Recurrent oral ulcerations (recurrent aphthous stomatitis) are one of the most common diseases of the oral mucosa that occurs in most of the population. The prevalence of disease in the general population ranges from 10-30%. In Europe alone, 17% of people have aphthous ulcers. The disease is more common in people with higher socio-economic status in women as well as in stressed individuals.
Sores usually occur in young persons with the greatest culmination of 10-19 years and with a tendency to frequent relapses throughout life. Rarely occur in individuals over 45 years of age. The recurrent nature makes them very unpleasant and they are difficult to bear due to the unpredictable start and intensity.
Sores appear on the oral mucosa in the form of a round, clearly limited pain ulceration with shallow necrotic bottom and slightly elevated reddened edges. The pain is greatest after 2-3 days of their appearance. Depending on the number and appearance, the sores are divided into:
– Small or minor sores, with the size of 1 cm in diameter, it is possible to have several in the mouth and subside spontaneously for 7-10 days without scarring;
– Large or major sores, larger than 1 cm, are fewer than the small ones. Most often appear on the lining of the lips, soft palate and gallbladder, persist for up to 1 month leaving scars. Larger ulcers of that type of sores occur in patients with AIDS, and it is explained by the disruption of immunoregulatory capacity;
– Herpetic sores, are characterized by numerous small shallow ulcers in size from a few millimeters in diameter and occur mostly in front of the mouth, usually the mucous membranes of the lips, tongue and the underlying mucosa. Due to the similarity of the clinical picture with herpes lesions, they also got that name.
Characteristic of all forms of sores, and at the same time one of the diagnostically important criteria for differentiating sores from other oral lesions caused by the herpes virus is their localization: sores exclusively appear on poorly keratinized and movable mucous, and never on the gingiva and hard palate.
Causes of sores
Although the disease is known for a long time, the exact causes of its occurrence today are not fully known and there are numerous dilemmas about it. Sores are thought to be a clinical syndrome with several possible causes, of which the most significant are:
– Haematological deficiency and
– Disorders of immunity.
An increasing number of evidence suggests on the immunopathogenetic basis of this disease, primarily of disorders in the T-immune system.
Additional possible causes include: psychic tension with increased fear, iron deficiency anemia, lack of vitamin B12, abnormal loss of weight, excessive consumption of acidic products, insufficient sleep, neutropenia, food allergy and immunosuppression in patients suffering from AIDS.
Important place in the etiology of ulcers takes the trauma as well (mechanical damage to the mucous membrane), which can be caused by many factors: forced brushing of the teeth, side in-growth with your own teeth, and small injuries from briquettes when wearing fixed orthodontic appliances.
Diagnosis and therapy
In the diagnosis of sores it is necessary to distinguish between clinically similar diseases that occur with recurrent ulcers, such as: herpes infection, multiforme erythema, pemphigus, etc. Requires a careful clinical examination and detailed history. Usually no medical treatment is required, as sores usually spontaneously withdraw in 10-14 days.
When to seek medical help?
You should visit your dentist when the symptoms of the sores become noticeably worsening, the ejaculations are repeated 2-3 times a year, or if there are other accompanying symptoms such as: rash, fever, diarrhea and headache.
The diagnostic and therapeutic algorithm is based on a strictly individual approach in every sick person:
– detection of the potential cause;
– referral of the patient to a medical specialist;
– treatment of sores;
– prevention of relapses.
Treatment of sores involves local or systemic use of choricosteroids, local anesthetics and antimicrobials (oral and throat cleansers that often have anti-inflammatory, antimicrobial and analgesic effects), as well as increased intake of vitamins (especially B12 and folic acid). Too much spicy foods should be avoided and proper and regular hygiene must be performed. The manner and length of therapy depends on the intensity of the sores.