Aphthous Stomatitis

A patient arrives at your office complaining of severe pain associated with small lesions in his mouth. He tells you that similar painful sores had erupted in the past, but they healed and disappeared. He says: “I was sure the problem was history, but it has popped up again. What's going on?”

Diagnosis. This patient has aphthous stomatitis lesions; views of these ulcers from other patients also are shown in this collection.

The pathogenesis of these lesions is not clearly understood. They generally arise on the tongue and/or oral mucosa of otherwise healthy persons. Recurrences are common; years may elapse between episodes in some patients, while others can experience successive outbreaks.

It is important to distinguish aphthous ulcers from herpes lesions; their location in the oral cavity is a clue. Unlike herpes ulcers, aphthae never affect the gingiva and the hard palate. The prodromal symptoms that can signal the onset of a herpes eruption may not accompany the sudden occurrence of aphthous stomatitis. Herpes usually can be ruled out by a culture of material from a lesion, but there is a small possibility of a false-negative finding.

The solitary ulcer in Figure 1 has a yellowish base surrounded by inflamed mucosa. It appeared on the left soft palate of a 34-year-old man who had a history of recurrent stomatitis on his lips and tongue. The lesion subsided spontaneously.

The minor aphthae shown in Figure 2 appeared on the underside of a 40-year-old woman’s tongue. The lesion caused pain in the right side of her upper neck that radiated into her right ear. The pain abated in 4 days and the ulcer cleared shortly thereafter.

Figure 3 shows minute white vesicles (herpetiform aphthae) on the uvula and right soft palate in a 43-year-old woman who had complained of a sore throat and bilateral earache for 3 days. The patient was afebrile; her anterior cervical glands were small and very tender. Results of a culture for herpes simplex virus were negative.