What are the Symptoms and Causes of Aphthous Ulcer?

Aphthous ulcer is a fairly common health problem, which affects as many as 10% of people and it can affect individuals of any age. Majority of individuals suffering from aphthous ulcer usually do not seek medical attention, as they are of minor type of aphthous ulcer, which usually heal in a week or two without any medical intervention. But many individuals with aphthous ulcer (generally herpetiform type of aphthous ulcer and majority of major type of aphthous ulcer) need medical intervention for healing.

What are the symptoms of aphthous ulcer?

Aphthous ulcers or canker sores are oval or round shape ulcers surrounded by erythematous (red in color due to inflammation) halo. The color of base of ulcer is gray or white. The ulcer usually begins as burning or tingling sensation and slowly progress to become red spot and finally ulcer.

The ulcer(s) is usually painful (severe pain in case of major type and herpetiform type). There may be swelling in the area as well as lymph nodes. Patient may find talking and eating (spicy and acidic foods may increase the pain and difficulty of eating) difficult due to pain in the ulcer on rubbing/friction. Sometimes ulcers may be infected and fever may accompany.

What are the causes of aphthous ulcer?

Several causes of aphthous ulcer have been identified and proposed. But it is not yet clear what exactly cause aphthous ulcer. It is accepted that several factors act in combination in casing aphthous ulcer. These factors are given below:

  • Minor injury: Most commonly minor injury is the triggering factor for aphthous ulcer. Injury to mucous membrane of mouth may occur due to brushing of teeth with hard toothbrush, accidental biting while eating, hard/sharp or abrasive foods (such as potato chips, toasts etc.), broken teeth or dentures etc. Accidental minor injury may also occur due to chemical irritation or thermal injury (eating hot food).
  • Stress (mental and physical stress). Lack of sleep.
  • Lack/deficiency of nutrients (such as vitamin B12, folic acid, iron, zinc etc.) in diet may lead to aphthous ulcer.
  • Certain drugs/medications (e.g. nicorandil, some antibiotics and cancer chemotherapy agents) may cause aphthous ulcer.
  • Food allergy and food sensitivities (such as chocolates, nuts and acidic foods such as citrus fruits).
  • Infection by Helicobacter pylori (the organism that cause peptic ulcer).
  • IBS (inflammatory bowel disease) such as Crohn’s disease and ulcerative colitis.
  • Celiac disease may cause aphthous ulcer.
  • Faulty immune system (which may attack own cells instead of germs) and HIV/AIDS, which suppress immune system.
  • Behcet’s disease has aphthous ulcer as a common symptom.
  • Hormonal disturbance during menstruation, pregnancy and menopause may lead to aphthous ulcer.
  • Some studies showed that use of toothpaste and mouthwash containing sodium lauryl sulfate (SLS) may increase incidence of aphthous ulcers, but some studies found no correlation between them.

Generally only one causative do not cause aphthous ulcer. It occurs only if more than one factor is present in same individual.

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