The Case of Two Pathologies - Part 1

A 32-year-old female came to the clinic with a complaint of pain on her tongue. The sore on her right lateral tongue had appeared a few days ago and was extremely painful. She was having trouble eating. As far as she could remember, this was the first time she had experienced something like this. 

The patient was great health otherwise.

Extra-oral exam was unremarkable. Intra-oral exam revealed three ulcers, on right lateral tongue in varying states of healing. One of the ulcers had a prominent red halo around it. Geographic tongue was also noted (See post, The Case of Two Pathologies - Part 2).

32-year-old female with aphthous ulcers

 The lesions were diagnosed as aphthous ulcers. Some topical anesthetic (Colgate's Orabase in this case) was applied to alleviate the pain and the patient was given some samples for home application. The patient was also directed to return if the episodes are recurrent for a topical corticosteroid prescription. The patient called me a few days later to let me know that the lesions had healed.

Aphthous Ulcers:

Aphthous ulcers are characterized by the appearance of recurrent painful ulcers with prominent red halos on parakeratinized areas of the oral cavity. They are believed to be an autoimmune process with unknown trigger factors. They are usually seen in a younger population, especially those leading high stress lives. 

Aphthous ulcers are classified into three type depending on their sizes; herpetiform (less than 3 mm), minor (3-10 mm) and major (>10 mm). Herpetiform and minor aphthae have a shorter healing time, about 7 to 10 days. Major aphthae can take up to 6 weeks to heal completely. 

The rate of recurrence is highly variable. Some patients may present with new ulcers before the previous ones have healed completely, while others may have recurrences decades later. 

For patients with regular recurrences, application of topical corticosteroids on active lesions is recommended. This allows the ulcer to heal a lot faster. It also decreases the frequency of recurrences in such patients. 

For patients who develop lesions once in a blue moon, topical anesthetic may be prescribed to help with the pain. In such patients, there is no need to prescribe topical corticosteroids.