Aphthous stomatitis is a recurring inflammatory condition of the oral mucosa marked by the formation of painful, shallow ulcerations — commonly known as canker sores — on the soft tissues inside the mouth. Unlike herpetic lesions, these ulcers are not caused by a virus and are not contagious.
Types of Aphthous Ulcers
Aphthous ulcers are classified into three clinical forms, each differing in size, frequency, and healing time:
- Minor aphthous ulcers: The most common type, typically under 10 mm in diameter, appearing on the buccal mucosa, labial mucosa, or floor of the mouth. They resolve within 7–14 days without scarring.
- Major aphthous ulcers (Sutton’s disease): Larger lesions exceeding 10 mm that may persist for weeks to months and frequently leave scarring upon healing.
- Herpetiform ulcers: Clusters of multiple small ulcers (1–3 mm) that can coalesce into larger, irregular lesions despite having no association with the herpes virus.
Common Causes and Triggers
The precise etiology of aphthous stomatitis remains incompletely understood, though several contributing factors have been consistently identified:
- Immune dysregulation affecting the integrity of the oral epithelium
- Nutritional deficiencies, particularly iron, folate, zinc, and vitamin B12
- Trauma to the oral mucosa from sharp foods, ill-fitting dental appliances, or aggressive toothbrushing
- Hormonal fluctuations and psychological stress
- Systemic conditions such as Crohn’s disease, celiac disease, or Behcet’s syndrome
Clinical Significance
Accurate differential diagnosis is critical, as aphthous stomatitis shares clinical features with traumatic ulcers, oral lichen planus, and — most importantly — squamous cell carcinoma. Any ulcer persisting beyond three weeks, displaying indurated margins, or failing to respond to standard palliative measures warrants biopsy and further systemic evaluation.
Management is primarily palliative, focused on reducing pain and accelerating healing. Topical corticosteroids such as triamcinolone acetonide applied directly to the affected mucosal surface remain a widely used first-line intervention. Patients with frequent recurrences benefit from systemic workup to exclude underlying nutritional deficiencies or gastrointestinal disorders that compromise the oral epithelium’s barrier function.
Identifying individual triggers and educating patients on minimizing mucosal trauma — including proper appliance fit and atraumatic oral hygiene technique — remains one of the most practical strategies for reducing both the frequency and severity of recurrence.