What is Aphthous Stomatitis and How to Recognize It?
Aphthous stomatitis is an inflammatory process of the oral mucosa (OM), with the primary morphological element being aphthae (canker sores). Unlike simple redness or blisters, an aphtha is a rounded erosion or superficial ulcer, covered by a grayish-white or yellow fibrinous coating. A characteristic sign is the presence of a bright hyperemic rim around the perimeter of the defect. The disease is rarely asymptomatic: even a single lesion causes pronounced nociceptive pain (increasing with mechanical contact), making eating and articulation difficult. According to statistics from the European Academy of Dentistry, the peak of initial consultations is in the 20-30 age group, although children and the elderly are also at risk. In Barcelona, with its multicultural population, we often observe disease outbreaks during the off-seasons, associated with acclimatization and stress.
Causes: Why Do Mouth Ulcers (Aphthae) Appear?
The etiology of aphthous stomatitis remains under research, but it is accepted as a polyetiological disease. The trigger is not a single factor but a combination of them. The primary factors are local immune imbalance and the body's reaction to bacterial antigens (most often, hemolytic streptococci). In Catalan clinics, including our diagnostic protocol, special attention is paid to ruling out systemic pathologies. Aphthae can be markers for Crohn's disease, ulcerative colitis, or HIV infection. Among local causes, microtraumas (biting, friction from braces or a sharp tooth edge), deficiency of B vitamins (especially B12), iron, and folic acid are the leaders. Hormonal fluctuations (in women) and severe stress are also proven triggers, as they influence cortisol levels and reduce the protective properties of saliva.
Clinical Picture: What Do Aphthae Look Like and Their Localization?
The clinical picture directly depends on the form of the disease. A typical aphtha (minor form) is 2-10 mm in diameter, with rounded contours and clearly demarcated from healthy tissue. Palpation is sharply painful. Lesions are primarily located on non-keratinized epithelium: the transitional fold, the inner surface of the lips and cheeks, and the floor of the mouth. On the gums, hard palate, and dorsum of the tongue (keratinized zones), aphthae appear less frequently, but when they do, they are often associated with trauma or salivary gland pathology. In Barcelona, due to high sun exposure, we also record cases where ultraviolet radiation acts as a cofactor for exacerbation. It is important to distinguish an aphtha from herpetic erosion: herpes always begins with a vesicle that bursts, while an aphtha forms directly as an ulcerative defect without a vesicular stage.
Classification and Types of Aphthous Stomatitis
In modern dentistry (2026 protocols), it is accepted to classify aphthous stomatitis based on clinical and morphological signs. The fibrinous form (most common) is distinguished, where aphthae heal without scarring in 7-10 days. The necrotic form is associated with epithelial destruction and occurs in patients with severe somatic diseases. The glandular form affects the excretory ducts of the minor salivary glands, causing ulcers to appear in atypical locations. The scarring form (Sutton's disease or major aphthae) presents as deep, crater-like defects that take over 3-4 weeks to heal, forming a scar. Deforming and lichenoid forms are also identified. Chronic recurrent course is diagnosed if exacerbations occur more than 3 times a year, requiring not only local treatment but also correction of the immune status.
Diagnosis: How to Differentiate It from Other Diseases?
Diagnosis of aphthous stomatitis in a dental clinic (e.g., Corona Dental in Barcelona) begins with visual examination and medical history. However, for extensive or recurrent lesions, we resort to laboratory methods. The standard includes a complete blood count (to rule out anemia and leukemia), PCR diagnostics for herpes viruses (HSV-1, HSV-2), and a microflora smear with antibiotic sensitivity testing. A crucial step is differential diagnosis with Behçet's syndrome (aphthae + genital ulcers), lichen planus, and pemphigus. In complex cases, a tissue biopsy is performed. According to Spanish recommendations, if an ulcer does not heal for more than 14 days, it is an indication for oncological vigilance and histological examination.
Stages of Development and Severity Grades
In its development, aphthous stomatitis goes through four stages. The first is the prodromal stage: the patient feels burning or tingling at the future site of the aphtha, and the mucosa is hyperemic. The second is the ulcer formation stage. The third is the necrotic plaque stage (the base becomes covered with fibrin). The fourth is the healing (epithelization) stage. Regarding severity, a distinction is made between mild (single aphthae, heal within 10 days, no intoxication), moderate (larger lesions, pain, lymph node enlargement), and severe (multiple deep aphthae, general malaise, frequent relapses). In severe cases, consultation with a gastroenterologist and immunologist is mandatory.
Treatment of Aphthous Stomatitis in Barcelona: Modern Protocols
Treatment is always comprehensive and depends on the trigger. In Barcelona, we follow protocols aimed at pain relief, ulcer cleansing, and regeneration stimulation. Local therapy includes applications of antiseptics (0.05% chlorhexidine digluconate or miramistin) and anesthetic gels with lidocaine. To accelerate epithelization, keratoplastics are used: solcoseryl (dental paste), sea buckthorn oil, or vitamin A. In severe cases, short-term use of topical corticosteroids is permissible (strictly as prescribed by a doctor). Systemic therapy is prescribed only for chronic recurrent cases: immunomodulators, antihistamines, and vitamin therapy (B12, C, iron). An important condition is dietary correction (avoiding spicy, acidic, rough foods) and discontinuing toothpastes containing sodium lauryl sulfate.
Prevention of Relapses
Prevention of aphthous stomatitis is based on hygiene principles and a healthy lifestyle. Patients with the chronic form are recommended an elimination diet (excluding food allergens: nuts, chocolate, coffee, strawberries). Regular oral hygiene and professional cleaning (every six months) reduce the bacterial load. In Barcelona's humid climate, it is important to maintain water balance so that saliva can perform its protective functions. Using a soft toothbrush (to avoid microtrauma) and toothpastes without aggressive foaming agents is mandatory. At the first signs (burning sensation), it is recommended to immediately start rinsing with an antiseptic to stop the development of the aphtha at the prodromal stage.
