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PATIENT STORY

A 58-year-old man presents with a 1-year history of painful sores in his mouth (Figures 43-1, 43-2, 43-3, 43-4). He has lost 20 pounds over the past year because it hurts to eat. The ulcers come and go, but are found on his tongue, buccal mucosa, and inner lips. Prior to the onset of these lesions, the patient had been in good health and was not on any medications. The physician recognized his condition as recurrent aphthous ulcers. No underlying systemic diseases were found on work-up. The patient was started on oral prednisone and given dexamethasone oral elixir to swish and swallow. Within 1 week the patient was able to eat and drink liquids comfortably and began regaining his lost weight. Long-term management of his problem required the use of other medications so as to successfully taper him off prednisone without recurrences.

FIGURE 43-1

Major aphthous ulcer on the buccal mucosa of a 58-year-old man who has been suffering with recurrent aphthous stomatitis for the past year. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 43-2

Two aphthous ulcers on the tongue of a 58-year-old man with recurrent aphthous stomatitis. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 43-3

Minor aphthous ulcer occurring simultaneously with major aphthous ulcers on the buccal mucosa and tongue of a 58-year-old man with recurrent aphthous ulcers. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 43-4

Aphthous ulcer located on unkeratinized (movable) mucosa in a 5-year-old girl. It is slightly raised, round, with a white-yellow necrotic center and surrounding erythema. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Aphthous ulcers are the most frequent form of ulcerations in the oral cavity. They can present as a single or multiple ulcerations, and with an occasional or recurrent pattern. They vary in size, but typically present as a round and shallow ulceration with a well-defined erythematous halo. Aphthous ulcers are painful and may interfere with oral function such as eating and speaking. Oral trauma, stress, and systemic diseases can contribute to the occurrence of these ulcers, but no precise etiology is apparent. The disabling character of this condition makes the patient seek medical evaluation. The medical management of recurrent aphthous stomatitis (RAS) can be frustrating and sometime requires aggressive treatment aimed at pain relief and prevention.

SYNONYMS

Canker sores, recurrent aphthous ulcer (RAU), aphthous stomatitis, RAS.

EPIDEMIOLOGY

  • Approximately 20% of ...

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