Aphthe

from Wikipedia, the free encyclopedia
Classification according to ICD-10
K12.0 Recurrent oral aphthous ulcers
ICD-10 online (WHO version 2019)
Three aphthae on the inside of the lower lip

An aphtha [ ˈaftə ] ( transliteration from ancient Greek ἄφθη , from the verb ἅπτω haptō , German ' to inflame' ) is painful damage to the mucous membrane of the gums , the oral cavity including the lips , tonsils or tongue, surrounded by an inflammatory border . In individual cases, other mucous membranes, e.g. B. in the genital area affected. It is an ulcer with a whitish fibrin coating . If several such sites occur at the same time as part of a primary infection, one speaks of the clinical picture of stomatitis aphthosa (also gingivostomatitis herpetic or oral rot ). If aphthous ulcers occur frequently ( recurrent ), one speaks of chronic recurrent aphthosis .

Causes of recurrent aphthosis

The causes ( etiology ) and mechanism ( pathogenesis ) of recurrent aphthosis are largely unclear. Bacteria , in particular streptococci , were discussed as triggers , but they were classified as unlikely. Likewise were viruses discussed as the cause, in particular adenoviruses and herpes viruses type 1 to 6, but no correlations were found here so far.

An emergence due to several influencing factors, including a genetic nature, is assumed. A familial accumulation of recurrent aphthae is observed in 30–40% of patients. What is certain, however, is that gluten can be a trigger for an existing celiac disease . Possible factors associated with aphthae are injuries to the oral mucosa , various foods, especially those containing histamine (walnuts, hazelnuts, nut chocolate, tomatoes, (blue) cheese, spicy foods, citrus fruits, alcoholic beverages), nutritional deficiencies ( vitamin B 12 -, iron or folic acid deficiency ), reduced acidity of gastric juice (subacidity) and changes in the hormonal balance. In severe cases, systemic diseases such as inflammatory bowel disease , Behçet's disease or HIV infections can be the cause.

No connection to the menstrual cycle , pregnancy or menopause is seen. Stress as a cause has been discussed for decades and has now been proven to be one of the influencing factors. Chemical irritation from ingredients such as sodium lauryl sulfate (SLS), which is often found in toothpaste , is discussed as a possible trigger. Smokers are less affected than non-smokers; The keratinization of the skin ( hyperkeratosis ) caused by smoking is considered to be a possible cause .

Clinical picture

Aphthe on the inside of the lower lip
Several large aphthae on the soft palate
Aphthous ulcers on the tongue

Smaller aphthous ulcers ( minor form ) have a diameter of less than one centimeter and they heal within one to two weeks. However, rare aphthae with a diameter of over one centimeter to about 30 mm and more have also been reported. These larger aphthae are of the major form , which can persist for weeks to months and heal with scarring. A large number of small aphthae appear in herpetiform ulcers, but this form is rare. It occurs acutely and very rarely relapses.

How painful aphthae are varies greatly from person to person. Aphthous ulcers can be very painful; if they are more severe, daily lifestyle is often significantly impaired. Talking, eating, swallowing water, or saliva is painful. The size of aphthous ulcers is often not a factor in the level of pain they cause. Rather, the place in the mouth where the aphtha occurs is decisive. For example, a relatively small aphtha with a diameter of a few millimeters that occurs on the tip of the tongue can be much more painful than a larger one that occurs in a mechanically less stressed place in the mouth (e.g. in the central cheek tissue). In a few cases, aphthae that are almost non-painful also occur.

Diagnosis

The diagnosis of recurrent aphthosis is based on the medical history and clinical picture, as specific laboratory tests are not available. In addition to the medical history, various laboratory parameters can help identify underlying diseases (immune diseases, infections, deficiencies).

treatment

In addition to local treatment, the treatment of systemic diseases is a priority. A causal therapy for recurrent aphthous ulcers without an underlying systemic underlying disease is not yet known. Antibiotics , antivirals or the administration of gamma globulins had no effect.

For the symptomatic treatment of aphthae, pain relievers such as lidocaine , polidocanol or benzydamine are used; Sprays, gargle solutions and gels or ointments (adhesive ointments for the oral mucosa) are available for therapy. Also, astringent agents such as rhubarb root extract , myrrh tincture , silver nitrate , Phenolsulfonsäureverbindungen and cresolsulfonic polycondensate policresulen are applied; their astringent or corrosive effect is said to accelerate healing by repelling dead tissue. Zinc sulphate and diluted hydrogen peroxide solution have a similar effect ; the latter also has a slightly antiseptic effect . If an infectious cause has been ruled out, the anti-inflammatory, prescription- only triamcinolone acetonide can be used , for example, as an ointment.

Folk medicine uses anti-inflammatory agents such as tea tree oil , lemon balm extract and rinses with chamomile and sage tea .

A mixture of sulfonated phenols and sulfuric acid reduces the discomfort caused by aphthae by dissolving the biofilm by means of dehydration . It is applied locally by the dentist using a blunt cannula . There are also applicators available for self-application.

Bednar aphthae

Bednar aphthous ulcers (named after the Austrian doctor Alois Bednar , 1816–1888) are the ulcerations of the oral mucosa that occur in infants during the first few months of life , mostly on the hard palate . Suckers caused by wiping the mouth are also included. They are caused by microtraumas. Bednar canker sores heal spontaneously. These are false aphthae that are similar to aphthous ulcers, but are not viral.

literature

(in chronological order)

  • Julius Basch: The aphthous disease and its treatment. In: German Medical Weekly . 54th year. Georg Thieme Verlag, Stuttgart 1928, ISSN  0012-0472 , pp. 1206-1208.
  • Rudolf Haensch: Chronically recurrent aphthosis. In: Archives for Dermatology and Syphilis . Volume 195. Springer, Heidelberg 1953, ISSN  0365-6020 , pp. 362-381.
  • Pierluigi Coli, Mats Jontell, Magnus Hakeberg: The Effect of a Dentifrice in the Prevention of Recurrent Aphthous Stomatitis. In: Oral Health Prev Dent. Volume 2, No. 2, 2004, pp. 133-142 ( PDF , English).
  • Andreas Altenburg, Nadine El-Haj, Christiana Micheli and others: Treatment of chronically recurrent oral aphthae. In: Deutsches Ärzteblatt . Volume 111, issue 40. Deutscher Ärzte-Verlag, Cologne 2014, ISSN  0012-1207 , pp. 665–673 ( online ; PDF ).
  • Aphthous mucosal diseases. In: Atlas of Pediatric Dermatology. Wiley-VCH Verlag, Weinheim 2018, ISBN 978-3-527-33774-3 , pp. 479-485.

Web links

Commons : Aphthe  - collection of images, videos and audio files
Wiktionary: Aphthe  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ A b c d Konrad Bork, Walter Burgdorf, Nikolaus Hoede: Oral mucous membrane and lip diseases: Clinic, diagnostics and therapy; Atlas and manual; with 37 tables . Schattauer Verlag, 2008, ISBN 978-3-7945-2486-0 , p. 60–.
  2. ↑ Peter A. Reichart: Chronically recurrent aphthae . In: DZZ - German Dental Journal . tape 60 , no. 6 , 2015 ( dgzmk.de - Scientific opinion of the German Society for Dentistry, Oral and Maxillofacial Medicine ).
  3. ↑ a b c d e Crispian Scully, Meir Gorsky, Francina Lozada-Nur: The diagnosis and management of recurrent aphthous stomatitis: a consensus approach . In: Journal of the American Dental Association . No. 134 , February 2003, p. 200–207 ( grahamazon.com [PDF; accessed February 16, 2016]).
  4. ↑ Aphthous ulcers and aphthoid lesions of the oral mucosa: diagnosis and treatment options. Registered guideline project, AWMF; Retrieved August 4, 2015.
  5. ↑ a b W. C Gonsalves, A. C Chi, B. W Neville: Common oral lesions: Part I. Superficial mucosal lesions . In: Am Fam Physician . tape 75 , no. 4 , 2007, p. 501-507 , PMID 17323710 ( aafp.org - review).
  6. ^ BE McCartan, A. Sullivan: The association of menstrual cycle, pregnancy, and menopause with recurrent oral aphthous stomatitis: a review and critique. In: Obstet Gynecol. 80 (3 Pt 1), Sep 1992, pp. 455-458. PMID 1495706 .
  7. ↑ A. Pedersen: Psychologic stress and recurrent aphthous ulceration. In: J Oral Pathol Med . 18 (2), 1989, pp. 119-22. PMID 2746521 .
  8. ↑ R. Handa: A study to evaluate the impact of examination stress on recurrent aphthous ulceration in professional college students in Jaipur district. In: Minerva Stomatol. 61 (11-12), 2012, pp. 499-507. PMID 23207675 .
  9. ↑ SL Zunt: Recurrent aphthous stomatitis. In: Dermatologic Clinics . Volume 21, Number 1, January 2003, pp. 33-39, ISSN  0733-8635 . PMID 12622266 .
  10. ↑ Zuzanna Ślebioda, Elżbieta Szponar, Anna Kowalska: Etiopathogenesis of Recurrent Aphthous Stomatitis and the Role of Immunologic Aspects: Literature Review . In: Arch Immunol Ther Exp (Warsz), 2014, 62 (3), pp. 205-215, PMC 4024130 (free full text).
  11. ↑ RS Rogers: Recurrent aphthous stomatitis: clinical characteristics and associated systemic disorders. In: Semin Cutan Med Surg. 16 (4), Dec 1997, pp. 278-283. PMID 9421219 .
  12. ↑ netdoktor.at GmbH (Ed.): Recurrent oral aphthae . ( netdoktor.at [accessed on April 26, 2017]).
  13. ↑ MR Alidaee, A. Taheri, P. Mansoori, SZ Ghodsi: Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial. In: Br J Dermatol . 153 (3), Sep 2005, pp. 521-525. PMID 16120136 .
  14. ^ SR Porter, K. Al-Johani et al. a .: Randomized controlled trial of the efficacy of HybenX in the symptomatic treatment of recurrent aphthous stomatitis. In: Oral diseases. Volume 15, Number 2, March 2009, pp. 155-161, ISSN  1601-0825 . doi: 10.1111 / j.1601-0825.2008.01503.x . PMID 19207485 .
  15. ↑ EP 1 587 477 B1 (PDF) European Patent Office.
  16. ↑ Safety data sheet HybenX ( Memento from April 13, 2014 in the Internet Archive ) (PDF)
  17. ↑ Norbert Schwenzer: Tooth-mouth-jaw medicine: Dental surgery . Georg Thieme Verlag, 2000, ISBN 3-13-116963-X , p. 234–.