Aphthous Ulcers: A Deeper Dive
Minor Aphthous Ulcer Photo source Hygiene Edge
Idiopathic is a term that may come to mind when we think of an aphthous ulcer as they seem to arise with no rhyme or reason. Our patients often ask us how to avoid getting them altogether and we are often left wishing there was something we could suggest for prevention. Yet, in the end we tell our patient something like, “I am sorry, I wish I had the secret to make it so you no longer get them.” While there may not be anything we can do to prevent them, we should ask ourselves if there could be an underlying systemic cause of the lesion. For example, there is evidence that links aphthous-like ulcers to other chronic diseases like Crohn’s Disease.
Minor Aphthous Ulcer Photo source Hygiene Edge
Have you ever had a patient that had an unusually large aphthous ulcer; possibly twice the size (> 1 cm in diameter) compared to the minor aphthous ulcer ( < 1cm) in image below? If so then this is categorized as a major aphthous ulcer. 1
One time I had a patient in my chair with a major aphthous ulcer on the palette that was about 1cm in diameter. I had recently been learning about aphthous ulcers in correlation to Irritable Bowel Disease (IBD), and more specifically Crohn’s Disease (CD). I asked the patient, who had not indicated anything regarding IBD on her health history, if she had ever had any issues with IBD. She told me she had been seeing doctors for the possibility of CD and she was shocked I even asked.
So the next time you see one or have a patient that gets them frequently ask yourself, does their health history indicate IBD or more specifically CD? If your patient does have CD, ask if they have any ulcers or other oral manifestations in their mouth during flare-ups.
An article from the Journal of Colitis and Crohn’s stated, “Oral manifestations such as oral aphthous ulcers are frequently associated with active disease and improve with the resolution of intestinal inflammation. Although oral manifestations can occur in both forms of IBD, it is more common in CD, with almost 50% of subjects reporting oral manifestations.” 2 Even though prevention of these lesions is not a current possibility, the ability to link them to a flare up of CD, can help a patient understand why they may be experiencing them.
Sarah Bateman, MEd, BSDH, RDH
Sources:
1. Amin, S., & All, R. (2018, October 3). Crohn's mouth ulcers: Symptoms, causes, and treatments. Medical News Today. Retrieved April 25, 2023, from https://www.medicalnewstoday.com/articles/323244
2. Hu, S., Mok, J., Gowans, M., Ong, D. E. H., Hartono, J. L., & Lee, J. W. J. (2022, May 2). Oral Microbiome of Crohn's Disease Patients With and Without Oral Manifestations. Academic.oup.com. Retrieved April 25, 2023, from https://academic.oup.com/ecco-jcc/article/16/10/1628/6577053
Note: Consent was given to use images.
Sarah has been a dental hygienist for eleven years and has been in the dental field for 17 years. She lives on a ranch with her husband and their little boy who is almost a year old! Sarah has worked private practice and was a clinical instructor and professor at the Utah College of Dental Hygiene for 8 years before she had her baby and moved to their dream ranch in Idaho! She still temps in private practice two times a month right now while enjoying baby cuddles!