Aphthous ulcers are erythematous, small, round, or ovoid oral ulcers with circumscribed margins, typically presenting first in childhood or adolescence, and not associated with systemic disease.

Causes

• genetic predisposition - positive family history in 40% of people
• smoking cessation - mostly within the first 2 weeks
• Iron, zinc, folic acid, vitamin B/D deficiency
• hormonal factors - can coincide with luteal phase of cycle
• local trauma
• anxiety
• exposure to certain foods - chocolate, coffee, peanuts, gluten

Management

General measures:

• Protective pastes that form a barrier over the ulcer so that exposure to irritating substances is reduced.
• Superficial tissue cauterisation using silver nitrate stick.
• Local anaesthetics benzocaine and lignocaine (lidocaine) to reduce pain.
• Medicated toothpaste without sodium laureth sulphate.
• Antibacterial mouthwashes to reduce secondary infection.
• Avoidance of foods that trigger or exacerbate the ulcers.
• Treatment of an associated condition or underlying cause, for example -
  • Dietary supplements of vitamins or minerals, if the diet is inadequate or a deficiency is identified.