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1-Introduction • Definition: Aphthous ulcers (recurrent aphthous stomatitis, RAS) are common, painful, non-infectious ulcers of the oral mucosa. • Epidemiology: • Affects ~20–25% of the population. • More common in females. • Onset often in childhood or adolescence. 2. Etiology & Risk Factors • Multifactorial origin: • Genetic predisposition (family history) • Nutritional deficiencies: iron, folate, vitamin B12 • Trauma (e.g., toothbrush, dental procedures) • Stress and hormonal changes • Food allergies (chocolate, nuts, acidic foods) • Immunological dysregulation • Systemic diseases (Crohn’s disease, Behçet’s syndrome, HIV) 3. Classification A. Minor Aphthous Ulcers (Mikulicz ulcer) • Most common type (~80%) • less than 10 mm in diameter • Heal in 7–14 days without scarring B. Major Aphthous Ulcers (Sutton disease, periadenitis mucosa necrotica recurrens) • 10 mm or more • Last for weeks; may heal with scarring • Often interfere with eating and speaking C. Herpetiform Ulcers • Multiple small (1–3 mm), coalescing ulcers • May resemble herpes simplex ulcers but unrelated to the virus • Heal in 7–10 days 4. Clinical Features • Round or oval painful ulcers • Yellow-white pseudomembrane with erythematous halo • Non-keratinized mucosa (buccal/labial mucosa, floor of mouth, soft palate) • No systemic symptoms in uncomplicated cases 5. Differential Diagnosis • Herpes simplex infection • Traumatic ulcers • Oral lichen planus • Erythema multiforme • Behçet’s disease • Crohn’s disease • Pemphigus vulgaris 6. Investigations • Mostly clinical diagnosis • Blood tests (if systemic association suspected): CBC, ferritin, folate, vitamin B12 • Biopsy (if atypical or non-healing ulcers) 7. Management A. General Measures • Avoid triggers (sharp teeth, spicy/acidic foods) • Maintain oral hygiene B. Topical Therapy • Topical corticosteroids (e.g., triamcinolone acetonide 0.1%) • Antiseptic mouthwashes (chlorhexidine) • Analgesic gels (lidocaine) C. Systemic Therapy (in severe/refractory cases) • Oral corticosteroids (prednisolone) • Immunomodulators (thalidomide, colchicine) • Nutritional supplementation if deficient 8. Prognosis • Recurrent but self-limiting • Tends to decrease in frequency with age • Major and herpetiform types may be more persistent 9. Recent Advances • Use of biologics in severe refractory cases • Laser therapy (e.g., low-level laser therapy – LLLT) • Role of probiotics under study 10. Conclusion • Aphthous ulcers are common and benign but can significantly affect quality of life. • Treatment is mainly symptomatic; identifying triggers and systemic associations is key. #science #ear #biology #ent #anatomy #nose #nosebleed #otolaryngology #throathealth #tonsils