Aphthae habituelle K12.0

Arnemnn 1787; Heberden 1802; von Mikulicz-Radecki and Kümmel 1898; Sutton 1911;

In 10-50% of the population, mostly minor type.

Unexplained, probably multifactorial triggering with corresponding disposition. Possible triggers are trauma, gastrointestinal disorders, hormonal influence (paramenstrual occurrence), infections, stress and food intolerances (nuts, more rarely tomatoes). One thinks of an immunological or autoimmunological malfunction with subsequent destruction of the epithelial cells. Familial accumulation.

Usually begins between the ages of 20 and 30, but also in childhood (mean age of onset of the disease in children 9.6 years); the prevalence decreases with increasing age. Gynaecotropia exists.

Typical is the recurrent occurrence over years (mean duration of disease is 3.6 years) (frequency of recurrences varies between weeks and months) of single or multiple pinhead-, rarely lentil-sized or even 3.0-5.0 cm large, usually very painful erosions or ulcerations with bright red margins in the area of the mucosa. Less commonly, a small very rapidly eroded painful vesicle may be observed initially. The painfulness makes eating and drinking difficult (especially acidic fruit juices). Accompanying symptoms may include increased salivation and foeter ex ore.

There are 3 types:

• Minor type (80%): Few erosions or shallow ulcers; size: < 0.3-05 cm; general symptomatology.
• Major type (Sutton type; 10%): Few, deep ulcers up to 3 cm in diameter; frequent regional lymphadenitis; moderate to high fever; general ill feeling.
• Herpetiform aphthae (10%): Very numerous; size: < 0.3 cm; disseminated, erosions or shallow ulcers; entire oral mucosa, similar to gingivostomatitis herpetica. Periodic course lasting years to decades. Short appearance-free intervals.

Notice! In case of large, constantly recurring aphthae, think of M. Behçet or M. Crohn

Disinfection: Mouth rinses initially with disinfecting solutions such as chlorhexidine R045, hexetidine (e.g. Hexoral solution), ethacridine lactate (e.g. 0.25% ethacridine lactate monohydrate solution with lidocaine 0.5%, dequalinium chloride (e.g. Maltyl solution).

Pain relief: In case of severe pain, mouth rinses with aqueous solutions containing benzocaine (e.g. Dolo-Dobendan solution) can be used. Combination preparations of 0.1% benzalkonium chloride/2% lidocaine (e.g. Dynexan A gel), which is applied several times to the painful lesions, or ethacridine lactate/lidocaine solutions (e.g. 0.25% ethacridine lactate monohydrate solution with lidocaine 0.5%) show good results.

In addition, glucocorticoid adhesive pastes or gels are indicated for extensive aphthae, which are applied to the lesion after dry swabbing with a cotton swab.

Alternatively, "mice" (gauze swabs) with medium to highly potent topical glucocorticoids (e.g. Clobegal cream) can be applied to the aphthae for about 30 minutes. Due to the longer retention time at the lesion, betamethasone valerate adhesive paste 0.1% R031 or prednisolone paste (e.g. Dontisolon D oral healing paste) are most suitable.

Alternatively, oral gels whose vehicle systems act as adhesive ointments can be used, e.g. 0.1% triamcinolone acetonide gel(e.g. Volon A adhesive ointment). Irrigation with glucocorticoids (e.g. 1 tbl. of prednisone 50 mg dissolved in 20 ml of aqua purificata; rinse the mouth with the solution for 5 minutes, do not swallow!) are common but not very effective (dilution effect by saliva, short retention time at the lesion). In the further course of treatment, mouthwashes that promote healing, such as dexpanthenol solution, can be applied to support the healing process. See also Dental products.

Alternatively: local tetracycline therapy (e.g. mouth rinses 4 times/day for 3-5 minutes with a solution of 300 mg doxycycline in 30 ml distilled water). In the case of deep, very painful aphthae, a glucocorticoid can be added (e.g. 20 mg prednisolone).

Alternative: effective pain treatment and, if used early, shortening of the course of the disease by local application of hydroxybenzene sulfonic acid and hydroxymethoxybenzene sulfonic acid (HYBENX, Oralmedic). Painful for a short time during application.

In menstruation-dependent aphthosis, estrogen-enhanced contraception may be useful.

Interval therapy with glucocorticoids (20-50 mg/day prednisolone p.o. in the acute phase).

Continuous therapy with DADPS (50 mg/day p.o.) shows an improvement of symptoms in individual cases.

The use of colchicine should be considered in exceptional cases in the major type (1-2 times/day 0.6 mg p.o.).

Thalidomide (not approved-experimental approach) shows (as in Behçet's disease) a good efficacy in some patients (100-300 mg/day p.o.).

Tanning drugs: Tanning drugs have an anti-inflammatory, weak antimicrobial and wound-healing effect. The lesions can be brushed several times a day with an undiluted tincture of sage or tormentil. Alternatively, a tincture of rhatania root is suitable.

Essential oil drugs: essential oil drugs such as clove oil, camomile flowers (camillosan solution), myrrh (10% myrrh tincture), sage leaves(aqueous solution with 1-5% sage leaf oil) and thyme herb(10% thyme tincture) have antibacterial, virustatic, antimycotic and sometimes also local antiphlogistic effects. They are well suited as an "alternative therapy" for habitual aphthae.

Alternatively, combinations are also suitable: (see below Tormentill-Myrrh-Adstringens (NRF 7.1.)

1. Belenguer-Guallar I et al (2014)Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent 6e:168-174
2. Gürkan A et al (2015) Recurrent Aphthous Stomatitis in Childhood and Adolescence: A Single-Center Experience. Pediatric Dermatol 32:476-480
3. Heberden W (1802) Commentaries on the History and Cure of Diseases. T. Payne (ed.), London
4. Sutton RL (1911) Pariadenitis mucosa necrotica recurrens. J Cutan Dis 29: 65-71
5. by Mikulicz-Radecki J, Caraway WF (1898) The diseases of the mouth. In: The diseases of the mouth. Gustav Fischer, Jena