Aphthous ulcers (aphthae) are recurrent, exquisitely painful oral ulcers that can
literally dominate and ruin a person's life. Aphthae affect the entire mucosal
surface of the mouth, including the lips and tongue, and can be so painful that
speaking and eating are difficult, and sufferers must resort to topical
anesthetics. As a physician and former aphthous sufferer, I offer the following
checklist of causative and aggravating factors:

A - Amalgams and metal dental work.

P - Poor oral hygiene.

H - Hot spices, such as pepper, cayenne, and cinnamon.

T - Trauma, such as biting your lip, tongue, or cheek.

H - Hunger, especially skipping meals.

A - Addictive substances (alcohol, tobacco, caffeine, sweets).

E - Exhaustion, stress, and anxiety.

Competing interests:
None declared