Mouth Aphthae: What They Are, Types of Ulcers, and Where They Come From

Woke up with an unpleasant feeling in your mouth, and there's a white spot that stings with every swallow? Most likely it's an aphtha: a small ulcer on the mucous membrane. Let's calmly sort out what it is, why it appears, and in which cases you shouldn't wait any longer.

What a mouth aphtha is and how it looks

An aphtha is a small superficial ulceration of the mucous membrane. It looks like a rounded erosion or a small ulcer of a yellowish-gray color with a bright red inflammatory rim: an aphtha has a red edge and a gray center. The pain makes chewing, swallowing, and speaking difficult.

The good news: most such ulcers heal on their own within one to two weeks, and aphthae within 5–7 days and without a scar. They are not considered contagious.

Why aphthae and mouth sores appear

A single ulcer is most often triggered by something that can be removed from your life. The most common causes:

• trauma: biting your cheek, braces rubbing, an ill-fitting denture, a rough filling or a sharp tooth edge, scratching your gum with a toothbrush, burning yourself with something hot;
• irritation: food that is too spicy, salty, or sour, a hard crust, very hot drinks, toothpaste with sodium lauryl sulfate;
• fatigue, stress, anxiety;
• lack of vitamins and minerals — iron, zinc, folic acid, vitamins B and D;
• medications (some nonsteroidal anti-inflammatory drugs, beta-blockers, nicorandil), hormonal changes, heredity, quitting smoking.

If there are several ulcers, this can be a symptom of other conditions: hand-foot-and-mouth disease (with a rash on the palms and soles), lichen planus (a white lacy pattern on the inner side of the cheeks), Crohn's disease and celiac disease, weakened immunity, for example with HIV or lupus. Aphthae can appear against the background of influenza, gastrointestinal diseases, and with the use of nicotine, including from e-cigarettes. Sometimes the cause is never found at all.

Where aphthae occur

Most often the sores are found on the inner side of the cheeks and lips, on the tongue itself, under the tongue, and deep in the mouth. There may be several at once. The gum can be scratched with a toothbrush — such an injury can also cause a sore.

An aphtha on the lip refers to the inner, mucous side. On the outside of the lip or around the mouth, herpes occurs: it starts with tingling, itching, or burning and may look like a group of small ulcers the size of a pinhead. These are different things, and they should not be confused.

Aphthae and mouth sores in children

In children, aphthae are often a standalone matter. Aphthae are accompanied by severe pain that makes chewing, swallowing, and speaking difficult, profuse salivation, and enlargement of the submandibular lymph nodes. Sores in the mouth also occur with viral infections and with hand-foot-and-mouth disease — in that case, look at the palms and soles. If the sores persist for longer than three weeks, the child is seen by a doctor.

Types of mouth ulcers: how an aphtha differs from others

An aphthous ulcer, or aphthous stomatitis, is rounded, with a red rim and a gray center, and is not considered contagious. Herpes is viral, appears on the lip outside or around the mouth, and starts with burning and tingling. An ulcer that does not heal for longer than three weeks, differs from your previous ones, has become larger, or has shifted closer to the throat is another matter: such ulcers sometimes turn out to be a sign of oral cancer, and they must be examined by a doctor. Separately, there are ulcers with lichen planus, with intestinal diseases, and with weakened immunity.

When a mouth ulcer should be shown to a doctor

The threshold is simple: three weeks. If the ulcer has not healed during this time, go to a dentist or family doctor. Also go if the ulcer bleeds, has become redder and more painful (this may indicate an infection), or if it does not look like the ones you had before. See a doctor if at the same time there are ulcers on the skin or genitals, or if joints hurt, redden, or swell.

At the appointment, the doctor will examine the ulcer, ask how long ago it appeared, what preceded it, and what medications you are taking. For severe, persistent, or infected ulcers, the doctor may prescribe stronger treatment — that is already their decision.

An aphtha by itself is not a reason to call an ambulance; 103 and 112 are for a life-threatening condition.

This material is for reference: it helps to understand what is happening but does not replace a doctor's consultation.

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