Aphthous stomatitis: symptoms, causes, treatment

Aphthous stomatitis is an acute inflammation of the oral mucosa with the formation of painful erosions (aphthous). Small round ulcers form on the inside of the lips, cheeks, tongue, tonsils, cause constant pain and affect overall well-being. Stomatitis is caused by a viral or bacterial infection, microtrauma of the mouth. But most often the disease develops against the background of stress or a decrease in the body’s defenses.

Causes of aphthous stomatitis

The exact cause of this disease remains unclear. It is assumed that HRAS is of an allergic nature; allergens can include: food, medicine, toothpastes, dust, worms.6,7 It is also assumed that the cause of the disease is an autoimmune reaction.8 A hereditary predisposition to this disease can be traced.

Predisposing factors:

• diseases of the digestive system (gastritis, gastric ulcer, cholecystitis, Crohn's disease)
• dysbacteriosis
• stress
• deficiency of iron, vitamins B1, B2, B6, B12, C
• chronic tonsillitis, otitis and rhinitis

Symptoms

The disease has rather sparse symptoms. Visually, it is easy to identify by the presence of characteristic ulcers on the inside of the lips, cheeks, soft palate and tongue (rarely). Keratinized (fixed) gums are not affected by aphthous stomatitis, which is another difference between aphthous stomatitis and herpetic stomatitis. At the initial stage of aphthae, the patient usually feels discomfort and burning, and the temperature may rise slightly. Diagnosis involves a visual examination, as well as taking blood tests and mucosal smears if the doctor suspects the presence of concomitant diseases.

HRAS classification:

Acute and chronic

According to the nature of the disease, aphthous stomatitis is divided into acute and chronic.

• Acute aphthous stomatitis. It occurs suddenly, most often due to viral infections and increased concentrations of staphylococci in the blood. Almost immediately, pain occurs and round-shaped aphthae are formed, covered with a grayish coating and having a characteristic red border. The pain makes it more difficult to eat and, in some cases, talk. With timely treatment, the causative agent of aphthous stomatitis is destroyed within 10-12 days, and the epithelial layer at the site of aphthous stomatitis returns to its normal state.
• Chronic (recurrent) aphthous stomatitis. It has been getting worse regularly for many years. This form of the disease occurs in the presence of chronic diseases, as well as under the influence of genetic factors. Recurrent aphthous stomatitis is often accompanied by fever and enlarged lymph nodes. Swelling is observed in the area where afts occur. If left untreated, ulcers begin to grow into the deeper layers of the mucosa: this process is accompanied by slight bleeding and severe pain.

HRAS as a symptom of the disease

Behçet's disease is a disease of unknown etiology, characterized by vascular damage, the appearance of aphthae in the oral cavity and genitals, damage to the eyes, joints, gastrointestinal tract, central nervous system and other organs. It has a chronic course and, if left untreated, can lead to disability.9

Symptoms:

HRAS

HRAS is the earliest symptom of the disease; aphthae can be of any size, recur at least 3 times a year, and are often located on the mucous membrane of the cheeks, lips, gums, tongue

Eye damage

Uveitis (inflammation of the membrane of the eye), blurred vision, “fog” before the eyes, redness of the eyes (rarely), lacrimation

Genital ulcers

Similar to mouth ulcers, but deeper and more painful

Skin redness

The skin exhibits erythema nodosum (red, painful subcutaneous nodules), rash

Other

• vessels in the form of thrombosis, aneurysms
• Nervous system damage: coma, meningitis, confusion
• joints may also be affected in the form of arthritis

Reiter's disease is a systemic infectious disease characterized by damage to the oral mucosa, genitourinary system, eyes and joints.10 The triggering factor for infection is often chlamydia and gonococci, and there is also a genetic predisposition. The disease has a severe course, and in case of complications it leads to disability (blindness, deforming arthritis) and even death.

It is important to remember that HRAS may indicate the presence of a serious systemic disease.

Diagnostic features

At the initial appointment, the dentist examines the oral cavity and analyzes complaints. To make an accurate diagnosis, you need to distinguish this form of the disease from others, as well as differentiate it from other pathologies that have similar symptoms. For extensive lesions, different diagnostic methods may be used:

• clinical blood tests;
• microflora smear;
• blood for PCR to determine the causative agent of the disease;
• biopsy (if indicated).

They are also necessary for recurrent forms of the disease. In simple cases, laboratory diagnostics are not required; aphthae are determined visually by an experienced specialist.

With the help of a comprehensive examination, the doctor will determine which microorganism caused inflammation with subsequent ulceration of the mucous membrane. He also differentiates the disease from herpetic stomatitis and oncological pathology.

Prevention of HRAS

Prevention should be aimed at monitoring the state of health in general, treating chronic diseases, and it is necessary to undergo regular examinations regarding the existing disease. Hardening and strengthening the immune system have a good effect. You need to visit the dentist to monitor your oral health once every 3-4 months to ensure timely detection of relapses. You should avoid using toothpastes, hygiene products with dyes or identified allergens. Taking antibiotics should only be done under the supervision of a doctor. It is recommended to avoid strong psycho-emotional stress and regularly carry out wet cleaning of the premises.

It is worth paying attention to Tantum® Propolis .

Tantum® Propolis

Propolis has an immunostimulating effect, promotes healing, vitamin C, which is part of it, is responsible for regeneration, participating in the synthesis of collagen.
Propolis also has antiviral and antifungal effects. Therefore, vitamin therapy Tantum® Propolis is an effective means of preventing stomatitis12 Find out more

Features of treatment

The main goal of treating aphthous stomatitis is to completely get rid of the disease or at least reduce the frequency of relapses to a minimum. Therapy is aimed at relieving inflammation, relieving unpleasant symptoms, and accelerating the recovery processes of the mucous membrane.

For each specific case, the doctor will develop a set of measures. The main ones include local and systemic drug treatment.

Rinsing with antiseptics can be done using medications or mouth rinses that contain antibacterial components. An alternative to rinsing is to use a spray. Typically, the treatment regimen includes 2-3 sessions of 1-minute rinsing immediately after brushing your teeth.

Local treatment methods include the application of gels with anti-inflammatory and analgesic effects.

Occlusive agents can reduce pain and speed up the healing of mucous membranes. They form an insoluble film on the ulcer, protecting the affected area from exposure to adverse factors.

Local glucocorticoid therapy is used against the background of immune diseases, as well as when standard measures are ineffective. They eliminate pain and quickly relieve inflammation, shortening the healing period. Such products are used only according to indications and are available with a prescription. In some cases, it is advisable to inject the drug under the base of the ulcer; this is done by a doctor.

Epithelialization drugs are used after acute inflammation has resolved. The specialist will prescribe a gel with an analgesic and healing effect, usually this occurs 5–6 days after the start of complex therapy.

Local laser therapy can relieve pain, speed up the healing process, and minimize the risk of relapse.

Systemic treatment of aphthous stomatitis in adults involves taking the following drugs:

• antihistamines (anti-allergic, anti-edematous effect);
• glucocorticoids (anti-inflammatory, analgesic effect);
• immunomodulators (to stimulate defenses and accelerate recovery).

And if antiallergic drugs can be recommended to any patient even in the absence of information about the exact causes of stomatitis, then other drugs are prescribed only according to indications: in case of acute severe course of the disease, frequent relapses, and the presence of severe systemic pathologies. An additional method of treatment is vitamin therapy - taking vitamins C, group B.

In addition to the main course of treatment, all patients without exception are recommended to adhere to a hypoallergenic diet, avoid taking too hot drinks and dishes, and spicy, irritating foods. It is better to give preference to toothpaste without sodium lauryl sulfate, this component can provoke the disease.

It is important to continue your oral hygiene, even if it is difficult. To make brushing your teeth easier, choose a soft toothbrush. If the disease recurs frequently, it is necessary to pay attention to the general state of health, promptly treat teeth and gums, replace fillings and dental structures.

The causative agent of the disease

Aphthous stomatitis is an infectious disease that develops after penetration of a pathogen into the body. The mucous membrane protects the tissues of the oral cavity from pathogenic microorganisms, but if damaged, the infection can penetrate inside. The causative agent of aphthous stomatitis does not immediately become active. If the patient has a strong immune system, then the incubation period begins. But when the immune system is weakened under the influence of any factors, the disease begins to progress.

There are several ways of contracting aphthous stomatitis.

1. Contact and household. The infection enters the oral cavity from dirty hands, objects, products, etc.
2. Interior. Every person’s body contains not only “good” bacteria, but also “bad” bacteria. When the immune system is weakened, pathogenic microorganisms begin to manifest themselves. These bacteria also include the causative agent of stomatitis.
3. Pathological. The cause of the disease may be another disease of a bacterial or viral nature. Stomatitis is mainly observed against the background of measles, smallpox and herpes.

Most people suffer from stomatitis in childhood, which has a simple explanation - the immunity of children is much weaker than that of an adult. Even with the chronic form of the disease, as the child grows older, relapses occur less and less frequently.

Literature:

1. Aphthous stomatitis. Nurse, No. 5, 2015, p. 21.
2. Mikhalchenko V.F., Firsova I.V., Fedotova Yu.M. and others. A new approach to the treatment of chronic recurrent aphthous stomatitis (Setton's aphthosis) using the method of photoactivated disinfection and the immunomodulator Galavit. Modern problems of science and education. No. 6, 2015, pp. 1-6.
3. Salomão Israel Monteiro Lourenço Queiroz, Marcus Vinícius Amarante da Silva. Ana Miryam Costa de Medeiros. Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis. (Recurrent aphthous ulcers: epidemiological study of etiological factors, treatment and differential diagnosis). An Bras Dermatol. 2018;93(3):341-6.
4. Maksimenko P.T., Skripnikova T.P., Khmil T.A. Nomenclature, clinical classification of diseases, changes in the mucous membrane of the oral cavity, lips and tongue. Ukrainian Dental Almanac, 2008, No. 4, pp. 28-36.
5. Sunday O. Akintoye, BDS, DDS, MS* and Martin S. Greenberg, DDS, FDSRCS. Recurrent Aphthous Stomatitis. Dent Clin North Am. April 2014; 58(2): 281–297. doi:10.1016/j.cden.2013.12.002
6. Galizina O.A. Main aspects of the occurrence, clinical manifestations, treatment and prevention of chronic recurrent aphthous stomatitis. Russian Dental Journal, 2014, No. 6, pp. 39-42.
7. Mahesh Chavan1, Hansa Jain2, Nikhil Diwan1, Shivaji Khedkar3, Anagha Shete1, Sachin Durkar. Recurrent aphthous stomatitis: a review. J Oral Pathol Med (2012).
8. Volkov E.A., Butova V.G. Clinical recommendations (treatment protocol) for chronic recurrent aphthous stomatitis. Russian Dental Journal, No. 5, 2014, pp. 35-50.
9. Instructions for medical use of the drug Metrogyl-Denta®.
10. Strakhova S.Yu., Drobotko L.N. Chronic recurrent aphthous stomatitis (lecture). RMZh, No. 29 dated December 27, 2006, p. 2096.
11. Dental gel for gums Metrogyl-Denta® in the treatment of periodontal diseases and oral mucosa. Practical medicine, No. 1(33), March, 2009, pp. 105-106.
12. Glukhmanyuk D.S., Malinovsky V.A. Aphthous stomatitis. Proceedings of the scientific and practical conference “Modern problems of pharmacology, cosmetology and aromology.” International Humanitarian University, Odessa Medical Institute, 2015. – 48 p.

Dentists' recommendations

Prevention of aphthous stomatitis is the surest way to prevent the disease in children. Parents of children with a hereditary predisposition, chronic diseases or weakened immunity should pay the greatest attention to preventive measures.

To reduce the risk of developing aphthous stomatitis, dentists recommend:

• monitoring the child's nutrition;
• exclusion of allergenic products (if indicated);
• periodic intake of vitamin complexes;
• maintaining oral hygiene at home;
• professional teeth cleaning every 6 months;
• timely treatment of dental diseases;
• treatment of any provoking diseases;
• contact your dentist at the first symptoms of aphthae.

Aphthous stomatitis is a complex dental disease caused by infection. Treatment of infectious pathology at home often only helps to eliminate symptoms and transition of the disease to a chronic form. Contacting a qualified dentist will allow you to individually select treatment tactics for complete recovery or achieve long-term remission with subsequent “attenuation” of the infection.

Treatment at home and folk remedies

As an addition to the main therapy, it is possible to use folk remedies. Ginseng, propolis and echinacea are considered good immunomodulators. Infusions of chamomile, propolis or oak bark help cope with inflammation; aloe and sea buckthorn oil promote healing of aphthae. In any case, it is unlikely that you will be able to get rid of the disease using folk remedies alone, so do not delay in visiting a doctor. Timely therapy helps cure aphthous stomatitis and eliminate its symptoms within two weeks. Advanced stages are much more difficult to respond to and can cause irreversible deformation of soft tissues.

Attention!

Conservative therapy implies the possibility of treatment at home, but a visit to a doctor is still necessary, since only a specialist can draw up an optimal rehabilitation plan (including prescribing an ointment, solution, antibiotics, anti-inflammatory drugs, etc.) and track intermediate results.

Types of aft.

Small aphthae is the most common type of aphthae (80-85%). Their size ranges from 1 to 10 mm. Ulcers can appear singly or several at a time (up to five).

Usually heal in 7-10 days.

Large aphthae (10-15%) - more than 10 mm in diameter, can even be up to 3 cm, deeper, take longer to heal (10-30 days).

They may leave scars behind. Very rare in children.

Herpetiform aphthae (5-10%) are small, from 1 to 3 mm, located in groups like herpetic vesicles. They heal quickly, within 10 days. They are not typical for children; they usually occur in the elderly.

The rest of the oral cavity looks normal - there is no inflammation of the gums, redness of the tonsils and pharynx, enlarged and painful cervical lymph nodes.

There is no fever or other general manifestations.

Aphthae in children is manifested primarily by refusal to eat and drink due to pain in the mouth.

The reasons for the recurrence of aphthae are not completely clear; the most popular theory is related to errors in the immune system.

Doctors most often do not find a specific cause of the failure; most likely it is a combination of several factors.

But doctors still have assumptions about some factors.

What systemic diseases can manifest as aphthae?

• Reiter's syndrome
• Behçet's disease
• AIDS
• cyclic neutropenia
• PFAPA syndrome

The gastroenterologist is especially interested in the connection between recurrent ulcers and specialized systemic diseases.

Celiac disease is found in 5% , and for a long time canker sores may be the only manifestation of a reaction to gluten.

Let me remind you that the estimated prevalence of celiac disease in the general population is about 1%.

Enamel defects and aphthous stomatitis in celiac and healthy subjects: Systematic review and meta-analysis of controlled studies

Other important conditions that manifest as canker sores are inflammatory bowel diseases: Crohn's disease and ulcerative colitis.

Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment