Aphthae: causes and treatment

Aphthae: causes and treatment

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Aphthae or French Aphthae can be observed as damage to the mucous membranes in the mouth and throat in connection with various diseases, although the processes leading to the formation of the aphthae remain largely unclear to this day. Since the aphthae can be accompanied by intense pain, especially when eating, but also when speaking and swallowing one's own saliva, the quality of life of those affected is often significantly reduced. In addition, the vesicles pose no particular health threat.


Aphthae are damage to the mucous membrane structures in the mouth and throat, which are usually recognizable as lens-sized, whitish ulcers on the gums, tongue, tonsils (tonsils) or in the oral cavity. It shows a reddish, inflamed border to the healthy mucosa. A regular or repeated occurrence is described as chronic recurrent aphthosis. Sometimes the term is also used for comparable ulcers of the mucous membranes in the genital area, which are not considered in this article.

Depending on their size, the damage to the mucous membranes can be divided into so-called “minor aphthae” (form a large part of the aphthae; reach a maximum size of one centimeter) and “major aphthous ulcers” (rather rare; reach a diameter of up to three centimeters and more ) differentiate. A special, very rare form are the so-called herpetiform aphthae, which are recognizable as a multitude of small blisters on the edge of the tongue and remind of the appearance of a herpes infection.


Depending on their location and number, the canker sores can lead to different levels of pain. If they are in places that are subject to high mechanical stress, they are usually associated with significantly greater impairments than, for example, an ulcer on the inside of the cheek. The general rule is: the more that form, the more severe the pain. In particular, acidic, but also hot and dry or rough dishes lead to an extremely unpleasant burning sensation on contact. This burning sensation in the mouth can not only occur while eating, but can also be seen when swallowing or speaking.

The aphthae are usually relatively small with a diameter of a few millimeters (minor aphthae), but in rare cases can also develop into larger ulcers with a diameter of several centimeters (major aphthae). While the smaller ulcers usually heal within around two weeks even without medical care, the healing of the major aphthae can take significantly longer periods of time and scars often remain afterwards in the area of ​​the mucous membrane.

Due to the pain of eating and drinking, they often result in refusal to eat, especially in young children. This can lead to a lack of fluids (dehydration) or other deficiency symptoms and should therefore not be taken lightly. A visit to the doctor is therefore strongly recommended in the event of refusal to eat.


The diagnosis is usually based on the typical appearance of the mucosal damage and the accompanying symptoms that can be observed. A smear from the affected mucous membrane can provide information about any infections that may be present and a blood test can be used to determine the underlying systemic diseases if in doubt.


Infections with (herpes) viruses or bacteria are often the cause of the development of symptoms, but other factors can also lead to the occurrence of mucosal damage. For example, aphthous ulcers are more common in patients with deficiency conditions such as iron deficiency or vitamin B12 deficiency. Injuries to the oral mucosa can also promote development. Hormonal fluctuations or impairments are also mentioned as possible causes in the medical literature. There is also a connection with digestive problems. In addition, aphthae are a possible side effect in severe systemic diseases such as Crohn's disease (inflammatory bowel disease), Behçet's disease (rare autoimmune disease) or AIDS. Gluten intolerance (celiac disease) is also a possible cause of the formation of aphthae. The sodium lauryl sulfate often contained in toothpaste is also suspected as a risk factor.

The most well-known form of an increased formation of aphthae in the mouth and throat is the so-called mouth rot, which is due to an infection with viruses of the genus Herpes simplex type 1. In the initial stage, patients initially suffer from fever and swelling or aphthae in the area of ​​the gums. The ulcers can spread more and more in the further course and occur almost in the entire mouth and throat. At the same time, there is usually a clear lymph node swelling in the area of ​​the neck and an unpleasant bad breath. In the course of the so-called hand-foot-mouth disease, usually triggered by the Coxsackie virus, aphthae can also be expected. The main symptom of the disease is an itchy rash on the hands, feet and mouth, which is characterized by noticeable blisters.


In most cases, the blisters heal within around two weeks even without medical care and targeted therapy is not possible based on current knowledge. However, various therapeutic measures can bring about a significant relief from the complaints, so that those affected are burdened by the aphthae in their everyday life much less. Here, conventional medicine often uses external pain relievers. These are used as a gel, mouthwash or ointments. If the symptoms are based on a viral infection, antiviral drugs are sometimes used to accelerate the healing process. Overall, however, those affected are primarily dependent on their self-healing powers and the medical measures can only have a supportive or soothing effect. The same applies to naturopathic approaches, which are then presented in more detail.

Naturopathy for aphthae

To support the healing process, various medicinal plants are used in naturopathy. For example, cold tea made from arnica flowers, chamomile flowers and / or sage leaves is used because of its anti-inflammatory effect. The cold tea is also suitable for mouthwashes. Dilute tinctures from echinacea are also used as mouthwashes for aphthae. This also applies to tea tree oil and lemon balm extracts. From the area of ​​homeopathy, Borax and Potassium Chloratum are available for treatment. They should enable healing to take place within a short time. Furthermore, the so-called oil pulling (mouthwash with cold-pressed, high-quality sunflower or sesame oil) is said to have a positive effect on aphthae.

However, the naturopathic procedures described serve - like the conventional medical approaches - only to alleviate the symptoms. The causes of chronic recurrent aphthae cannot be remedied with their help. In naturopathy, for example, measures that generally strengthen the immune system counteract such a tendency to education. The so-called constitutional treatment from the field of homeopathy, for example, is suitable for this. Which measures still apply depends on the patient's individual symptoms. The choice of suitable measures should be left to experienced therapists to avoid possible adverse effects. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Editor, Barbara Schindewolf-Lensch


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