Recurrent painful oral ulcers in a young adult
21-year-old female
§Chief complaint
Mouth ulcers every few weeks for 3 years
§Medical & dental history
- 01Vegetarian diet
- 02Menstrual irregularity; no gastrointestinal symptoms
- 03No sharp teeth or appliances
§Clinical examination
- 01Three round shallow ulcers 4-6 mm with yellow-grey floors and erythematous haloes on non-keratinised mucosa
- 02No ulcers on the hard palate or attached gingiva
- 03No genital ulcers, no ocular symptoms, no skin lesions
- 04No lymphadenopathy or fever
§ figuresFigures (3)
Fig. 1A case of Aphthous stomatitis in my mouth
“Aphthous Stomatitis in the mouth” · RaydenAG · CC BY-SA 4.0 · Wikimedia Commons
Fig. 2Aphthous Stomatitis
“Aphthous stomatitisNZ” · DermNetNZ · CC BY 4.0 · Wikimedia Commons
Fig. 3Mouth ulcer associated with Aphthous stomatitis on the labial mucosa
“Aphthous stomatitis on the labial mucosa” · Farhan 9909 · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Recurrent Aphthous Stomatitis figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Minor recurrent aphthous stomatitis with iron deficiency
Confinement to non-keratinised mucosa, small size, recurrence and healing without scarring define minor aphthae. Absence of genital and ocular involvement excludes Behcet disease. Haematinic deficiency is the commonest correctable cause.
§Investigations
- 01Full blood count, ferritin, vitamin B12, folate — ferritin 6 ng/mL
- 02Coeliac serology (tTG-IgA) — negative
- 03No biopsy needed for typical aphthae
§Treatment plan
- 01Iron replacement and dietary advice
- 02Topical: chlorhexidine mouthwash, benzydamine, topical corticosteroid at prodrome
- 03Avoid SLS-containing toothpaste and known dietary triggers
- 04Systemic therapy only for severe, disabling disease
§Follow-up & outcome
- 01Ulcer frequency fell from fortnightly to twice yearly after 3 months of iron therapy
- 02Ferritin normalised at 6 months
§Clinical pearls / learning points
- 01Aphthae never occur on keratinised mucosa — an ulcer on the hard palate or attached gingiva is something else.
- 02Screen for haematinic deficiency and coeliac disease in every adult with recurrent aphthae.
- 03Any single ulcer lasting more than 3 weeks must be biopsied.
§References
- Scully C, Porter S. Oral mucosal disease: recurrent aphthous stomatitis.
§Similar cases
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