Painful blisters on the tongue and oral mucosa – the unpleasant aphthae
Painful, inflamed blisters on the mucous membranes of the mouth cause distress to around 10% of people. During an assessment in the dental surgery, the patient may complain mainly of very severe pain, but the symptoms may also include small or large mucous blisters and sometimes ulcers. In addition to the symptoms that may occur, this article also provides information on how to treat the different types of aphthae.

The first symptoms
The first symptoms are not the blisters, but a burning, painful sensations. If the patient visits his dentist at this stage, he may even feel uncomfortable, because apart from the pain, which only he feels, the dentist will not see any symptoms and will not understand what the problem is. After 1-2 days, the blisters will only appear, and later they will burst and form even more painful ulcers. The ulcers are then surrounded by an inflamed, red yard. General symptoms also appear outside the mouth: feeling unwell, headaches, lethargy, not feeling like doing anything, and difficulty eating or drinking. The symptoms are often accompanied by an unpleasant mouth smell, making the patient’s social life difficult. The ulcers occur less frequently at first, 1-2 times a year, but as the patient gets older they may recur more frequently, up to weekly.

Causes
It is still not known exactly what causes this unpleasant, painful condition. The viral origin seems to be the most likely, with certain subgroups of the herpes virus often found in the depths of the ulcers. In some cases, a bacterial origin may be more likely. The hormonal and immune status of the patient is certainly a factor – hormonal imbalances and a weakened immune system are more common. It may also occur in certain diseases of the gastrointestinal tract or in certain vitamin deficiencies. In some cases, aphthae occur just after dental surgery. This does not necessarily mean that the sterility of the instruments in the surgery where we were visiting was not adequate. During a major dental procedure, the mucous membrane can dry out and become damaged during the long treatment, so this important line of defence does not function as well as it normally would. The debris removed from the cavity contains large amounts of pathogens, which are more easily dispersed in the mouth by the spray of the drill. In more sensitive patients, these conditions are already a sufficient basis for painful inflammation. It has also been observed that aphtha sensitivity can be hereditary, often with several patients in the same family presenting with the same symptoms.

Types of aphthae
Minor aphta, recurrent aphta (Mikulicz aphta) Mikulicz aphta occur in young adults, painful ulcers develop in small clusters, no blister develops, instead painful ulcers are seen immediately. After a prolonged illness, symptoms disappear in about two weeks – the disease heals spontaneously. Large aphta (Sutton aphta) Sutton aphta is more common in adults. Usually a large ulcer develops, with pain corresponding to its size. It is a tough, very scary lesion, unfortunately even the doctor may mistake it for an oral cavity tumour, so the dentist will recommend a trial excision in this case. It remains for a very long time, with a healing time of more than a month. Herpetiform ulceration (Cooke’s aphta) Cooke’s aphta is found mainly in older patients. It is characterised by tiny, pinprick-like ulcers that heal without scarring. It is often mistaken for herpetic mucositis.

Treatment of aphta:

No specific treatment is known so far. The dentist will mainly recommend symptomatic treatment.

The patient can choose from the following therapeutic options:

•     removal of factors causing mechanical irritation – e.g. bad fillings, bad crown, chipped tooth
  • this prevents further damage to the mucosa eliminating infectious debris

• B vitamins (B1, B2, B6, B12)
  • e.g. multivitamin tablets or liquid
• Antiseptic mouth rinses e.g. Curasept rinses
  • 0.2 % clorhexamed for excellent disinfection
• Other trace elements – folic acid, iron
• The analgesic solution, mainly anaesthetic and anti-inflammatory
  • maybe prescribed by a doctor.