Stomatitis/ Apthous Stomatitis (Canker Sores)

• Anywhere in mouth: painful ulcerations
• May present initially as red, indurated papules that erode rapidly to form gray, red-bordered ulcers
• Minor ulcers: 2-10 mm, heal in one week-10 days
• Major ulcers: >10 mm, 10-30 days to heal
• 1/3 pf pt with recurrent apthous ulcers have a family hx of the d/o
• usually adolescents

Etiology

• Altered local regulation of cell-mediated immune system
• Activation and accumulation of cytotoxic T cells
• Predisposing factors: illness, trauma, emotional stress, low serum iron or ferritin, B12/folate deficiency, menstruations (accompanied by fall in progestogens during luteal phase), food hypersensitivity, allergic, drug reactions.
• Apthous stomatitis is not due to HSV infection! Recurrent herpes infections stay on the lips and rarely cross the mucocutaneous junction; involvement of oral mucosa is involved in only primary infections: Herpetiform ulcers: herpetiform, few to numerous 1-2 mm lesions that coalesce into plaques, healing over 7-10 days

Treatment

• Palliative: topical anesthetics and steroids
• 0.2% aqueous chlorhexidine gluconate mouthwash (to maintain oral hygeine)
• Relief of pain (esp before eating): topical anesthetic (ie viscous lidocaine) or oral rinse (elixir of diphenhydramine, viscous lidocaine, 0.5% dyclonine hydrochloride)
• BEWARE: overdose of local anesthetics can cause methemoglobinemia.
• Topical corticosteroid in a mucosal adhering agent (0.1% triamcinolone in Orabase) may help reduce inflammation
• Topical tetracycline mouthwash may also hasten healing

Herpetic gingivostomatitis

• Mostly 6mo -3 yrs
• Vesicle --> shallow ulcers --> heal 1-2 weeks
• Treatment: topical anesthetics, good hygiene

CHLA Board Review 2005