APHTHOUS ULCER

Chapter XII STOMATOLOGICAL DISEASES

APHTHOUS ULCER GENERAL CONSIDERATION
 An aphthous ulcer is a shallow mucosal ulcer with flat, fairly even borders surrounded by erythema. The ulcer is often covered

with a pseudomembrane. It has never been adequately demonstrated that this lesion is due to a virus or any other specific

chemical, physical or microbial agent. One or more ulcers may be present, and they tend to be recurrent.
     It is called oral ulcer in traditional Chinese medicine, and is usually caused by upward steaming of the stomach heat.
CLINICAL MANIFESTATIONS
     They are often painful; nuts, chocolates, and irritants such as citrus fruits often cause flare-ups of aphthous ulceration, but

abstinence will not prevent recurrence. Stresses of various types have also been shown to be contributory. Aphthous ulcer may be

associated with inflammatory bowel disease, Behcet's syndrome, infectious mononucleosis and prolonged fever. The diagnosis

depends mainly upon ruling out similar but more readily identifiable disease, a history of recurrence, and inspection of the ulcer.
DIAGNOSIS
     • The aphthous ulcer is usually recurrent.
     • Inspection of the ulcer. The ulcer is a shallow mucosal ulcer with flat, fairly even borders surrounded by erythema.
     • The diagnosis depends mainly upon ruling out similar but more readily
identifiable disease.
TREATMENT
I. Management in Western medicine.
     Bland mouth rinses and hydrocortisone--antibiotic ointment reduce pain and
encourage healing. Hydrocortisone in an adhesive base (orabase) has been particularly useful. Sedatives, analgesics and vitamins

may help indirectly. Vaccines and gamma globulins have not proved significantly beneficial. Although caustics relieve pain by

cauterizing the fine nerve endings, they also cause necrosis and scar tissue. Systemic antibiotics are contraindicated. Systemic

corticosteroids in high doses for a short period of time may be very helpful for severe debilitating recurrent attacks.
     Healing, which usually occurs in 1 to 3 weeks, may be only slightly accelerated
by treatment. Occasionally, aphthous ulcers take the form of periadenitis, in which
they are larger, persist sometimes for months, and may leave a scar. This form can
be confused with carcinoma.
II. Management in traditional Chinese medicine.
     Oral ulcer is thought to be caused by excessive heat in the stomach, with the
manifestations such as polydipsia, preference for cold drinks, fetid breath, ulceration of the mouth, swelling and pain of the gums,

burning sensation of the epigastrium, scanty dark urine, constipation, red tongue with thick yellowish coating. The principle of the

treatment is to dissipate heat and detoxify the body, and the most effective formula often prescribed is Qing Wei San Jia Jian.
     Constituents:
     Skunk bugbane  12g
     Chinese goldthread  10g
     Chinese angelica  15g
     Fresh and dried root of rehmannia  30g
     Root-bark of peony  15g
     Gypsum  30g
     Dyers woad root 30g
     Dyers woad leaf 30g
     Honeysuckle flower  30g
     Root-bark of peony  15g
     Root of Zhejiang figwort  30g
     Skullcap  12g
     Decoction and dosage. All the above herbs are put together into a boiler to be simmered twice and then the broth of each

mixed, half of the mixed broth each time, twice a day. Two to four doses are prescribed.