Aphtes: A medical mystery?

For some it might happen after they ate too many tomatoes or other fruits and vegetables with a lot of acid, for no known reason causing the appearance: Little painful stains at the inner lips or under the tongue. The white core is surrounded by a red circle. What is that and can it be prevented? Does it need treatment?

What are aphthae?

Aphthae occur mainly in the gum or the oral mucosa. However, they can also occur on the tongue, the inside of the lips or in the palate. Aphthae are usually initially recognized by pain. Further examination of the mouth then reveals a milky-yellowish spot surrounded by a reddish border. The pain or burning usually occurs in combination with eating or drinking. Aphthae are among the most common diseases of the oral and pharyngeal mucosa in adults.

There are three types of aphthae: minor aphthae, major aphthae and herpetiform aphthae. Minor aphthae are relatively small, about the size of a lentil, and damage the mucosa only superficially. They heal on their own without scarring and are the most common. Major aphthae, on the other hand, grow up to three centimeters in size and penetrate deep into the mucosa. Affected persons often suffer from them for weeks and most often a scar remains.

The last form – herpetiform aphthae – are the rarest of the three. They resemble herpes blisters, often appearing on the edge of the tongue or the inside of the lips. They can also occur in large numbers, but their size is only a few millimeters. Contrary to what the name might suggest, they are not triggered by the herpes virus.

So far, there are no explanations why aphthae appear anyway. A hereditary predisposition, circulatory disorders of the mucosa, but also a deficiency of vitamin B12 or iron are suspected. But also mechanical stimuli might cause the development of aphthae like small injuries with a toothbrush or bad fitting braces. Therefore aphthae are one of many mysterious diseases – luckily not a bad one though.


Unlike most inflammatory oral diseases, however, aphthae heal on their own and do not require separate treatment. While the positive effects from benzalkonium chloride are used to combat many oral inflammations in the mouth and throat, this does not yet appear to be necessary for aphthae. The therapy to treat aphthae however is purely symptomatic and only used to alleviate the discomfort of pain or burning. Ointments or gels containing a local anesthetic can help against this.

But also some natural treatments like herbal tinctures of myrrh, clove or rhubarb root can help with the pain. However, those treatments are mostly needed when aphthae occur on multiple spots at the same time or multiple times within a short period. Otherwise most people just endure the pain since it is usually over after a few days.

Only in cases where aphthae do not heal on their own, cause severe pain or deep mucosal defects, recur frequently or are accompanied by other symptoms such as fever, a doctor should be consulted to clarify, if no other and more harmful diseases are causing the appearance.