Aphthous Ulcers, Emergency Medicine

Matthew R. Berkman Reviewed 06/2017
 


Basics

Description

Painful ovoid or round ulcerations on the mucous membranes of the mouth, tongue or genitals: 
  • Commonly referred to as “canker sores”

Etiology

  • Unknown

  • Etiology likely multifactorial with ...

Diagnosis

Signs and Symptoms

  • Minor aphthous ulcers:

    • 70–90% of all aphthae

    • <5 mm in diameter; up to 5 appear at a time

    • Painful, shallow ulcers with necrotic centers

    • Raised, circumscribed margins and eryt...

Treatment

Ed Treatment/Procedures

  • Treatment guided by severity and duration of symptoms

  • Goal is for symptomatic pain relief and reduction of inflammation.

Medication

  • Mild to moderate disease:

    • Avoid oral tr...

Follow-Up

Disposition

Admission Criteria

  • Unable to eat or drink after appropriate analgesia

  • Abnormal vital signs or evidence of dehydration

Discharge Criteria

  • Tolerating fluids

  • Adequate analgesia

  • Normal vita...

Pearls and Pitfalls

  • The vast majority of aphthous ulcers are benign, self-limited, and treated symptomatically

  • ED physicians must consider underlying systemic cause of ulcers.

Additional Reading

  • Akintoye  SO, Greenberg  MS. Recurrent aphthous stomatitis. Dent Clin North Am.  2005;49:31–47.

  • Brocklehurst  P, Tickle  M, Glenny  AM, et al. Systemic interventions for recurre...

Codes

ICD9

  • 528.2 Oral aphthae

  • 608.89 Other specified disorders of male genital organs

  • 616.50 Ulceration of vulva, unspecified

ICD10

  • K12.0 Recurrent oral aphthae

  • N50.8 Other specified disorders of male genit...

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