Aphthous stomatitis

These ulcers occur periodically and heal completely between attacks. In the majority of cases, the individual ulcers last about 7–10 days, and ulceration episodes occur 3–6 times per year. Most appear on the non-keratinizing epithelial surfaces in the mouth – i.e. anywhere except the attached gingiva, the hard palate and the dorsum of the tongue – although the more severe forms, which are less common, may also involve keratinizing epithelial surfaces. Symptoms range from a minor nuisance to interfering with eating and drinking. The severe forms may be debilitating, even causing weight loss due to malnutrition.


The condition is very common, affecting about 20% of the general population to some degree.^[1] The onset is often during childhood or adolescence, and the condition usually lasts for several years before gradually disappearing. There is no cure, but treatments such as corticosteroids aim to manage pain, reduce healing time and reduce the frequency of episodes of ulceration.

Prognosis[edit]

By definition, there is no serious underlying medical condition, and most importantly, the ulcers do not represent oral cancer nor are they infectious. However, aphthae are capable of causing significant discomfort. There is a spectrum of severity, with symptoms ranging from a minor nuisance to disabling.^[4] Due to pain during eating, weight loss may develop as a result of not eating in severe cases of aphthous stomatitis. Usually, the condition lasts for several years before spontaneously disappearing in later life.^[3]

Epidemiology[edit]

Aphthous stomatitis affects between 5% and 66% of people, with about 20% of individuals in most populations having the condition to some degree.^[6][8] This makes it the most common disease of the oral mucosa.^[20] Aphthous stomatitis occurs worldwide, but is more common in developed countries.^[3]


Within nations, it is more common in higher socioeconomic groups.^[3] Males and females are affected in an equal ratio, and the peak age of onset between 10 and 19 years.^[7] About 80% of people with aphthous stomatitis first developed the condition before the age of 30.^[6] There have been reports of ethnic variation. For example, in the United States, aphthous stomatitis may be three times more common in white-skinned people than black-skinned people.^[16]

History, society and culture[edit]

"Aphthous affectations" and "aphthous ulcerations" of the mouth are mentioned several times in the treatise "Of the Epidemics" (part of the Hippocratic corpus, in the 4th century BCE),^[25] although it seems likely that this was oral ulceration as a manifestation of some infectious disease, since they are described as occurring in epidemic-like patterns, with concurrent symptoms such as fever.


Aphthous stomatitis was once thought to be a form of recurrent herpes simplex virus infection, and some clinicians still refer to the condition as "herpes" despite this cause having been disproven.^[26]


The informal term "canker sore" is sometimes used, mainly in North America,^[27] either to describe this condition generally, or to refer to the individual ulcers of this condition,^[28] or mouth ulcers of any cause unrelated to this condition. The origin of the word "canker" is thought to have been influenced by Latin, Old English, Middle English and Old North French.^[29] In Latin, cancer translates to "malignant tumor" or literally "crab" (related to the likening of sectioned tumors to the limbs of a crab). The closely related word in Middle English and Old North French, chancre, now more usually applied to syphilis, is also thought to be involved.^[29] Despite this etymology, aphthous stomatitis is not a form of cancer but rather entirely benign.


An aphtha (plural aphthae) is a non specific term that refers to an ulcer of the mouth. The word is derived from the Greek word aphtha meaning "eruption" or "ulcer".^[9] The lesions of several other oral conditions are sometimes described as aphthae, including Bednar's aphthae (infected, traumatic ulcers on the hard palate in infants),^[30] oral candidiasis, and foot-and-mouth disease. When used without qualification, aphthae commonly refers to lesions of recurrent aphthous stomatitis. Since the word aphtha is often taken to be synonymous with ulcer, it has been suggested that the term "aphthous ulcer" is redundant, but it remains in common use.^[31] Stomatitis is also a non-specific term referring to any inflammatory process in the mouth, with or without oral ulceration.^[32] It may describe many different conditions apart from aphthous stomatitis such as angular stomatitis.


The current most widely used medical term is "recurrent aphthous stomatitis" or simply "aphthous stomatitis".^[4] Historically, many different terms have been used to refer to recurrent aphthous stomatitis or its sub-types, and some are still in use. Mikulicz's aphthae is a synonym of minor RAS,^[9] named after Jan Mikulicz-Radecki. Synonyms for major RAS include Sutton's ulcers (named after Richard Lightburn Sutton), Sutton's disease,^[33] Sutton's syndrome and periadenitis mucosa necrotica recurrens.^[3][9] Synonyms for aphthous stomatitis as a whole include (recurrent) oral aphthae, (recurrent) aphthous ulceration and (oral) aphthosis.^[6][15]


In traditional Chinese medicine, claimed treatments for aphthae focus on clearing heat and nourishing Yin.^[34]


Rembrandt Gentle White toothpaste did not contain sodium lauryl sulfate, and was specifically marketed as being for the benefit of "canker sore sufferers". When the manufacturer Johnson & Johnson discontinued the product in 2014, it caused a backlash of anger from long-term customers, and the toothpaste began to sell for many times the original price on the auction website eBay.^[35][36]