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{{Aphthous ulcer}}
{{Aphthous ulcer}}
{{CMG}}; {{AE}} {{SaraM}}
{{CMG}}; {{AE}} {{SaraM}} {{Jose}}


==Overview==
==Overview==
The exact cause of aphthous ulcers is unknown. Factors that provoke them include [[stress (psychology)|stress]], [[fatigue (physical)|fatigue]], [[illness]], injury from accidental biting, [[hormone|hormonal]] changes, [[menstruation]], sudden [[weight loss]], [[food allergy|food allergies]], the foaming agent in toothpaste ([[Sodium lauryl sulfate|SLS]]), and deficiencies in [[vitamin B12]], [[iron]], and [[folic acid]].<ref>{{cite journal |author=Wray D, Ferguson M, Hutcheon W, Dagg J |title=Nutritional deficiencies in recurrent aphthae |journal=J Oral Pathol |volume=7 |issue=6 |pages=418–23 |year=1978 |pmid=105102}}</ref>  Some drugs, such as [[nicorandil]], also have been linked with mouth ulcers.  In some cases they are thought to be caused by an overreaction by the body's own [[autoimmunity|immune system]].
The exact cause of aphthous ulcers is unknown. Factors that provoke them include [[stress (psychology)|stress]], [[fatigue (physical)|fatigue]], [[illness]], injury from accidental biting, [[hormone|hormonal]] changes, [[menstruation]], sudden [[weight loss]], [[food allergy|food allergies]], the foaming agent in toothpaste ([[Sodium lauryl sulfate|SLS]]), and deficiencies in [[vitamin B12]], [[iron]], and [[folic acid]].


==Causes==
==Causes==
===Trauma===
===Trauma===
Trauma to the mouth is the most common trigger of aphthous ulcers.[[Physical trauma]], such as that caused by toothbrush abrasions, laceration with sharp foods or objects, accidental biting (particularly common with sharp canine teeth), or [[dental braces]] can cause mouth ulcers by breaking the mucous membrane.<ref name="pmid8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135  }} </ref><ref name="pmid7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393  }} </ref><ref name="pmidPMID 105102">{{cite journal| author=Wray D, Ferguson MM, Hutcheon WA, Dagg JH| title=Nutritional deficiencies in recurrent aphthae. | journal=J Oral Pathol | year= 1978 | volume= 7 | issue= 6 | pages= 418-23 | pmid=PMID 105102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=105102  }} </ref>
Trauma to the mouth is the most common trigger of aphthous ulcers and includes:<ref name="pmid8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135  }} </ref><ref name="pmid7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393  }} </ref><ref name="pmidPMID 105102">{{cite journal| author=Wray D, Ferguson MM, Hutcheon WA, Dagg JH| title=Nutritional deficiencies in recurrent aphthae. | journal=J Oral Pathol | year= 1978 | volume= 7 | issue= 6 | pages= 418-23 | pmid=PMID 105102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=105102  }} </ref>
*Toothbrush abrasions
*Laceration with sharp foods or objects
*Accidental biting (particularly common with sharp canine teeth)
*[[Dental braces]]


===Drugs===
===Drugs===
Common medications, that can result in recurrent aphthous stomatitis, include:
*[[Beta blockers]]
*[[Beta blockers]]
*[[NSAIDs]]
*[[NSAIDs]]
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*[[Folate]]
*[[Folate]]
*[[Zinc]]
*[[Zinc]]
*[[Vitamins B1]], [[Vitamins B2|B2]], [[Vitamins B6|B6]], and [[Vitamins B12|B12]]
*[[Vitamin B1|Vitamins B1]], [[Vitamin B2|B2]], [[Vitamin B6|B6]], and [[Vitamin B12|B12]]


===Allergic Factors===
===Allergic Factors===
It is thought that aphthous ulcer may be caused by [[hypersensitivity]] to certain environmental allergens or food substances such as milk, chocolate, cheese, nuts, tomatoes, and wheat.<ref name=Allergens-aphthous>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.</ref><ref name=Allergens-Aphthous-2>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.</ref>
It is thought that aphthous ulcer may be caused by [[hypersensitivity]] to certain a[[llergens]] such as:<ref name=Allergens-aphthous>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.</ref><ref name=Allergens-Aphthous-2>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.</ref>
*Environmental allergens
*Food allergens
**Milk
**Chocolate
**Cheese
**Nuts
**Tomatoes
**Wheat


===SLS containing Toothpaste===
===SLS containing Toothpaste===
The large majority of toothpastes sold in the U.S. contain [[Sodium dodecyl sulfate|Sodium lauryl sulfate]] (SLS), which is known to cause Aphthous ulcers in certain individuals.  Using a [[toothpaste]] without SLS will reduce the frequency of Aphthous ulcers in persons who experience Aphthous ulcers caused by SLS.<ref name="pmidPMID 7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=PMID 7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393  }} </ref><ref name="pmidPMID 8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=PMID 8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135 }} </ref>
The large majority of toothpastes sold in the U.S. contain [[Sodium dodecyl sulfate|Sodium lauryl sulfate]] (SLS), which is known to cause aphthous ulcers in certain individuals.<ref name="pmidPMID 7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=PMID 7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393  }} </ref><ref name="pmidPMID 8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=PMID 8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135  }} </ref>
However, some studies find no connection between SLS in toothpaste and mouth ulcers.<ref name="pmidPMID 10218040">{{cite journal| author=Healy CM, Paterson M, Joyston-Bechal S, Williams DM, Thornhill MH| title=The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration. | journal=Oral Dis | year= 1999 | volume= 5 | issue= 1 | pages= 39-43 | pmid=PMID 10218040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10218040 }} </ref>


===Microbial Factors===
===Microbial Factors===
It is thought that aphthous ulcers may be caused by microbial factors such as [[Streptococcus|Streptococcus sanguis]], [[Helicobacter pylori]], [[Varicella zoster]], and [[Cytomegalovirus]].<ref name=Microbial-aphthous> 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.</ref><ref name=CMV-Aphthous> 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. </ref><ref name=Varicella-Aphthous> 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.</ref>
It is thought that aphthous ulcers may be caused by microbial factors such as:<ref name=Microbial-aphthous> 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.</ref><ref name=CMV-Aphthous> 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. </ref><ref name=Varicella-Aphthous> 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.</ref>
 
*[[Streptococcus|Streptococcus sanguis]]
===Immune System===
*[[Helicobacter pylori]]
Although the exact cause is not known, aphthous ulcers are thought to form when the body becomes aware of and attacks [[molecules]] which it does not recognize.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> The presence of the unrecognized [[molecule]]s garners a reaction by the [[T-cell]]s, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory [[T-cell]]s.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref>
*[[Varicella zoster]]
Repeat episodes of aphthous ulcers can be indicative of an [[immunodeficiency]], signalling low levels of [[immunoglobulin]] in the mucous membrane of the mouth. Certain types of [[chemotherapy]] cause mouth ulcers as a side effect.<ref name="pmidPMID 15894112">{{cite journal| author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H| title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. | journal=Immunol Lett | year= 2005 | volume= 99 | issue= 1 | pages= 57-62 | pmid=PMID 15894112 | doi=10.1016/j.imlet.2005.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15894112 }} </ref>
*[[Cytomegalovirus]]
*[[Coxsackie A]]
*[[Herpes simplex]]
*[[Epstein-Barr]]
*[[HIV]]
*[[Tuberculosis]]
*[[Syphilis]]
*[[Coccidioides immitis]]
*[[Cryptococcus neoformans]]
*[[Blastomyces dermatidis]]<ref name="pmid28360966">{{cite journal| author=Edgar NR, Saleh D, Miller RA| title=Recurrent Aphthous Stomatitis: A Review. | journal=J Clin Aesthet Dermatol | year= 2017 | volume= 10 | issue= 3 | pages= 26-36 | pmid=28360966 | doi= | pmc=5367879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28360966 }} </ref>


===Systemic Disease===
===Systemic Disease===
Common systemic conditions that may be caused in aphthous ulcer are include:<ref name=Behcet’s-disease> 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.</ref>
Common systemic conditions that may be caused in aphthous ulcer are include:<ref name=Behcet’s-disease> 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.</ref><ref name="pmidPMID 15894112">{{cite journal| author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H| title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. | journal=Immunol Lett | year= 2005 | volume= 99 | issue= 1 | pages= 57-62 | pmid=PMID 15894112 | doi=10.1016/j.imlet.2005.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15894112  }} </ref>
*[[Behcet’s syndrome]]
*[[Behcet syndrome]]
*MAGIC syndrome
*MAGIC syndrome
*[[Cyclic neutropenia]]
*[[Cyclic neutropenia]]
*[[Crohn’s disease]]  
*[[Crohn’s disease]]  
*[[Ulcerative colitis]]
*[[Ulcerative colitis]]
*[[HIV]]  
*[[Celiac disease]]
*Cyclic neutropenia
*[[HIV]]
*[[Cyclic neutropenia]]
*[[PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis)]]
*[[Sweet syndrome Familial Mediterranean fever]]
*[[Hyperimmunoglobulinemia D]] with periodic fever syndrome
*[[Anemia]]
*[[Neutropenia]]
*[[Hypereosinophilic syndrome]]
*[[Lichen planus]]
*[[Linear IgA bullous dermatosis]]
*[[Epidermolysis bullosa]]
*[[Chronic granulomatous disease]]
*[[Wegener’s granulomatosis]]<ref name="pmid28360966">{{cite journal| author=Edgar NR, Saleh D, Miller RA| title=Recurrent Aphthous Stomatitis: A Review. | journal=J Clin Aesthet Dermatol | year= 2017 | volume= 10 | issue= 3 | pages= 26-36 | pmid=28360966 | doi= | pmc=5367879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28360966  }} </ref>


===Others===
*[[Stress (psychology)|Stress]]
*[[Fatigue (physical)|Fatigue]]
*[[Illness]]
*Smoking
*[[Hormone|Hormonal]] changes
*[[Menstruation]]
*Sudden [[weight loss]]
*[[Pemphigus vulgaris]]
*[[Linear IgA disease]]
*[[Erythema multiforme]]<ref name="pmid28360966">{{cite journal| author=Edgar NR, Saleh D, Miller RA| title=Recurrent Aphthous Stomatitis: A Review. | journal=J Clin Aesthet Dermatol | year= 2017 | volume= 10 | issue= 3 | pages= 26-36 | pmid=28360966 | doi= | pmc=5367879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28360966  }} </ref>


==References==
==References==
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{{WH}}
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[[Category:Disease]]
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[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
{{WH}}
{{WS}}

Latest revision as of 22:26, 12 January 2021

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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]

Overview

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.

Causes

Trauma

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

Drugs

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]

Others

References

  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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