An apthous ulcer is the most common ulcerative condition of the oral mucosa, and presents as a painful punched-out sore on oral or genital mucous membranes. They are also called apthae, apthosis, apthous stomatitis and canker sores.


  • Emotional stress and lack of sleep
  • Mechanical trauma, for example, self-inflicted bite
  • Nutritional deficiency, particularly of vitamin B, iron, and folic acid
  • Certain foods, including chocolate
  • Certain toothpastes; this may relate to sodium laureth sulphate (the foaming component of toothpaste)
  • Menstruation
  • Certain medications, including nicorandil, given for angina
  • Viral infections.


An aphthous ulcer is typically a solitary round or oval punched-out sore or ulcer inside the mouth on an area where the mucosa is not tightly bound to the underlying bone, such as on the inside of the lips and cheeks or underneath the tongue. Aphthous ulcers can also affect the genitalia in males and females.
Recurrent aphthous ulcer usually begins as a round yellowish elevated spot surrounded by a red halo. This then breaks down into a punched-out ulcer, which is covered with a loosely attached white, yellow, or greyish membrane. Surrounding tissue is healthy and unaffected. The ulcer can be painful, particularly if irritated by movement or eating certain types of food such as citrus fruit.


  • Apthous ulcer mostly heals in 1 or 2 weeks
  • Protective pastes that form a barrier over the ulcer so that exposure to irritating substances is reduced.
  • Superficial tissue cauterisation using silver nitrate stick.
  • Local anaesthetics benzocaine and lignocaine (lidocaine) to reduce pain.
  • Medicated toothpaste without sodium laureth sulphate.
  • Antibacterial mouthwashes to reduce secondary infection.
  • Avoidance of foods that trigger or exacerbate the ulcers.
  • Treatment of an associated condition or underlying cause, for example –
  • Dietary supplements of vitamins or minerals, if the diet is inadequate or a deficiency is identified.
  • Reduction in stress.
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