A 21-year-old female dental student reported to the oral surgery department with a complaint of painful ulcers in the mouth. On taking history we discovered that the ulcers appeared 2-3 days ago and she had been in extreme pain since then. The patient told us that the ulcers had appeared once before on the labial mucosa but had healed within a week. Her medical history was clear of any significant medical illness.
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| 21-year-old female with aphthous ulceration on right buccal mucosa |
Intraoral examination revealed 2 small ulcers less than 1 cm in size on the buccal mucosa. Both ulcers had a characteristic red halo around it.
Based on the patient's history (spontaneous onset, history of previous ulcers healing in 7 days) and clinical appearance of the lesions (presence on unattached mucosa, distinct red halo around the ulcers), a diagnosis of aphthous ulcers was made.
Kenalog Orabase gel was prescribed to the patient with directions to apply it 4 to 6 times a day. The patient recovered within a few days.
Notes from Dr. K:
Aphthous ulcers, AKA canker sores, are a common oral pathology with reported incidences of up to 25% in the general population. They fall in the category of autoimmune processes. A variety of etiologies have been proposed as an initiating factor for this process, including allergies, genetics, good disorders, hormonal disorders, nutritional problems, smoking cessation, and following trauma. Scientific evidence on all these is equivocal. An increased incidence of aphthous ulceration has been reported with systemic diseases, such as nutritional deficiencies, immunodeficiencies, gastrointestinal diseases.
Aphthous ulcers tend to occur in young adults more frequently, especially those who lead high stress lives. The ulcers are classified into three types, minor, major and herpetiform. The case that Dr. M's shared today is an example of the minor type. The ulcers are usually multiple, between 3-10 mm in dimensions, and exclusively involve parakeratinized mucosa (everything except for the alveolar ridge and hard palate). The lesions often appear at one site, heal over a period of 7 days and occur elsewhere. Patients may have one episode in a lifetime, or may not experience a day of relief without the ulcers.
The diagnosis is usually made on clinical grounds, on the basis that Dr. M states with the case above. Potent topical corticosteroids help in a faster recovery. They also seem to help in decreasing the frequency of ulceration. In patients with continuous episodes, it may be worthwhile to undergo a complete systemic evaluation.
Another case of aphthous ulcers: http://mydayinclinic.blogspot.com/2015/02/the-case-of-two-pathologies-part-1.html
Aphthous ulcers, AKA canker sores, are a common oral pathology with reported incidences of up to 25% in the general population. They fall in the category of autoimmune processes. A variety of etiologies have been proposed as an initiating factor for this process, including allergies, genetics, good disorders, hormonal disorders, nutritional problems, smoking cessation, and following trauma. Scientific evidence on all these is equivocal. An increased incidence of aphthous ulceration has been reported with systemic diseases, such as nutritional deficiencies, immunodeficiencies, gastrointestinal diseases.
Aphthous ulcers tend to occur in young adults more frequently, especially those who lead high stress lives. The ulcers are classified into three types, minor, major and herpetiform. The case that Dr. M's shared today is an example of the minor type. The ulcers are usually multiple, between 3-10 mm in dimensions, and exclusively involve parakeratinized mucosa (everything except for the alveolar ridge and hard palate). The lesions often appear at one site, heal over a period of 7 days and occur elsewhere. Patients may have one episode in a lifetime, or may not experience a day of relief without the ulcers.
The diagnosis is usually made on clinical grounds, on the basis that Dr. M states with the case above. Potent topical corticosteroids help in a faster recovery. They also seem to help in decreasing the frequency of ulceration. In patients with continuous episodes, it may be worthwhile to undergo a complete systemic evaluation.
Another case of aphthous ulcers: http://mydayinclinic.blogspot.com/2015/02/the-case-of-two-pathologies-part-1.html
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