Otolaryngology Book

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Canker SoresAka: 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
    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
    2. Gonsalves (2007) Am Fam Physician 75:501

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.
ConceptsDisease or Syndrome (T047)
ICD9528.00, 528.2, 528.2
MSHD013281
EnglishAphtha, Aphthae, Aphthous Stomatitides, Aphthous Stomatitis, Aphthous Ulcer, Aphthous ulceration, Aphthous Ulcers, CANKER SORE, Canker sores, CANKER SORES ORAL, Oral aphthae, Oral aphthous ulcer, STOMATITIS APHHNOUS, STOMATITIS APHTHOUS, ULCER APHTHOUS ORAL, Ulcerative stomatitis
Spanishafta, afta oral, aftas bucales, aftas orales, estomatitis aftosa, ulcera aftosa, ulcera aftosa oral, ulceracion aftosa
Parent ConceptsStomatitis (C0038362), Oral cavity (C0226896), Oropharyngeal disorders (C0553694), Diseases of the oral soft tissues, excluding lesions specific for gingiva and tongue (C0155958), Non-Neoplastic Oral Cavity Disorder (C1335025), Skin Ulcer (C0037299), Aphthous Stomatitis (C0038363), Ulcer (C0041582), Oral Ulcer (C0149745), Mucosal ulcer (C0236053), Ambiguous concept (C1274012), Duplicate concept (C1274013), Disorder of oral mucous membrane (C1290071), Aphthous ulcer of mouth (disorder) (C1961115)
SourcesCOSTAR, CSP, CST, DXP, ICD9CM, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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