The Articulate Canker Aphthous Ulcer

Abstract

Anubha Bajaji

Aphthous ulcer occurs as a frequent, idiopathic, painful, singular, multiple or reoccurring oral ulceration. Of obscure aetiology, oral trauma, stress, anxiety, diverse systemic diseases as coeliac disease, Crohn’s disease, Behçet’s syndrome, reactive arthritis or infection with human immune deficiency virus (HIV), drugs such NSAIDs, β-blockers, angiotensin converting enzyme (ACE) inhibitors, deficiencies of vitamins and trace elements as zinc, iron, B12, folate or sensitivity to food and chemicals may engender the ulcer. Contingent to magnitude, aphthous ulcer is subcategorized into minor ulcer, major ulcer or herpetiform ulcer. Aphthous ulcer manifests upon non-keratinized oral mucosa as a well circumscribed, centric, necrotic ulcer circumscribed by a grey, fibrinous exudate and an erythematous halo. The ulcer requires a segregation from contact dermatitis, lichen planus, oral carcinoma, infection with herpes simplex virus (HSV), various drug induced lesions or autoimmune diseases. Aphthous ulcer can be evaluated with clinical examination, complete blood count with nutritional deficiencies of iron, folate or vitamin B12, neutropenia, serum anti-endomysial antibodies and transglutaminase (tTg-IgA) for coeliac disease and investigations for HIV. Cogent therapeutic options are local anaesthetics, coating or occlusive agents as bismuth subsalicylate, sucralfate, 2-octyl cyanoacrylate, bio-adherent emollient pastes, oral antiseptics as chlorhexidine gluconate, hydrogen peroxide, antiinflammatory agents as glucocorticoids, metalloprotease inhibitors, antimicrobials as tetracycline, doxycycline, minocycline, honey, immunomodulatory agents as amlexanox, colchicine, cyclosporine, cyclophosphamide, dapsone, methotrexate, montelukast, thalidomide or retinoids.

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