Small ulcers with a big impact: mouth ulcers are tiny but often very painful ulcers of the oral mucosa. Many sufferers are familiar with the unpleasant spots that make it difficult to eat, drink or even speak. Even though mouth ulcers are harmless in most cases, they have a considerable impact on quality of life – especially if they recur. In the following article, you will find out what causes can have aphthae, how the symptoms manifest themselves and what options are available to alleviate the symptoms.

What are aphthae?

In medical terms, recurrent aphthae are referred to as recurrent aphthous stomatitis. This is one of the most common diseases of the oral mucosa [Scully & Porter, 2008].

Typical are round to oval ulcers in the mouth with a whitish-yellowish coating and an inflamed, reddened edge.

It is estimated that around 15 to 25 percent of the population in Central Europe are affected [Akintoye & Greenberg, 2014]. Aphthae often occur in the following areas:

• on the inside of the lips
• on the buccal mucosa
• on the side of the tongue
• on the soft palate

The size can vary – from very small lesions to larger ulcers covering several millimeters.

Causes: Why do aphthae develop?

The exact causes of aphthae have not yet been conclusively clarified. However, it is clear that it is not a bacterial or viral infection. Rather, immune reactions play a decisive role.

Aphthae are caused by an overreaction of the immune system in which T lymphocytes attack healthy tissue [Zhou et al., 2015]. As a result, tissue dies and the sensitive nerve endings are exposed – which causes the typical pain.

Frequently discussed risk factors

• Genetic predisposition: If aphthae occur in both parents, there is a probability of up to 90% that the children will also be affected [Scully & Porter, 2008].
• Stress and psychological strain: Many sufferers report a connection between psychological strain and increased incidence.
• Hormonal influences: Cycle-related fluctuations or hormonal changes can favor aphthae.
• Micro-injuries: Small injuries to the mucous membrane, e.g. caused by hard food or a toothbrush, can trigger aphthae.
• Food intolerances: Hot foods/spices, nuts or citrus fruits are considered possible triggers.

One possible trigger that is often overlooked is a nutrient deficiency. Studies show that the following deficiencies in particular can increase the risk of recurring aphthae:

• Iron deficiency: Iron plays a role in the oxygen supply to cells. If it is lacking, the mucous membrane can be more susceptible to inflammation.
• Vitamin B12 deficiency: This vitamin is crucial for cell division and the health of the nervous system. A deficiency can delay the healing of mucosal lesions.
• Folic acid deficiency: Folic acid is important for blood formation and tissue regeneration. A deficiency is often associated with aphthae.

Several studies indicate that up to 20% of people with recurrent aphthae have a vitamin B12 or folic acid deficiency [Volkov et al., 2009].

Tip: A balanced diet with plenty of fruit, vegetables, wholegrain products and sufficient fluids can support the health of the mucous membranes. If aphthae occur frequently, it is worth consulting a doctor to check whether there is a nutrient deficiency.

Symptoms and course

Aphthae symptoms are clearly recognizable: The small, bright spot in the mouth with a red border feels sore and painful.

Typical complaints:

• Stinging or burning pain
• Difficulties with eating and drinking
• Problems brushing your teeth
• In severe cases: swollen lymph nodes or mild fever
  

The healing time is usually 7 to 14 days. After that, aphthae disappear on their own, but can reappear again and again [Scully & Porter, 2008].

Treatment: home remedies vs. modern methods

As aphthae usually heal on their own, treatment focuses on relieving pain and supporting healing.

Home remedies for aphthae

Many people initially resort to tried and tested household remedies:

• Mouthwashes with medicinal plants such as camomile, sage, arnica, mallow or rhatania have long been used to provide relief.
• Propolis (bee resin) has a slightly antiseptic and soothing effect on the mucous membrane.
• Tea tree oil is also frequently mentioned as an anti-inflammatory home remedy, but should only be used with caution.

The effectiveness of these home remedies is not always scientifically proven, but many sufferers report positive experiences.

Modern treatment options

In dentistry and oral care, various products are now available that are used specifically for aphthae. Modern preparations have the advantage that their composition is often specially tailored to the needs of the oral mucosa and the effect can be better controlled.

• Topical gels and solutions that form a protective film over the affected area, thereby shielding the sensitive nerve endings.
• Products with hyaluronic acid, which promote the natural regeneration of the mucous membrane [Pfützner et al., 2001].
• Pain-relieving preparations in the form of lozenges, sprays or gels.

GENGIGEL’s clinically proven formula soothes pain, supports healing and protects sensitive areas in a natural way – without any chemicals that could cause burning of the mucous membranes.

When should you see a doctor with aphthae?

In most cases, aphthae are harmless. However, a visit to the doctor is advisable if:

• the aphthae are very large or unusually painful,
• they recur frequently,
• the ulcers persist for longer than 2 weeks,
• accompanying symptoms such as fever or fatigue,
• There is uncertainty as to whether these are actually aphthae.

A dentist can clarify possible causes such as nutritional deficiencies or other illnesses and make specific treatment recommendations.

Conclusion: small cause, big effect

Aphthae in the mouth are small, but can be very painful and severely impair quality of life. Although the exact causes are not fully understood, immune reactions, genetic factors, stress and nutritional deficiencies play an important role.

The symptoms can often be alleviated somewhat with simple household remedies. Modern oral care products can also support the healing of the mucous membrane. However, it is advisable to seek medical advice if the symptoms occur frequently or are very severe.

Sources

• Akintoye, S. O., & Greenberg, M. S. (2014). Recurrent aphthous stomatitis. Dental Clinics of North America, 58(2), 281-297.
• Pfützner, W., et al. (2001). Topical hyaluronic acid in the treatment of recurrent aphthous ulcers: A clinical trial. Journal of Oral Pathology & Medicine, 30(9), 556-560.
  Scully, C., & Porter, S. (2008). Oral mucosal disease: Recurrent aphthous stomatitis. British Journal of Oral and Maxillofacial Surgery, 46(3), 198-206.
• Volkov, I., Rudoy, I., & Freud, T. (2009). Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: A randomized, double-blind, placebo-controlled trial. Journal of the American Board of Family Medicine, 22(1), 9-16.
• Zhou, Y., et al. (2015). The immunopathogenesis of recurrent aphthous stomatitis. Journal of Dental Research, 94(5), 666-673.