aphthae

Aphthae, also known as aphthous ulcers or canker sores, are small, shallow, noninfectious ulcers of the oral mucosa. They are usually round or oval with a yellow or gray base and a surrounding red halo. Most occur on non-keratinized mucosa such as the inside of the lips and cheeks, the floor of the mouth, the underside of the tongue, or the soft palate. They are uncommon on keratinized gingiva or the hard palate and are typically painful.

Three clinical forms are recognized: minor aphthae (the most common), major aphthae (larger and longer lasting, with possible scarring), and herpetiform aphthae (clusters of small ulcers). Minor aphthae typically heal within one to two weeks without scarring; major lesions may take longer and occasionally leave a scar. Recurrence is common, particularly in individuals with a history of ulcers.

Etiology is multifactorial and not fully understood. Triggers include local trauma, stress, hormonal fluctuations, and nutritional deficiencies (iron, folate, vitamin B12). Immune dysregulation and genetic predisposition also appear to play a role. Aphthae can be associated with systemic conditions such as celiac disease, Crohn's disease, and Behçet's disease, and may be influenced by certain medications or infections.

Diagnosis is clinical and usually straightforward; other causes of oral ulcers are considered if features are atypical. Treatment emphasizes symptom relief and healing. Options include topical corticosteroids (for example, triamcinolone paste or fluocinonide), topical anesthetics, antiseptic mouthwashes, and protective pastes. Severe or frequent cases may require systemic therapies or specialist evaluation. Most lesions resolve spontaneously within two weeks.