This document provides an overview of aphthous ulcers, also known as canker sores. It discusses their other names, predisposing factors, pathogenesis, presentations as minor, major or herpetiform ulcers, diagnosis, differentials, associated systemic disorders, and treatment. The three main types are minor aphthae (Mikulicz ulcers), major aphthae (Sutton’s ulcers) and herpetiform aphthae (Cooke’s ulcers). Diagnosis involves meeting major and minor criteria. Aphthous ulcers can be associated with conditions like celiac disease and recurrent aphthous stomatitis. Treatment options are also covered.

1. DR RANDY CHANCE BMSC BDS

2. Outline

3. INTRO
(Lipschutz
ulcers)

6. OTHER NAMES
The term “aphthous” is derived from a Greek word “aphtha” which
means ulceration

7. It is commoner in:

8. Predisposing factors

9. Pathogenesis

13. Viral associations

14. • Characteristics of aphthous ulcers which are indicative of
infectious etiology include recurrent ulceration,
lymphocytic infiltration, perivascular cuffing, presence of
auto-antibodies, inclusion bodies in case of herpetiform
ulcers and similarity of RAS to viral ulcerative diseases in
animals.

15. Presentation
Minor
Major
Herpetiform

16. Minor aphthae (Mikulicz ulcers)

18. Major aphthae (Sutton’s ulcers)

20. Herpetiform aphthae (Cooke’s ulcers)
They recur so frequently that ulceration may be virtually
continuous.

22. • There could be more than one type in a patient but that would
herald an underlying systemic problem
• The usual combinations seen would be major + herpetiform and
may be the first sign of the disease in up to 75% of cases
• Sometimes the ulcerations can be the only sign of celiac disease
•Mikulicz>Cooke>Sutton

25. Pre-ulcerative stage is predominantly lymphocytic infiltrates with initial CD4
preponderance. Later CD8+ outnumbers CD4+. Mainly in a perivascular distribution

26. Diagnosis

27. Major criteria for diagnosis of RAU minor (Natah et al.[12] 2004)
Minor criteria for diagnosis of RAU minor
4 major and 1 minor

28. By Jan Polák - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16627492

29. Local differentials

30. Systemic disorders associated with aphthous-
like ulceration

31. Treatment