Aphthous ulcer causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2] José Eduardo Riceto Loyola Junior, M.D.[3]


The exact cause of aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid.



Trauma to the mouth is the most common trigger of aphthous ulcers and includes:[1][2][3]

  • Toothbrush abrasions
  • Laceration with sharp foods or objects
  • Accidental biting (particularly common with sharp canine teeth)
  • Dental braces


Common medications, that can result in recurrent aphthous stomatitis, include:

Genetic Factors

The role of genetic factors is the best-defined underlying cause of aphthous ulcer. Certain genetically specific HLAs which have been identified in aphthous ulcer patients include:[4]

  • HLA-A2
  • HLA-B5, B12, B44, B51, B52
  • HLA-DR2 and HLA-DR7
  • HLA-DQ series

Nutritional Factors

Aphthous ulcers are commonly seen in nutritional deficiencies. Low serum levels of following elements may result in recurrent aphthous ulcer:[5]

Allergic Factors

It is thought that aphthous ulcer may be caused by hypersensitivity to certain allergens such as:[6][7]

  • Environmental allergens
  • Food allergens
    • Milk
    • Chocolate
    • Cheese
    • Nuts
    • Tomatoes
    • Wheat

SLS containing Toothpaste

The large majority of toothpastes sold in the U.S. contain Sodium lauryl sulfate (SLS), which is known to cause aphthous ulcers in certain individuals.[8][9]

Microbial Factors

It is thought that aphthous ulcers may be caused by microbial factors such as:[10][11][12]

Systemic Disease

Common systemic conditions that may be caused in aphthous ulcer are include:[14][15]



  1. Herlofson BB, Barkvoll P (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontol Scand. 54 (3): 150–3. PMID 8811135.
  2. Herlofson BB, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study". Acta Odontol Scand. 52 (5): 257–9. PMID 7825393.
  3. Wray D, Ferguson MM, Hutcheon WA, Dagg JH (1978). "Nutritional deficiencies in recurrent aphthae". J Oral Pathol. 7 (6): 418–23. PMID 105102 PMID 105102 Check |pmid= value (help).
  4. Albanidou‐Farmaki, E., et al. "HLA haplotypes in recurrent aphthous stomatitis: a mode of inheritance?." International journal of immunogenetics 35.6 (2008): 427-432.
  5. Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991; 20: 389–91.
  6. Wray D, Vlagopoulos TP, Siraganian RP. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982; 54(4):388–95.
  7. Pacor ML, Di Lorenzo G, Martinelli N, et al. Results of double-blind placebo- controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis. Int Arch Allergy Immunol 2003;131(4):296–300.
  8. Herlofson BB, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study". Acta Odontol Scand. 52 (5): 257–9. PMID 7825393 PMID 7825393 Check |pmid= value (help).
  9. Herlofson BB, Barkvoll P (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontol Scand. 54 (3): 150–3. PMID 8811135 PMID 8811135 Check |pmid= value (help).
  10. Lindemann RA, Riviere GR, Sapp JP. Serum antibody responses to indigenous oral mucosal antigens and selected laboratory-maintained bacteria in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1985;59:585.
  11. Leimola-Virtanen R, Happonen RP, Syrjanen S. Cytomegalovirus (CMV) and Hel- icobacter pylori (HP) found in oral mucosal ulcers. J Oral Pathol Med 1995;24: 14–7.
  12. Pedersen A, Hornsleth A. Recurrent aphthous ulceration: a possible clinical mani- festation of reaction of varicella zoster of cytomegalovirus infection. J Oral Pathol Med 1993;22:64–8.
  13. 13.0 13.1 13.2 Edgar NR, Saleh D, Miller RA (2017). "Recurrent Aphthous Stomatitis: A Review". J Clin Aesthet Dermatol. 10 (3): 26–36. PMC 5367879. PMID 28360966.
  14. Klein P, Weinberger A, Altmann VJ, et al. Prevalence of Behcet’s disease among adult patients consulting three major clinics in a Druze town in Israel. Clin Rheu- matol 2010;29(10):1163–6.
  15. Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H (2005). "Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations". Immunol Lett. 99 (1): 57–62. doi:10.1016/j.imlet.2005.01.002. PMID 15894112 PMID 15894112 Check |pmid= value (help).

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