You talk about Aphthous ulcerations, what is this and what causes it? What does it look like and which treatment is recommended? Thank you for taking time! /Stefan

Dear Stephan:

As much as we know about conditions within the oral cavity, the cause of aphthous ulcerations remain a mystery. We do know a great deal concerning the clinical presentation which would be an ulcer on non-keratinized or non-fixed tissues such as the floor of the mouth, buccal mucosa (cheek tissue, the area inside the mouth below the lips, etc) and the posterior oropharynx (the back of the throat). These ulcers are usually self limiting in immunocompetent people, in other words they will go away on their own in a few days, but in immunocompromised patients they can be more painful and last a very long time. Almost always they have a grey or yellow pseudomembrane surrounded by a halo of erythema (redness/inflammation).

The treatment we use at the Infectious Disease Program of Grady Health System is topical steroid rinses (Decadron elixir or Celestone syrup) for minor aphthous ulcerations. For major aphthous ulcers, we use systemic steroids. The advantage that steroid use has is the reduction of inflammation, which is the cause of pain.

For pain relief, depending on the size of the lesions, we use topical rinses such as Ulcerease or for more debilitating lesions we use systemic pain meds. A new product we are using is Soothe N' Seal, which protects the affected area like a band-aid.

I hope this information proves helpful.

Sincerely,

DR