Aphthous ulcer overview

# Overview
An aphthous ulcer or canker sore is a type of mouth ulcer which presents as a painful open sore inside the mouth, caused by a break in the mucous membrane.  The condition is also known as aphthous stomatitis, and alternatively as "Sutton's Disease," especially in the case of multiple or recurring ulcers.

# Historical Perspective
The term aphthae was first used by Hippocrates at between 460-370 B.C., in relation to disorders of the mouth.

# Classification
Aphthous ulcer may be classified into 3 groups: major aphthous stomatitis, minor aphthous stomatitis and herpetiform stomatitis.

# Pathophysiology
The exact pathophysiology of aphthous ulcer is not fully understood. The pathogenesis of recurrent aphthous ulcer is varies based on underlying medical conditions. 
It is thought that aphthous ulcer is the result of the cross reactivity theory between microbial antigens and mitrocondrial heat shock protein, dysembryoplastic theory, histopathogenesis of glandular cells in myxoma or the thrombotic theory. Predisposing factors implicated so far in the development of aphthous ulcers are: trauma, smoking cessation, stress, hormonal disorders and food hypersensitivities.

# Causes
The exact cause of aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid.

# Differentiating Gonadoblastoma from Other Diseases
Aphthous ulcer must be differentiated from malignant ulcers, infections, rheumatic and cutaneous disease.

# Epidemiology and Demographics
The prevalence of aphthous ulcer is estimated to range from 1,000 to 60,000 cases per 100,000 individuals annually among adult, and 1,000 to 60,000 cases per 100,000 individuals among children.

# Risk Factors
Common risk factors in the development of recurrent aphthous ulcers are use of denture or braces, gender, age, family history, oral diseases and stress.

# Screening
There is insufficient evidence to recommend routine screening for gonadoblastoma. However, patients with XY gonadal abnormalities should be followed using sonography starting at age 2, every six months, until the gonads are removed.

# Natural History, Complications, and Prognosis
The natural history, complications and prognosis of recurrent aphthous ulcers varies with disease severity.

# Diagnosis

## Diagnostic Study of Choice
There is no single diagnostic study of choice for the diagnosis of aphthous ulcers.

## History and Symptoms
Symptoms of aphthous ulcers include oral pain, dysphagia, and oral bumps that may have resolved spontaneously in the past.

## Physical Examination
Patients with aphthous ulcers usually present with ulcers that may be may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not. These characteristics help physicians to classify the disease.

## Laboratory Findings
There are no specific laboratory findings associated with aphthous ulcers.

## Electrocardiogram
There are no ECG findings associated with aphthous ulcers.

## X-ray
There are no X-ray findings associated with aphthous ulcers.

## Ultrasound
There are no echocardiographic and ultrasound findings associated with aphthous ulcers.

## CT scan
There are no CT-Scan findings associated with aphthous ulcers.

## MRI
There are no MRI findings associated with aphthous ulcers.

## Other Imaging Findings
There are no other imaging findings associated with aphthous ulcers.

## Other Diagnostic Studies
There are no other diagnostic studies findings associated with aphthous ulcers.

# Treatment

## Medical Therapy
The majority of cases of aphthous ulcers are self-limited and require only supportive care. Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral hygiene should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers and cause pain. Strong mouthwash such as Listerine has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.

## Surgery
Surgical intervention is not recommended for the management of aphthous ulcers.

## Primary Prevention
There is no established method for prevention of aphthous ulcers. Dental hygiene and regular dentistry visits though are highly advised for improving bucal health and reducing the risk of aphthous ulcers.

## Secondary Prevention
There is no established method for prevention of aphthous ulcers. Dental hygiene and regular dentistry visits though are highly advised for improving bucal health and reducing the risk of aphthous ulcers.