Aphthous Ulcer, its Aetiology and Pre-disposing Factors

Recurrent Aphthous Stomatitis: (Aphthous ulcers: Aphthae: canker sores)

Recurrent Aphthous Stomatitis is an unfortunately common disease characterized by the development of painful, recurring solitary or multiple of the oral mucosa.

Because of the similarity between this disease and herpes simplex infection with respect to precipitating factors leading to development of lesions, certain aspects of the clinical appearance of lesions, duration of lesions, chronic recurrence and general failure of response to any form of therapy, the two diseases have been generally confused until only a short time age.

A series of intense investigation over the past few years have conclusively established the fast that there is no etiologic relationship between recurrent Aphthous Stomatitis and herpes simplex infection.

It is discussed in this section and at this point only because of its similarity to the viral disease etiology .Numerous possible etiologic factors have been suggested in the interesting history of recurrent Aphthous Stomatitis and these have been adequately reviewed by ship and this group and, more recently, in the workshop.

BACTERIAL INFECTION:

The work of Barile, of Graykowski and of Stanley a few years ago very strongly implicated a pleomorphic, transitional L-form of an X- Hemolytic streptococcus, streptococcus sanguis, as the causative agent of the disease.

This organism has been consistently isolated from the lesions of patients with typical Aphthous ulcers, and microorganisms morphologically consistent with the L – Form streptococcus have been found histologically I the vast majority of Aphthous lesions. Once again, it should be emphasized that the herpes simplex virus cannot be isolated from these Aphthous ulcers.

The administration of this pleomorphic streptococcus to guinea pigs and rabbits has produced lesions of the skin and the oral mucosa which appear clinically and histologically similar to Aphthous ulcers in the human.

Finally, the work of Graykowski and his associates has shown that patients with recurrent Aphthous . Thus, there is some evidence for this disease being an immunologic hypersensitivity reaction to an L – form streptococcus.

Precipitating Factors

A variety of situations have been repeatedly identified immediately preceding the outbreak of Aphthous ulcers in relatively large numbers of patients.

TRAUMA: The traumatic incidents included self – inflicted bites, oral surgical procedures, tooth brushing, dental procedures, needle injections and dental trauma.

ENDOCRINE CONDITIONS : It has been recognized for many years that a time relationship exists between the occurrence of the menstrual period and the development of Aphthous ulcers.

Most series show that the incidence of Aphthae is greatest during the premenstrual period. It has been reported that women may have remission of their Aphthous lesions during pregnancy but show eruptions following parturition, sometimes very rapidly , on rare occasions, the upset of the diseases has been associated with menarche and menopause.

PSYCHIC FACTORS: The role of psychic factors in certain oral disease is well recognized. In cases of Aphthous ulcers, acute psychological problem appears many times to have precipitated attacks of the disease, although this is a difficult factors to analyze.

ALLERGIC FACTORS: Many patients with recurrent Aphthous ulcers have a history of asthma, hay fever or food or drug allergies. This may be purely fortuitous finding because of the high incidence of allergies in the general population .

How ever the outbreak of Aphthae following the use of certain foods or drug in the same patients had been reported so frequently that allergy must be considered a precipitating factors .

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About Aphthous Ulcer, its Aetiology and Pre-disposing Factors