Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 8-19: Intraoral Ulcerative Lesions + Key Features Download Section PDF Listen +++ ++ Canker sore or ulcerative stomatitis Large or persistent areas of ulcerative stomatitis may be secondary to Erythema multiforme or drug allergies Acute herpes simplex Pemphigus Pemphigoid Epidermolysis bullosa acquisita Bullous lichen planus Behçet disease Inflammatory bowel disease Cause remains uncertain, although an association with human herpesvirus 6 has been suggested Stress seems to be a major predisposing factor Frequency of viral rhinitis and bedtime after 11 PM were independent predictors of aphthous ulcer frequency and severity in college students + Clinical Findings Download Section PDF Listen +++ ++ Very common and easy to recognize Found on freely moving, nonkeratinized mucosa (eg, buccal and labial mucosa and not attached gingiva or palate) May be single or multiple, are usually recurrent, and appear as small, round painful ulcerations with yellow-gray fibrinoid centers surrounded by red halos Minor ulcers are < 1 cm and generally heal in 10–14 days Major ulcers are > 1 cm and can be disabling in their degree of oral pain + Diagnosis Download Section PDF Listen +++ ++ Based on clinical appearance When the diagnosis is not clear, incisional biopsy is indicated + Treatment Download Section PDF Listen +++ ++ Topical corticosteroids (triamcinolone acetonide, 0.1%, or fluocinonide ointment, 0.05%) in an adhesive base (Orabase-Plain) provide symptomatic relief Other topical therapies are diclofenac 3% in hyaluronan 2.5%, doxymycine-cyanoacrylate, mouthwashes containing the enzymes amyloglucosidase and glucose oxidase, and amlexanox 5% oral paste A 1-week tapering course of prednisone (40–60 mg daily orally) can be used For recurrent ulcers Cimetidine maintenance therapy Thalidomide has been used selectively in those who are also HIV-positive