Otolaryngology Book

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Canker Sores

Aka: Canker Sores, Aphthous Ulcer, Aphthous stomatitis
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  1. Epidemiology
    1. Prevalence: 5-21% in United States
  2. Pathophysiology
    1. Benign autoimmune condition
    2. Nutritional deficiency may contribute in some cases
      1. Iron Deficiency Anemia
      2. Vitamin B12 Deficiency or Folic Acid deficiency
  3. Symptoms
    1. Multiple painful Oral Ulcers
  4. Signs
    1. Small round or oval white ulcer 1-5 mm in size
      1. White or yellow pseudomembrane covers center
      2. Surrounded by halo of reddened mucosa
      3. Typically less than 1 cm in size
    2. Distribution
      1. Single or multiple ulcers may coalesce
      2. Forms on nonkeratinizing oral mucus membranes
        1. Labial mucosa
        2. Buccal mucosa
        3. Ventral Tongue
  5. Course
    1. Resolves spontaneously in 2 weeks
  6. Differential Diagnosis
    1. See Oral Ulcer
    2. Primary Herpetic Gingivostomatitis
    3. Herpangina
    4. Hand Foot and Mouth Disease
    5. Behcet's Syndrome
    6. Reiter's Syndrome
    7. Inflammatory Bowel Disease
    8. Celiac Sprue
  7. Management: General
    1. Good Oral Hygiene
    2. Avoid Toothpaste containing Sodium Lauryl Sulfate (SLS)
      1. Aphthous Ulcer recurrence associated with use
      2. Reference
        1. Herlofson (1994) Acta Odontol Scand 52:257-9
    3. Chlorhexidine gluconate (Peridex) mouthwash
      1. Reduces severity of episode
  8. Management: Controlling Pain
    1. Topical anesthetic
      1. Dyclonine HCl Solution provides numbing for 1 hour
      2. Lidocaine (Xylocaine, ointment 5% or viscous)
      3. Diphenhydramine HCl (Benadryl elixir)
        1. Alone or with Kaopectate
      4. Warning: Avoid extensive use over too wide an area
        1. May cause cotton-mouth feeling or taste loss
        2. May be worse than original problem
      5. Anesthetic in Denture-like adhesive:
        1. Benzodent
        2. Orajel Denture
    2. Silver Nitrate Stick
      1. Destroys local nerve endings
      2. Provides pain relief for duration of eruption
      3. Ulcers may enlarge and heal more slowly
    3. Coat lesions
      1. Carafate (Sucralfate)
  9. Management: Aborting Lesions and shortening course
    1. Suppress oral streptococci
      1. Saturate gauze pledget with antibiotic
      2. Dissolve in 30 cc water or elixir of Benadryl
        1. Tetracycline 250 to 100 mg or
        2. Keflex 250 mg
      3. Apply for 10-20 minutes 4-6 times/day for 5-7 days
    2. Topical Corticosteroids
      1. Kenalog 0.1% in Orabase applied qid
      2. Allow Corticosteroid tablet to dissolve at lesion qid
        1. Hydrocortisone Sodium Succinate 2.5 mg
        2. Betamethasone 17-valeraet 0.1 mg
      3. Aphthasol (Amlexanox 5% oral paste)
        1. Applied to lesions after meals and at bedtime
  10. Management: Severe or recurrent Aphthous Ulcers
    1. Systemic Corticosteroids
      1. Taken for 4 days during prodromal period
    2. Colchicine 0.6-1.8 mg PO qd
      1. Response in 4-6 weeks
      2. Significant toxicity
    3. Phenelzine (MAO inhibitor)
      1. Strict dietary and concurrent medication limits
    4. Dapsone
    5. Thalidomide
      1. High risk medication
      2. May be useful in severe cases in HIV patients
  11. References
    1. Porter (2005) Clin Evid 13:1687-94
    2. Gonsalves (2007) Am Fam Physician 75:501-7

Aphthous Stomatitis (C0038363)

Definition (MSH) A recurrent disease of the oral mucosa of unknown etiology. It is characterized by small white ulcerative lesions, single or multiple, round or oval. Two to eight crops of lesions occur per year, lasting for 7 to 14 days and then heal without scarring. (From Jablonski's Dictionary of Dentistry, 1992, p742)
Definition (CSP) recurrent disease of the oral mucosa of unknown etiology, characterized by small white ulcerative lesions lasting 7 to 14 days.
Definition (NCI) A recurrent disease of the oral mucosa of unknown etiology. It is characterized by small white ulcerative lesions, single or multiple, round or oval, lasting for 7-14 days and healing without scarring.
Concepts Disease or Syndrome (T047)
MSH D013281
ICD9 528.2
SnomedCT 321258009, 426965005, 196529004, 303117009, 196534000, 398870000, 83312008, 155661008, 196536003, 110426005, 322224003, 367526005
English Aphthae, Aphthous Stomatitides, Aphthous Ulcer, Canker Sore, Canker Sores, Sore, Canker, Sores, Canker, Stomatitides, Aphthous, Stomatitis, Aphthous, Ulcer, Aphthous, Ulcers, Aphthous, APHTHOUS STOMATITIS, APHTHOUS ULCER, Aphthous Stomatitis, CANKER SORE, CANKER SORES ORAL, STOMATITIS APHTHOUS, STOMATITIS, APHTHOUS, ULCERS APHTHOUS ORAL, Ulcer, aphthous, aphthous stomatitis, Oral aphthae, NOS, ULCER APHTHOUS ORAL, STOMATITIS APHHNOUS, Oral aphthae NOS, Ulcerative stomatitis NOS, Oral aphthous ulcer, Aphthous stomatitis, Canker sore, Aphthous ulceration, Aphthous ulcer, Aphthous ulcer of mouth, Aphthous ulceration (disorder), Aphthous ulcer of mouth (disorder), Oral aphthae, canker sore, Aphthous ulcers, aphthous ulcer (diagnosis), aphthous ulcer, (Oral aphthae) or (mouth ulcer) (disorder), Stomatitis aphhnous, Ulcer aphthous oral, Ulcers aphthous oral, Stomatitis aphthous, Ulcer aphthous, Canker sores oral, ORAL ULCER APHTHOUS, Oral aphthae NOS (disorder), Stomatitis, Aphthous [Disease/Finding], Ulcer;aphthous, aphthae, aphtha, aphthous oral ulcers, aphthous ulcerations, aphthous ulcers, canker sores, oral aphthous ulcers, aphthous ulceration, cankers sores, oral aphthae, oral aphthous ulcer, oral canker sores, Aphthous Ulcers, Ulcerative stomatitis, Canker sores, Aphtha (morphologic abnormality), Aphtha, oral; aphthae, stomatitis; aphthae, stomatitis; aphthous, ulcer; aphthae, ulcer; aphthous, aphthae; oral, aphthae; stomatitis, aphthae; ulcer, aphthous; stomatitis, aphthous; ulcer, (Oral aphthae) or (mouth ulcer), Oral aphthae (disorder) [Ambiguous], Oral aphthae (disorder), Oral aphthous ulcer (disorder), Oral aphthous ulcer [Ambiguous]
French STOMATITE APHTEUSE, Aphtes buccaux, Ulcère buccal aphteux, Ulcère aphteux, Ulcération aphteuse orale, Aphthe, APHTES BUCCAUX, ULCERATIONS APHTEUSES BOUCHE, Aphte, Stomatite aphteuse
Portuguese ESTOMATITE AFTOSA, Úlcera aftosa, Ulcerações da boca, Úlcera aftosa da boca, Aftas da boca, Úlceras aftosas da boca, Afta, FERIDA CANCEROSA ORAL, ULCERAS AFTOSAS DA BOCA, Estomatite aftosa, Aftas, Estomatite Aftosa, Úlcera Aftosa, Úlcera Dolorosa
Spanish ESTOMATITIS AFTOSA, Úlcera aftosa, Úlcera aftosa oral, Úlceras bucales, Aftas orales, Ulcera aftosa, Úlceras aftosas orales, Oral aphthous ulcer, Mouth ulcer, Oral aphthae, ulceración aftosa, Oral aphthous ulcer [Ambiguous], ulceración aftosa (trastorno), ulceración aftosa en boca, (Oral aphthae) or (mouth ulcer), ulceración aftosa en boca (trastorno), ORALES, LESIONES ULCERADAS, ULCERAS AFTOSAS, afta (anomalía morfológica), afta oral (trastorno), afta oral, aftas bucales (trastorno), aftas bucales, SAI (trastorno), aftas bucales, SAI, aftas bucales, aftas orales (concepto no activo), aftas orales (trastorno), aftas orales, afta, estomatitis aftosa, úlcera aftosa oral, úlcera aftosa, Estomatitis aftosa, Afta, Canker Sore, Estomatitis Aftosa, Úlcera Aftosa, Ulcera Aftosa
German STOMATITIS APHTHOSA, orale Aphten, Ulkus aphthoes, Ulkus aphthoes oral, aphthoeses Ulkus, Mundulzerationen, Aphthen, APHTOESE MUNDGESCHWUERE, MUNDSCHLEIMHAUT LAESION, Stomatitis aphtosa, Aphthae, Aphthe, Aphthenerkrankung, Ulkus, aphthöses
Dutch kankerpijn oraal, orale aften, afte, orale aftoïde ulcus, zweren aftoïd oraal, stomatitis aftoïd, aftoïde stomatitis, aften; oraal, aften; stomatitis, aften; ulcus, aphthosa; stomatitis, aphthosum; ulcus, oraal; aften, stomatitis; aften, stomatitis; aphthosa, ulcus; aften, ulcus; aphthosum, afteuze stomatitis, Afte, Mondaften, recidiverende, Mondzweer, Recidiverende mondaften, Stomatitis, afteuze
Italian Aftosi orale, Ulcera aftosa della bocca, Ulcere aftose della bocca, Afta, Afte, UIcera dolorosa, Ulcera aftosa, Stomatite aftosa
Japanese 口腔アフタ, アフタ性口内潰瘍, 口腔口唇潰瘍, アフタ性口腔潰瘍, ｺｳｸｳｺｳｼﾝｶｲﾖｳ, ｱﾌﾀｾｲｺｳﾅｲｴﾝ, ｱﾌﾀｾｲｶｲﾖｳ, ｺｳｸｳｱﾌﾀ, ｱﾌﾀｾｲｺｳﾅｲｶｲﾖｳ, ｱﾌﾀｾｲｺｳｸｳｶｲﾖｳ, ｱﾌﾀ, 回帰壊死性粘液腺周囲炎, 濾胞性口内炎, 口唇潰瘍, アフタ性口内炎, 潰瘍-アフタ性, 急性ヘルペス性口内炎, 急性ヘルペス性歯肉口内炎, アフタ性潰瘍, アフタ, 口内炎-アフタ性
Swedish Stomatit, aftös
Czech stomatitida aftózní, Aftózní vřed, Aftózní vřed v ústech, Aftózní stomatitida, Aftózní vředy v ústech, Orální afty, Afta
Finnish Aftainen suutulehdus
Russian AFTY, IAZVA AFTOZNAIA, STOMATIT AFTOZNYI, PERIADENIT, AFTOZNYI STOMATIT, АФТОЗНЫЙ СТОМАТИТ, АФТЫ, ПЕРИАДЕНИТ, СТОМАТИТ АФТОЗНЫЙ, ЯЗВА АФТОЗНАЯ
Croatian STOMATITIS, AFTOZNI
Polish Zapalenie jamy ustnej pryszczykowe, Zapalenie jamy ustnej plamisto-włóknikowe, Zapalenie jamy ustnej aftowe, Aftowe zapalenie jamy ustnej
Hungarian Aftás stomatitis, Oralis aphthák, Fekély, aphthás, Oralis aphthás fekély, Fekélyek, oralis, aphthás, Stomatitis aphtosa, Aphthás fekély, Aphthák, orális aphtás stomatitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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