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  1. Erik W M A Bischoff, general practitioner ,
  2. Annemarie Uijen, general practitioner ,
  3. Mark van der Wel, general practitioner
  1. 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
  1. Correspondence to: E Bischoff e.bischoff{at}elg.umcn.nl
  • Accepted 21 May 2008

A 25 year old man presents with oral ulcerations that cause him great discomfort. He explains that these ulcers recurred several times last year, but that the current presentation is far more painful. He asks for your advice on treatment and prevention of these burning sores.

What issues you should cover

Aphthous ulcers⇓ (aphthae or canker sores) are painful solitary or multiple erosions of the oral mucous membrane. Aphthous ulcer is the most common condition of the oral mucosa in developed countries, affecting around 20% of the general population, mostly young adults. Diagnosis is based on history and examination (see box).

Fig 1 Minor aphthous ulcer of the tongue

Differentiation of aphthous ulcers from other oral diseases

  • In acute necrotising ulcerative gingivitis (mixed bacterial infection), ulcerations are seen in combination with strong halitosis and gingivitis. Antibiotics are indicated

  • Infection with HIV causes large lesions that heal very slowly

  • Squamous cell carcinoma presents with a solitary persistent ulcer that lasts for more than two weeks. Biopsy of such a non-healing ulcer is definitely indicated to rule out intraoral neoplasia

  • Herpes stomatitis (herpes simplex virus) causes abundant small vesicles and ulcers, with fever and cervical lymphadenopathy, particularly in infants. The lesions last about 10 days

  • Herpangina (coxsackie virus infection) causes general malaise, …

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