Description

• Self-limited, painful ulcerations of the nonkeratinized oral mucosa that are typically recurrent.
• Synonyms: Canker sores; aphthae; aphthous stomatitis:
  • Comes from “aphtha” meaning “ulcer” in Greek; first used by Hippocrates between 460 and 370 BC to categorize oral disease (1,2).
• Referred to as recurrent aphthous stomatitis (RAS) if a patient has at least 3 episodes within 3 years in varying locations of the mouth (1).
• Categorization:
  • Minor aphthous ulcers:
    • Usually <10 mm in diameter
    • Self-limitted, healing within 1–2 weeks
    • Rarely effect the dorsum of the mouth.
    • Nonscarring
  • Major aphthous ulcers (Sutton disease):
    • Usually >10 mm in diameter
    • Can effect the dorsum of the mouth.
    • May take weeks–months to heal.
    • Generally more painful than minor aphthous ulcers
    • May cause scarring.
  • Herpetiform ulcers (HU):
    • Unrelated to viral-caused herpetic stomatitis
    • Occur in small clusters in 10s–100s, lasting 1–4 weeks
    • Generally more painful than minor aphthous ulcers
    • May cause scarring.

Epidemiology

• Usually, the inital episode occurs in childhood, then begins to taper after the 3rd decade (3).
• More common in women, Caucasians, and nonsmoking patients.
• More common in patients of higher socioeconomic status.

• Most frequent inflammatory disorder of the oral mucosa.
  • Minor aphthous ulcers:
    • Most common: 70–90% of all aphthae
  • Major aphthous ulcers:
    • 10–15% of all aphthae
  • Herpetiform:
    • Least common: 7–10% of all aphthae

Prevalence
Lifetime prevalence of 25–40%

Risk Factors

• Genetics:
  • 40% of patients have family history of RAS.
  • If familial, attacks are usually more severe and begin earlier in life.
  • Possible HLA antigen associations
• Trauma: Sharp teeth, dental treatments, mucosa toothbrush injury, and so forth
• Increased stress
• Nutritional deficiencies: Iron, vitamin B, and folate
• Immunodeficiency
• Recent cessation of tobacco use
• Food sensitivity: To benzoic acid/cinnamaldehyde

Etiology

Exact etiology unknown; likely multifactorial