers . They account for 10% of the cases of aphthous stomatitis, which makes them the second most common type of aphthous ulcers.
Compared to minor aphthous ulcers, they are larger (they can reach dimensions greater than one centimeter), longer lasting (they can take even more than a month to heal) and more painful.
As far as the training sites are concerned, they tend to mainly affect the internal mucosa of the lips, the mucosa of the soft palate and the mucosa of the pharynx.
Finally, major aphthous ulcers are noted for their possible association with systemic symptoms, such as fever and / or general malaise.
- Herpetiform aphthous ulcers . They are the least common type of aphthous ulcers: in fact, the remaining 5% of aphthous stomatitis cases stand out.
Similar to the lesions caused by the herpes virus (which justifies the name), they begin like so many small spots of 1-2 millimeters, which in a few days unite in a single ulcer of significant size.
Capable of lasting up to 2 weeks, herpetiform aphthous ulcers are more common among women (the reason for this is unknown) and, compared to other types of aphthous ulcers, tend to affect people of a slightly more advanced age.
How often do Ulcers form?
The frequency with which aphthous stomatitis causes the appearance of an ulcer on the oral mucosa varies from patient to patient: for some, this annoying phenomenon occurs 2-4 times a year; for someone else, however, it is much more frequent, so much so that sometimes it can happen to witness the formation of a new lesion where the previous one is still healing.
Important!
Sufferers of aphthous stomatitis are subject to periodic formation of an ulcer on the oral mucosa.
This means that aphthous stomatitis tends to recur with a certain frequency.
Prodromal Symptoms
Readers are reminded that the prodromal symptoms are the non-specific clinical manifestations that precede the typical symptoms of a certain disease or medical condition.
In aphthous stomatitis, it often happens that the appearance of an ulcer in the mouth is a pain and an annoying burning sensation where the future oral lesion will appear.
Generally, these prodromal symptoms of aphthous stomatitis occur 1-2 days before the actual symptoms.
Evolution of aphthous stomatitis in adulthood
Aphthous stomatitis is considered a disorder of young age; with aging, in fact, the appearance of aphthous ulcers related to it becomes less and less frequent, until practically no longer occurs (except for rare exceptions).
The frequency with which aphthous stomatitis produces ulcers on the oral mucosa begins to decrease around 30 years.
Generally, in old age, aphthous stomatitis no longer shows itself; in a certain sense it is as if, with aging, it would heal.
Diagnosis
In general, the diagnosis of aphthous stomatitis is clinical, ie based on physical examination and medical history (see details); however, it may happen that this approach is insufficient / inadequate and that, for the diagnostic confirmation of the current condition, the information provided by:
- Blood tests . It is useful when the doctor suspects that the present aphthous ulcer may depend on some systemic condition.
- Culture analysis of aphthous ulcer after buccal swab . It is useful to the doctor when he has the doubt that the lesion is due to an oral herpes virus (the reader is reminded that some canker sores may look like lesions produced by the herpes virus).
- Ulcer biopsy . It consists in the laboratory analysis of a small sample of cells taken from the ulcer.
It allows to establish the exact nature of the lesion and to identify all its peculiarities.
Practiced rarely, it is useful when the doctor has the doubt that the ulcer is the sign of a squamous cell carcinoma of the skin.
Deepening: physical examination and medical history
The objective examination consists in the observation of the patient in order to ascertain the symptoms and signs that the latter complains and exhibits
In the case of aphthous stomatitis, the physical examination is often decisive for the diagnosis, as the ulcers have a characteristic appearance and are easily recognizable to an experienced eye, such as that of a doctor.
The anamnesis is the critical study of the symptoms observed during the physical examination and of the facts of medical interest collected through specific questions (concerning not only the symptomatology, but also the general state of health, habits, recurrent illnesses in the family, etc. ).
In the case of aphthous stomatitis, the anamnesis can be decisive for diagnostic purposes, since it allows us to understand the possible factors triggered by the formation of canker sores.
How to identify a responsible food of aphthous stomatitis
If from diagnostic investigations it emerges that aphthous stomatitis is connected to some food allergy, the best way to identify the food responsible for the symptomatology is to implement an elimination diet: this approach consists in eliminating in sequence from daily nutrition the foods that could trigger the symptoms, so as to identify the food whose suspension coincides with the disappearance of the disorder.
Therapy
Currently, those who suffer from aphthous stomatitis can only rely on symptomatic therapy, as the medical community has not yet managed to develop a treatment that can cure the condition in question definitively.
Over the years, aphthous stomatitis tends to gradually decrease the frequency with which it produces ulcers on the oral mucosa.
Symptomatic Therapy of Aphthous Stomatitis: the purpose
The symptomatic therapy of aphthous stomatitis has the aim of attenuating the pain caused by ulcers, while waiting for the latter to meet their natural resolution (readers are reminded that mouth ulcers produced by aphthous stomatitis resolve spontaneously in a bow time of 1-2 weeks, for less severe cases, and over a month, for the most severe cases).
The resolution of ulcers produced by aphthous stomatitis is only a matter of time.
Meanwhile, the patient no longer attenuates the pain resulting from these injuries, resorting to a symptomatic type of therapy.
Symptomatic therapy of aphthous stomatitis: what does it consist of?
Turning to practical aspects, the symptomatic therapy of aphthous stomatitis includes:
- The increase in fluid intake .
Fluid intake promotes hydration of the oral mucosa ; hydration of the oral mucosa attenuates soreness of ulcers;
- The temporary exclusion from the diet of spicy and / or salty foods, and of acid drinks .
When spicy and / or salty foods, and acidic drinks come into contact with canker sores, the pain associated with them is sharpened and becomes even more annoying; with the abolition of these foods until the ulcers disappear, the patient avoids the inconvenience just described;
- Repeat washings with chloredixin mouthwash .
The oral hygiene guaranteed by the use of the chloredixin mouthwash reduces the pain of ulcers.
The chloredixin mouthwash is a pharmacological preparation; therefore, patients should use it only on the instructions of their doctor;
- The application, directly on the lesion, of a corticosteroid drug (topical corticosteroid).
Corticosteroids are anti-inflammatory drugs .
The application of a corticosteroid on ulcers produced by aphthous stomatitis has the effect of attenuating inflammation and, consequently, pain.
The management of aphthous stomatitis through the use of a corticosteroid is reserved for the most severe clinical cases, in which the pain is very intense and the permanence of ulcers prolonged.
The use of any corticosteroid should only be done on medical prescription, as it is a pharmacological category rich in side effects (especially when its use is improper).
It is important to point out that the majority of people with aphthous stomatitis can control the pain of ulcers only through temporary correction of the diet and hydration of the oral mucosa, therefore without having to rely on drugs.
Prognosis
Aphthous stomatitis is a troublesome condition, but not serious; although it produces painful oral lesions, in fact, it is a benign disease and, over the years, tends to be less and less disturbing.
