Aphthous stomatitis: what it is, causes, where it occurs, and whether it is contagious

Painful mouth ulcers are a common reason for visiting a dentist or general practitioner. Usually this is aphthous stomatitis: small round ulcerations that heal on their own. Below is what is known about the causes, appearance, and timelines, so that a conversation with a doctor can be focused.

Aphthous stomatitis: what it is

Stomatitis is inflammation of the oral cavity and lips, in which the mucosa becomes red and single or multiple ulcers may appear. The aphthous form means the formation of aphthae: painful round ulcerations with a white or beige fibrin coating in the center and red inflamed mucosa around them. Such aphthae, as a rule, heal within 1–1.5 weeks without scars and rarely become chronic; ordinary mouth ulcers resolve on their own within one to two weeks. The mechanism is not fully understood: the immune system probably reacts to unrecognized molecules, and lymphocytes attack the area of the mucosa.

Causes of aphthous stomatitis

Among the causes are bacteria and viruses, microtrauma, burns, weakened immunity, and sometimes radiation sickness. Everyday triggers include biting the cheek, poorly fitting dentures, braces, rough fillings, injury from a toothbrush, fatigue, stress, hormonal changes, heredity, deficiency of iron, zinc, folic acid, vitamins B and D, taking certain medications, and smoking cessation. Poor hygiene and gastrointestinal diseases are also mentioned.

If there are several ulcers, the cause may be different:

• enterovirus infection with a rash on the hands and feet;
• lichen planus with a white lacy pattern on the inner side of the cheeks;
• Crohn's disease and celiac disease;
• weakened immunity due to HIV infection or lupus.

What stomatitis looks like: tongue, gums, palate, lip, and cheek

Most often aphthae appear on the inner side of the cheeks and lips; they can occur on the tongue, under the tongue, on the gums, on the palate, and closer to the back of the throat. An ulcer looks like a small round sore with a red edge and a gray or white center, and the surrounding mucosa appears inflamed. Photos from the internet can only give an approximate idea: the diagnosis is made on examination. In catarrhal stomatitis, the mucosa is swollen, with a white or yellow coating, and there may be bleeding gums and bad breath.

Aphthous stomatitis in adults and children

The causes (trauma, stress, hormonal changes, vitamin deficiency) are described in the same way for all ages. In advanced forms, especially in children, there may be multiple ulcers, fever, and worsening of general well-being.

Whether aphthous stomatitis is contagious and how it differs from herpetic stomatitis

Aphthous stomatitis is not contagious. Herpetic stomatitis is caused by the herpes simplex virus: vesicles appear, which burst after about three days, often with fever, drowsiness, gingivitis, and viscous saliva, and the illness lasts about eight days. A cold sore on the lips is also herpetic: it occurs on the lips or around the mouth and often begins with tingling, itching, or burning.

Recurrences and which doctor to see

Recurrent aphthous stomatitis means repeated episodes with the same signs. Diagnosis is based on examination: the doctor reviews the history, assesses the appearance of the ulcers, their location, and whether they recur; special tests such as biopsy or culture are not used. In aphthae, the tissue around the ulcer looks healthy, and there are usually no pronounced systemic symptoms. You should see a dentist or general practitioner if an ulcer persists for more than three weeks, differs from previous ones — larger, closer to the back of the throat — bleeds, or becomes more painful and redder, which can be a sign of infection. A long-healing ulcer is sometimes a sign of oral cancer. A separate reason is ulcers on the skin or genitals, or painful joints. For severe, persistent, or infected ulcers, the doctor discusses stronger treatment.

Aphthous stomatitis by itself is not a reason to call an ambulance. 103/112 — for life-threatening conditions, for example signs of stroke or heart attack, as well as after serious injury.

This material is for reference: it helps you understand what to ask the doctor, but does not replace a consultation — the decision on management remains with the patient and the dentist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer