Aphthous Stomatitis vs Traumatic Ulcers: Clinical Differences, Symptoms, and Treatment Guidelines

✅ Abstract
Aphthous stomatitis and traumatic ulcers are two of the most frequent causes of painful oral ulcerations.

📌 Recommended Article :

PDF 🔽 Management of Angular Cheilitis in children ... Angular Cheilitis occurs more in children and it is caused by children sensitivity against certain contact agents like toys, foods, sunlight, allergy against medicines, cosmetics, and long term antibiotic treatment.

Despite their similar appearance, their etiology, pathophysiology, and management differ significantly. Accurate differentiation is essential for effective treatment and prevention of recurrence.

Advertisement


✅ Introduction
Oral ulcers affect a large portion of the population, often interfering with speech, eating, and oral hygiene. The most common types seen in clinical practice are recurrent aphthous stomatitis (RAS) and traumatic ulcers. While RAS is considered an immune-mediated inflammatory condition, traumatic ulcers result from mechanical, thermal, or chemical injury to the oral mucosa.

📌 Recommended Article :

Dental Article 🔽 How to Manage a Pediatric Patient with Oral Ulcers ... Common etiologies include aphthous stomatitis, viral infections (e.g., HSV-1, hand-foot-mouth disease), traumatic ulcers, and systemic diseases such as celiac or Behçet’s disease.

✅ Clinical Features

➤ Aphthous Stomatitis
▪️ Etiology: Multifactorial; includes genetic predisposition, stress, hormonal changes, nutritional deficiencies (B12, folate, iron), and hypersensitivity reactions.
▪️ Lesion Characteristics: Round or oval ulcers with a yellow-gray pseudomembrane and erythematous halo, typically found on non-keratinized mucosa (buccal, labial, ventral tongue).
▪️ Symptoms: Pain, burning sensation, and discomfort during eating or speaking.
▪️ Duration: 7–14 days, recurrent pattern.
▪️ Types: Minor, major, and herpetiform aphthae.

➤ Traumatic Ulcers
▪️ Etiology: Caused by mechanical irritation (biting, sharp tooth edges, orthodontic appliances), thermal burns, or chemical agents (aspirin, alcohol-based mouthwash).
▪️ Lesion Characteristics: Irregular borders, often surrounded by erythema; may be covered by a yellow fibrinous exudate.
▪️ Location: Usually on keratinized mucosa (tongue borders, palate, gingiva).
▪️ Symptoms: Localized pain and tenderness.
▪️ Duration: Heals within 7–10 days after removing the traumatic factor.

📌 Recommended Article :

PDF 🔽 Hereditary Gingival Fibromatosis in a pediatric patient - Characteristics and treatment ... Hereditary gingival fibromatosis is a rare, benign, genetic disorder characterized by progressive enlargement of the gingival tissue. It has no symptoms and can be generalized or localized.

📊 Comparative Table: Aphthous Stomatitis vs Traumatic Ulcers

Aspect	Aphthous Stomatitis	Traumatic Ulcers
Etiology	Immune-mediated; nutritional or stress-related factors	Mechanical, chemical, or thermal trauma
Lesion Characteristics	Round, yellowish ulcers with red halo, smooth borders	Irregular margins with erythematous border
Common Sites	Non-keratinized mucosa (labial, buccal, tongue)	Keratinized mucosa (palate, gingiva, tongue borders)
Duration	7–14 days; recurrent episodes	Heals within 7–10 days after removing irritant
Treatment	Topical corticosteroids, anesthetics, chlorhexidine	Removal of cause, anesthetics, healing gels
Recurrence	Frequent	Rare unless trauma persists

✅ Pharmacological Treatment

📊 Pharmacological Treatment in Adults

Condition	Medication	Dosage and Duration
Aphthous Stomatitis	Topical corticosteroid (Triamcinolone acetonide 0.1%)	Apply a thin layer 2–3 times daily until healing
—	Chlorhexidine 0.12% mouthwash	Rinse twice daily for 7–10 days
—	Topical anesthetic (Lidocaine 2% gel)	Apply before meals, up to 4 times daily
—	Systemic corticosteroid (Prednisone 20 mg/day)	For severe or major aphthae; taper over 5–7 days
Traumatic Ulcer	Topical anesthetic (Lidocaine 2%)	Apply as needed for pain relief
—	Hyaluronic acid gel	Apply 2–3 times daily for mucosal healing
—	Antiseptic rinse (Chlorhexidine 0.12%)	Rinse twice daily for 7 days

📌 Recommended Article :

Webinar 🔽 Webinar: Oral cancer: Risk factors, management, procedures and types of treatment ... Oral cancer is caused by an uncontrolled proliferation of cells in the oral mucosa. Neoplasms can be benign or malignant and occur mostly in men over 50 years of age.

📊 Pharmacological Treatment in Children

Condition	Medication	Dosage and Duration
Aphthous Stomatitis	Triamcinolone acetonide 0.025% paste	Apply 2 times daily after meals
—	Chlorhexidine 0.06% mouthwash or spray	Rinse or spray twice daily under supervision
—	Lidocaine 2% gel	Apply small amount, maximum 3 times daily
Traumatic Ulcer	Benzocaine 7.5% gel	Apply small amount 2–3 times daily
—	Hyaluronic acid spray	Apply twice daily to affected area

💬 Discussion
Differentiating between aphthous stomatitis and traumatic ulcers is crucial, as the former may be associated with systemic diseases such as Behçet’s syndrome, inflammatory bowel disease, or celiac disease. Traumatic ulcers, conversely, typically heal once the causal factor is removed.
Topical corticosteroids remain the mainstay treatment for aphthous ulcers, while barrier and healing agents suffice for trauma-induced lesions. Regular oral examinations and patient education on trauma prevention and nutritional balance play key roles in reducing recurrence.

✍️ Conclusion
Although aphthous stomatitis and traumatic ulcers share similar clinical manifestations, their etiology and management differ. A thorough clinical history and lesion evaluation are vital to determine the correct diagnosis. Topical corticosteroids are effective for aphthous ulcers, whereas eliminating the irritant is sufficient for traumatic ulcers.

📌 Recommended Article :

PDF 🔽 Oral cysts in newborns: Characteristics, diagnosis and treatment ... Oral mucosal cysts in newborns are classified according to their origin and location. In the case of neonates, oral alterations are difficult to detect by the clinician.

🔎 Recommendations

1. Encourage patients to maintain good oral hygiene and avoid trauma.
2. Evaluate for nutritional deficiencies in recurrent aphthous cases.
3. Use topical corticosteroids only under professional supervision.
4. Educate patients about non-irritant diets and stress management.
5. Reassess ulcers persisting beyond two weeks to rule out malignancy or systemic conditions.

📚 References

✔ Scully, C., & Porter, S. R. (2008). Recurrent aphthous stomatitis: current concepts of etiology, pathogenesis, and management. Journal of Oral Pathology & Medicine, 37(5), 283–293. https://doi.org/10.1111/j.1600-0714.2008.00651.x
✔ Woo, S. B., & Sonis, S. T. (2014). Recurrent aphthous ulcers: A review of diagnosis and treatment. Journal of the American Dental Association, 145(3), 288–295. https://doi.org/10.14219/jada.2013.30
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral & Maxillofacial Pathology (4th ed.). Elsevier Health Sciences.
✔ urge, S., Kuffer, R., Scully, C., & Porter, S. R. (2006). Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Diseases, 12(1), 1–21. https://doi.org/10.1111/j.1601-0825.2005.01143.x

📌 More Recommended Items

► Odontogenic Infections and Their Link to Systemic Diseases: What Should We Monitor?
► Differences and Relationship Between Leukoplakia, Erythroplakia, and Oral Lichen Planus
► Differential Diagnosis of Perioral Dermatitis: Clinical Insights and Management