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Aphthae / Aphthous Stomatitis

Aphthae are common oral lesions that affect approximately 10% to 20% of the population. The etiology of aphthous stomatitis is unknown but according to an increasing evidence, its development has an immunogenic process that causes the ulceration of the involved oral mucosa.

Aphthous ulcers are usually classified into three different types: minor, herpetiform and major

Aphthous ulcers associated with Behçet’s disease:

Aphthous-like stomatitis is the initial manifestation in 25% to 75% of patients with Behçet’s disease. Preferential sites of ulceration are the mucous membranes of the lips, gingiva, cheeks and tongue. The palate, tonsils, and pharynx are rarely involved (unlike reactive arthritis or Stevens–Johnson syndrome). Most oral ulcers occur in crops (3 to >10 lesions), are less than 1 cm in diameter, heal without scarring within 1 to 3 weeks, and are recurrent.

Complex aphthosis:

Patients without systemic manifestations of Behçet’s disease who have recurrent oral and genital aphthous ulcers or almost constant multiple (>3) oral aphthae. Differentiation from complex aphthosis may be difficult because the initial clinical presentation of Behçet’s disease is often confined to oral and genital ulceration.

Differential Diagnosis of Aphthous Stomatitis:

Idiopathic 70%
B12/folate/iron deficiency 22%
Gluten-sensitive enteropathy 2%
Menstrually related 2%
Complex aphthosis 2%
Inflammatory bowel disease 1%
Behçet’s disease 1%






Aphthous Ulcers in Children - University of Rochester

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