Which physical findings are characteristic of aphthous stomatitis (canker sore)?

Updated: Sep 25, 2020
  • Author: Ginat W Mirowski, MD, DMD; Chief Editor: William D James, MD  more...
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Answer

Regardless of the clinical form of recurrent aphthous ulcer, ulcers are confined to the nonkeratinized mucosa of the mouth, sparing the dorsum of the tongue, the attached gingiva, and the hard palate mucosae, which are keratinized unless the patient is HIV positive. Although patients may have submandibular lymphadenopathy, fever is rare. Most patients are otherwise well. Different gradations and their findings are as follows:

  • Recurrent aphthous ulcer minor (see image below): Recurrent aphthous ulcer minor is characterized by discrete shallow ulcers smaller than 1 cm in diameter. The ulcers are covered by a yellow-gray pseudomembrane (fibrinous exudate) and are surrounded by an erythematous halo.

  • Minor aphthous ulcer: Small superficial oval erosi Minor aphthous ulcer: Small superficial oval erosions with yellow pseudomembrane and an erythematous border are evident on the labial aspect of the left lower lip.
  • Recurrent aphthous ulcer major (see image below): Recurrent aphthous ulcer major is characterized by oval ulcers that are larger (>1 cm in diameter; often 2-3 cm) and deeper than those observed in recurrent aphthous ulcer minor. The ulcers may coalesce and often have an irregular border.

  • Major aphthous ulcer: Large oval ulcer with white Major aphthous ulcer: Large oval ulcer with white pseudomembrane and raised red border located on the right upper labial mucosa adjacent to the buccal commissure. Note the irregular margin so typical in major aphthae.
  • Herpetiform recurrent aphthous ulcer (see image below): Herpetiform recurrent aphthous ulcer is characterized by crops of smaller ulcers; tens of ulcerations may be present in clusters. The ulcers can coalesce to produce a widespread area of irregular ulceration.

  • Herpetiform aphthous ulcer: Grouped and single tin Herpetiform aphthous ulcer: Grouped and single tiny white to yellow ulcers scattered on the labial mucosa and on the ventral aspect of the tongue.

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