The ulceration may affect keratinized mucosal surfaces in addition to non keratinized.

Adjacent ulcers may merge to form larger, continuous areas of ulceration.

Recurrence may be so frequent that ulceration is virtually continuous.

Despite this association, a gluten free diet does not usually improve the oral ulceration.

Ulceration episodes usually occur about 3 6 times per year.

Early lesions have a central zone of ulceration covered by a fibrinous membrane.

This kind of ulceration is considered by some to be separate from true aphthous stomatitis.

Between episodes of ulceration, there is usually an ulcer free period of variable length.

Aphthous like ulceration is the first sign of the disease in 25 75 of cases.

If investigations reveal deficiency states, correction of the deficiency may result in resolution of the ulceration.

Synonyms for aphthous stomatitis as a whole include (recurrent) oral aphthae, (recurrent) aphthous ulceration and (oral) aphthosis.

MAGIC syndrome is a possible variant of Behçet disease, and is associated with aphthous like ulceration.

In some persons, attacks of ulceration occur at the same time as asymptomatic viral shedding and elevated viral titres.

Some of these conditions may cause ulceration on other mucosal surfaces in addition to the mouth such as the conjunctiva or the genital mucous membranes.

There is no cure, and treatments aim to manage pain, reduce healing time and reduce the frequency of episodes of ulceration.

Stomatitis is also a non specific term referring to any inflammatory process in the mouth, with or without oral ulceration.

In cyclic neutropenia, more severe oral ulceration occurs during periods of severe immuno dysregulation, and resolution of the underlying neutropenia prevents the cycle of ulceration.

Many of the systemic diseases cause other symptoms apart from oral ulceration, which is in contrast to aphthous stomatitis where there is isolated oral ulceration.

The pain is often tolerable with simple dietary modification during an episode of ulceration such as avoiding spicy and acidic foods and beverages.

Persons with certain systemic diseases may be prone to oral ulceration, but this is secondary to the underlying medical condition (see the systemic disease section).

No therapy is curative, with treatment aiming to relieve pain, promote healing and reduce the frequency of episodes of ulceration.

Dysphagia, flatulence, glossodynia, dry mouth, gingival pain, loose stools, oesophagitis, lower abdominal pain, mouth ulceration, oral pain, rectal haemorrhage Renal and urinary disorders

Immunity At least 40 of people with aphthous stomatitis have a positive family history, suggesting that some people are genetically predisposed to suffering with oral ulceration.

In the majority of cases, the individual ulcers last about 7 10 days, and ulceration episodes occur 3 6 times per year.

Major aphthous ulcers (major aphthae) are similar to minor aphthous ulcers, but are more than 10 mm in diameter and the ulceration is deeper.

Each episode of ulceration usually produces a greater number of ulcers, and the time between attacks is less than seen in minor aphthous stomatitis.

These ulcers are clinically and histopathologically identical to the lesions of aphthous stomatitis, but this type of oral ulceration is not considered to be true aphthous stomatitis by some sources.

Factors which decrease the thickness of mucosa increase the frequency of occurrence, and factors which increase the thickness of the mucosa correlate with decreased ulceration.

Occasionally, in females where ulceration is correlated to the menstrual cycle or to an oral contraceptive, progestogen or a change in oral contraceptive may be beneficial.

This is classically (40 of the time) a single, firm, painless, non itchy skin ulceration with a clean base and sharp borders between 0.3 and 3.0 cm in size.

For example, many sources refer to oral ulceration caused by anemia and or nutritional deficiencies as aphthous stomatitis, and some also consider Behçet's disease to be a variant.

Central corneal ulceration is also a significant cause of monocular blindness worldwide, accounting for an estimated 850,000 cases of corneal blindness every year in the Indian subcontinent alone.

Herpetiform ulceration Herpetiform ulcers, (also termed stomatitis herpetiformis, or herpes like ulcerations) is a subtype of aphthous stomatitis so named because the lesions resemble a primary infection with herpes simplex virus (primary herpetic gingivostomatitis).