Aphthous Stomatitis: Three Types

Classification. Aphthae are classified into three types:

• Minor ulcers usually measure less than 5 mm and are seen on the labial and buccal mucosa. They are generally round and white to yellowish with an erythematous margin and can erupt individually or in clusters.

• Major aphthae, or periadenitis mucosa necrotica recurrens, can be 1 to 3 cm in diameter, may be round or oval, and arise on the lips, soft palate, or fauces.

• Herpetiform ulcers are multiple, recurring crops of 2- to 3-mm painful lesions that are widespread throughout the oral cavity. Reassure your patient that despite their name, these ulcers are not caused by a herpesvirus infection.

Therapy. Generally, no treatment is needed for aphthous stomatitis. The pain eases within a week of onset, and the lesions resolve in about 14 days. Lesion pain and irritation from teeth and food can be treated by a tetracycline-triamcinolone mouthwash. Topical anesthetic or corticosteroid therapy may be helpful.

Figure 4 shows an ulcer on the right soft palate of a 38-year-old woman who had experienced pain in the right side of her palate and neck. Her cervical glands were not enlarged.

An afebrile 23-year-old man with no cervical gland enlargement presented with the very painful, large, shallow, yellowish-based ulcer shown in Figure 5; there was surrounding injection at the left anterior tonsillar pillar. The lesion responded to treatment with tetracycline and triamcinolone mouthwash.

The aphthae on the right anterior tonsillar pillar in Figure 6 was the cause of this 35-year-old woman’s “most severe sore throat.” She was afebrile, with bilateral anterior cervical gland enlargement that was tender only on the right side.