Aphthous Stomatitis

Aphthous stomatitis or ulceration is one of the most common oral lesions, affecting 20 percent of the normal population ( Fig 234-6). Although uncertain, significant evidence suggests that the etiology appears to be a cell-mediated immune response to a yet unidentified triggering agent. Three etiologic factors are known to predispose aphthous ulcer formation: an immune imbalance, a breach in the mucosal barrier, and an allergic response. Aphthous ulceration involves the nonkeratinized epithelium, especially the labial and buccal mucosa, and begins as an erythematous macule that ulcerates and forms a central fibropurulent eschar. Lesions measure from 2 to 3 mm to several centimeters in diameter, are painful, and frequently are multiple. They usually resolve spontaneously in 10 to 14 days. Aphthous stomatitis occurs in a major and minor form. The major form has larger, deeper ulcers that take up to 6 weeks to heal. A third form called herpetiforme apthae have up to 100 ulcers each 1 to 2 mm in diameter and take 7 to 10 days to heal. Treatment consist of topical corticosteroids such as betamethasone syrup or 0.01% dexamethasone elixir as a mouth rinse. Fluocinonide 0.05% gel applied topically to isolated lesions is acceptable. Resolution typically occurs 2 days after therapy. Aphthous major is more resistant to therapy and may require intralesional steroid injection or systemic steroid therapy. —I7

FIG. 234-6. Apthous stomatitis. (Courtesy of Baldev Singh, B.D.S., Ph.D.)
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