Aphthous Ulcers in Non-Smokers – Link to Immune and Nutritional Factors

Aphthous Ulcers in Non-Smokers – Link to Immune and Nutritional Factors

Write a short note on apthous ulcers.
Answer:

Apthous Ulcers

Aphthous ulcer is the most common type of non-traumatic, ulcerative condition of the oral mucosa.

“Understanding aphthous ulcers: Causes and symptoms”

Aphthous ulcers

Apthous Ulcers Etiology

The exact etiology is not known and only the probable factors have been identified which are as follows:

• Genetic predisposition: The disease often affects several members of the same family and moreover identical twins are most frequently affected.
• Exaggerated response to trauma: The ulcer develops in those mucosal sites which are subjected to trauma in the past, For Example. toothpick injury.
• Immunological factors: The disease may occur due to some autoimmune reactions, or in patients with immunosuppression, For Example. AIDS. Some investigators believe it
  is an immune complex-mediated type III or cell-mediated type 4 reaction.
• Microbiologic factors: The disease may be caused by herpes simplex virus Type I or S. sanguis.

Causes of aphthous ulcers

“Importance of addressing nutritional deficiencies in aphthous ulcers”

• Nutritional factors: Deficiency of vitamin B12, folate, iron, etc. often reported in patients with aphthous ulcers; moreover supplementation of these elements may cause
  rapid recovery.
• Systemic conditions: Behcet’s syndrome, Crohn’s disease, and Celiac disease are associated with increased incidences of aphthous ulcers.
• Hormonal imbalance: Hormonal change during the menstrual cycle may be associated with a higher incidence of aphthous ulcers.
• Non­smoking: The disease almost exclusively occurs in non-smokers or people who have given up smoking recently.
• Allergy and chronic asthma: Allergic manifestations to any medicines or foods (For Example. nuts and chocolates, etc.) may lead to the development of an aphthous ulcer.
• Miscellaneous factors: Stress and anxiety.

“Common causes of recurrent aphthous stomatitis explained”

Aphthous Ulcers Clinical Features

• Aphthous ulcers usually develop over the movable, nonkeratinized oral mucosa like the tongue (lateral borders), vestibule, lips, buccal mucosa, soft palate and flor of the mouth, etc.
• The highest incidence of the disease is reported during early adult life.
• Before the appearance of the ulcer, the involved area produces a burning or tingling sensation, but the ulcers are never preceded by vesiculations.
• These ulcers recur in an interval of about 3 to 4 weeks.
• Clinically aphthous ulcers present three recognizable forms, namely:
  • Minor aphthous ulcers
  • Major aphthous ulcers
  • Herpetiform ulcers.

“Role of immune dysfunction in causing aphthous ulcers”

Minor Aphthous Ulcer

• It is the most common type of aphthous ulcer of the oral cavity and it appears episodically either as a single lesion or in clusters of 1 to 5 lesions.
• The ulcers are very painful, shallow, round, or elliptical in shape and they measure about 0.5 cm in diameter with a crateriform margin.
• The lesion is usually surrounded by an erythematous “halo” and is covered by a yellowish, fibrinous membrane.
• Minor aphthous ulcers mostly develop over the nonkeratinized mucosa, For Example. lips, soft palate, anterior fauces, the floor of the mouth, and ventral surface of the tongue (gland-bearing mucosa), etc.
• The ulcer lasts for about 7 to 10 days and then heals up without scarring but recurrence is common.
• New lesions may continue to appear during an attack for about 3-4 weeks period.
• Few lesions may be present in the mouth almost continuously.

“Impact of autoimmune disorders on aphthous ulcers”

Major Aphthous Ulcers

• Major aphthous ulcers are less common than the minor form of the disease.
• These are larger, 0.5 cm in diameter, and can be as big as several centimeters in diameter.
• Major aphthous ulcers are more painful lesions than the minor variety, and they persist in the mouth for longer durations as they take more time to heal.
• These lesions are considered to be the most severe among all types of aphthae and they often make the patients ill.

“Impact of iron deficiency on mouth ulcers in non-smokers”

• Only one or two lesions develop at a time and are mostly seen over the lips, soft palate, fauces, etc. Besides involving the non-keratinized mucosa, major aphthous ulcers can involve the masticatory mucosa as well, such as the dorsum of the tongue and gingiva, etc.
• The ulcer appears crateriform (owing to its increased depth) and it heals with scar formation in about 6 weeks’ time.
• Few lesions may look like malignant ulcers, moreover, sometimes these lesions occur in association with HIV infections.
• Major aphthous ulcers often become secondarily infected and in such cases, the healing process is further delayed.

“Global prevalence of aphthous ulcers in non-smokers”

Herpetiform Ulcers

• Herpetiform type of aphthous ulcers produces recurrent crops of extremely painful, small ulcers in the oral mucosa, which resemble herpetic ulcers. However, these ulcers do not develop following vesiculations and exhibit no virus-infected cells.
• Their numbers vary from a few dozen to several hundred and each ulcer is surrounded by a wide zone of erythema.

“Role of topical corticosteroids in treating aphthous ulcers”

• The size of these ulcers ranges between l to 2 mm in diameter only. However, on a few occasions, small ulcers coalesce together to form large irregular ulcers.
• The ulcers last for several weeks or months.
• Children in their late teens often suffer from this disease and the lesions occur in both gland-bearing mucosa as well as over-keratinized mucosa.
• The lesions usually heal up within l to 2 week time.