I have oral ulcers again, and I can’t eat spicy food anymore.
Also known as “mouth ulcers“, it is a very common oral mucosal disease.
Occurs mainly on the soft palate, inner lip, and tongue,
Congestion of ulcers and central mucosa
Do you think that common oral ulcers are just oral ulcers?
It may be the oral manifestation of other diseases!
common mouth ulcers
Recurrent aphthous stomatitis (RAS), also known as recurrent oral ulcers, recurrent aphthous ulcers, burning pain is its prominent feature, the appearance is single or multiple round or oval ulcers of different sizes, covering the surface Gray-white or yellow pseudomembrane with a central depression and clear border, and the surrounding mucosa is red and slightly swollen. It has the characteristics of periodicity, recurrence, and self-limiting, and the age is not limited. The age of onset is estimated to be between 10 and 20 years old, and there are more women. It can occur all year round and can heal itself in about 10 days.
Ulcers associated with other diseases
Severe patients with frequent ulcer attacks, such as multiple times a month, ulcers larger than 1 cm, and long healing time, should seek medical attention in time. Many systemic diseases may manifest as repeated oral ulcers that do not heal easily, and beware of the “warning lights” of other diseases. Among them, the most common diseases are rheumatic immune system diseases and digestive system diseases, as well as malignant tumors.
* Chronic gastritis, gastroduodenal ulcers, constipation, hemorrhoids and other gastrointestinal diseases, the incidence of recurrent oral ulcers will increase significantly.
This is because the mucosal structure of the human body is similar, and the main lesions of chronic gastritis, gastroduodenal ulcer and other diseases are in the mucosa of the digestive tract. At the same time, the oral mucosa is also relatively “fragile”.
Another important reason why patients with gastrointestinal diseases are prone to recurrence of oral ulcers is that the disease affects the body’s absorption of vitamins.
* herpetic stomatitis
Infants and young children frequently, with systemic symptoms, fever, chills and so on. Small clusters of vesicles appear in the mouth, which quickly rupture to form clusters of small superficial ulcers. May be located on keratinized and non-keratinized mucosa, with red and swollen gums.
Severe pain, swollen submandibular lymph nodes. Taking smears, ballooning cells, multinucleated giant cells and intranuclear inclusions were seen.
* Stomatitis caused by herpes zoster virus
It is caused by the varicella-zoster virus. It is more common in middle-aged and elderly people, and it is usually the first onset. Facial lesions occur in the distribution area of the trigeminal nerve, with severe pain, clustered or scattered blisters, and can merge with each other. Ulcers form after the blisters of the oral mucosa are ruptured, and scabs form after the blisters of the skin are ruptured.
*necrotizing sialometadysplasia
Cause unknown. It is generally believed that infarct necroinflammation occurs due to ischemia. Occurs on the palate, especially at the junction of the hard and soft palate (90%) – crater-like ulcers with clear boundaries. There is granulation tissue on the ulcer surface, and the edge is raised. Ulcers are 1-3cm in diameter and usually heal within 4-10 months. Ulcers can go deep to the bone surface, but no bone destruction is seen on X-ray.
*Wright syndrome
Wright syndrome refers to an inflammatory disease with the triad of arthritis, urethritis, and conjunctivitis, which may be associated with oral ulcers and purulent keratoderma, which can manifest as superficial oral ulcers, initially blisters, Gradually develop into superficial, mostly painless.
*Inflammatory bowel disease
Oral ulcers in ulcerative colitis (UC) are uncharacteristic.
Oral ulcers are more common in Crohn disease (CD), and in addition to RAS manifestations, it can also have painful oral ulcers, as well as gum ulcers.
*systemic lupus erythematosus
The mucosal damage of SLE is mainly manifested as oral ulcers. The typical lesions are small spots on the buccal mucosa, gums, and upper palate, which gradually develop into superficial painful ulcers. Ulcers can also occur in other parts such as the nasal septum mucosa and the perineal mucosa.
*PFAPA (Cyclic Fever – Aphthous Stomatitis – Pharyngitis – Lymphadenitis)
It presents with periodic fever with oral ulcers, pharyngitis, and lymphadenitis, with a recurrence pattern of approximately once a month.
*Behcet’s disease
Recurrent mouth ulcers are most commonly seen in Behçet’s disease. Behçet’s disease is a disease characterized by the triad of oral ulcers, vulvar ulcers, and ocular lesions as the main clinical symptoms. In addition, Behçet’s disease may also involve the digestive tract, resulting in ulcers in various parts of the digestive tract. Bleeding and perforation of digestive tract ulcers are important reasons for the poor prognosis of Behcet’s disease.
*Sjogren’s syndrome
Sjögren’s syndrome is a chronic autoimmune disease that invades exocrine glands, especially salivary glands and lacrimal glands. Patients will experience recurrent painful oral ulcers, accompanied by severe dry mouth and dry eyes. Symptoms of multi-system damage can also occur due to the involvement of other exocrine glands and other organs outside the glands, such as pulmonary interstitial fibrosis, anemia, leukopenia, renal tubular acidosis, and purpura.
*A20 haploinsufficiency
The clinical phenotype of HA20 is variable and covers a variety of manifestations of autoimmune and autoinflammatory diseases. Therefore, clinicians need to have sufficient awareness of screening before genetic diagnosis. Like Behçet’s disease, the clinical manifestations of HA20 include oral ulcers, genital ulcers, pseudofolliculitis-like, erythema nodosum and other rashes, bilateral uveitis, and changes in central nervous system vasculitis.
*Cyclic agranulocytosis
At the same time of agranulocytosis, can be accompanied by oral ulcers, fever, pharyngitis, dysphagia and sepsis.
*Hyperimmunoglobulin D syndrome
A rare autosomal recessive disorder characterized by recurrent fever. Some patients may develop oral ulcers or genital ulcers.
* cancerous ulcer (malignant ulcer)
Malignant tumors can occur anywhere in the oral mucosa. Common tongue cancer, cheek cancer, soft palate cancer, malignant granuloma and so on. *Other diseases that cause mouth ulcers
In fact, many diseases can cause oral ulcer-like lesions. For example, tuberculosis, syphilis, AIDS, Yersinia infection, typhoid, paratyphoid, etc.
It can be seen that ulcers on the oral mucosa can be a common manifestation of many diseases, which requires analysis and differential diagnosis based on medical history, clinical manifestations and a series of examinations. On the premise of multidisciplinary comprehensive diagnosis and treatment, reasonable diagnosis and treatment suggestions should be given for systemic diseases that cause oral ulcers, so as to achieve early diagnosis and early treatment, so as to improve the prognosis.
Reference: [1] Fatahzadeh M. Recurrentoral herpes: diagnosis & management. JNJ Dent Assoc, 2012, 83(4): 24-26.
[2] Professional Committee of Oral Mucosal Diseases of Chinese Stomatological Association, Professional Committee of Integrated Traditional Chinese and Western Medicine of Chinese Stomatological Association, Zhou Gang. Guidelines for the diagnosis and treatment of recurrent aphthous ulcers (trial) [J]. Chinese Journal of Stomatology, 2012, 47( 7): 402-404.
[3] Siu A ， Landon K ， Ramos D M . Differential diagnosis andmanagement of oral ulcers.[J]. Seminars in Cutaneous Medicine & Surgery，2015， 34(4)：171.
