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16.6 Aphthous Ulceration

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Aphthous or recurrent aphthous stomatitis (RAS) are painful recurrent mucous membrane ulcerations. Usually affect the non-keratinized oral mucous membrane.

Diagnostic Criteria

There are 3 types of aphthous ulcers as follows:

Minor Aphthous Ulcers

Small round or ovoid ulcers 2–4 mm in diameter, surrounded by an erythematous halo and some edema It occurs in groups of only a few ulcers (i.e. 1–6) at a time. Found mainly on the non keratinized mobile mucosa of the lips, cheeks, floor of the mouth, sulci, or ventrum of the tongue. Heal spontaneously in 7–10 days and have little or no evidence of scarring.

Major Aphthous ulcers

Painful ulcers on non-keratinized oral mucous membrane, they are large 1–3 cm edged ulcers, and several may be present simultaneously. There is marked tissue destruction which is sometimes constantly present.  Healing is prolonged often with scarring

Herpetiform ulcers

These occur in a group of multiple ulcers which are small (1–5 mm) and heal within 7– 10 days. Rationale of treatment is to offer symptomatic treatment for pain and discomfort, especially when ulcers are causing problems with eating

Pharmacological Treatment33

S:Triamcinolone acetonide cream 0.1% apply 12 hourly for 5days


B: Chlorhexidine gluconate 0.2% mouthwash used 8 hourly for 5 days

If systemic therapy is required;

B: Prednisolone (PO) 20mg 8 hourly for 3 days then dose tapered to prednisolone (PO) 10mg 8 hourly for 2 days then 5mg 8 hourly for other 2 days.

A: Paracetamol (PO) 1gm 8 hourly for 3 days when required for pain

Referral: If the ulcers persist for more than 3 weeks after treatment, such lesions may need histological diagnosis after specialist opinion. Therefore, refer the patient to the next facility with adequate expertise and diagnostic equipments.

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