口腔溃疡 · 黏膜被自己的免疫攻破

参考文献 · 7

1. Staines, K., & Greenwood, M. (2015). Aphthous ulcers (recurrent). BMJ Clinical Evidence, 2015, 1303. Most people develop a few ulcers under 10 mm that heal in 7-10 days without scarring; in 10% lesions exceed 10 mm and can scar; up to 66% of young adults give a history consistent with recurrent aphthous ulceration, lessening with age; most are idiopathic, local physical trauma may trigger ulcers in susceptible people. Topical corticosteroids may reduce new ulcers, pain and healing time without notable adverse effects (low-quality evidence; e.g. one RCT of 240 people, mean ulcer duration 6 days with dexamethasone ointment vs 7 with placebo); chlorhexidine rinses may reduce severity and pain, inconclusive for new ulcers (very low); local analgesics and tetracycline mouthwash: unknown (full text PMC4356175; PMID 25720501). pmc.ncbi.nlm.nih.gov/articles/PMC4356175
2. NHS. (2024). Mouth ulcers. Usually clear up within a week or 2; see a GP or dentist if one lasts longer than 3 weeks, is different from previous ulcers (bigger, near the back of the throat), or bleeds or becomes more painful and red; a long-lasting mouth ulcer is sometimes a sign of mouth cancer. Also see a GP with ulcers elsewhere (skin, genitals) or painful, red or swollen joints. Not contagious; not to be confused with cold sores. Causes: biting the cheek, badly fitting dentures or braces, rough fillings or a sharp tooth, cuts or burns from hard food or hot drinks, food intolerance or allergy, toothbrush damage or irritating toothpaste, tiredness, stress or anxiety; hormonal changes, genes, deficiency of iron, zinc, folic acid, vitamin B or D, medicines including some NSAIDs, beta blockers or nicorandil, and stopping smoking. Several ulcers may be hand, foot and mouth disease, oral lichen planus, Crohn's or coeliac disease, or a weakened immune system (HIV, lupus). Self-care: soft toothbrush, cool drinks through a straw, softer foods; avoid very spicy, salty or acidic food, rough crunchy food, very hot or acidic drinks such as fruit juice, and toothpaste containing sodium lauryl sulphate. Pharmacy: antimicrobial mouthwash, painkilling gel or spray, corticosteroid lozenges, salt mouthwash (half a teaspoon of salt in a glass of warm water, rinse and spit). A GP or dentist may prescribe stronger medicine for severe, persistent or infected ulcers. www.nhs.uk/conditions/mouth-ulcers
3. Scully, C., & Porter, S. (2008). Oral mucosal disease: recurrent aphthous stomatitis. British Journal of Oral and Maxillofacial Surgery, 46(3), 198-206. Recurrent, small, round or ovoid ulcers with erythematous haloes and yellow or grey floors, usually first in childhood or adolescence; genetic predisposition with interleukin genotype associations and sometimes a family history; diagnosis is clinical and must be differentiated from Behcet disease (aphthous-like ulcers with genital ulceration and eye disease, particularly posterior uveitis). Topical corticosteroids and most other treatments reduce severity but do not stop recurrence (abstract, PMID 17850936). 10.1016/j.bjoms.2007.07.201
4. Edgar, N. R., Saleh, D., & Miller, R. A. (2017). Recurrent aphthous stomatitis: a review. Journal of Clinical and Aesthetic Dermatology, 10(3), 26-36. Minor aphthae under 10 mm typically resolve within 14 days; major aphthae over 10 mm may persist over six weeks and pose a scarring risk; herpetiform RAS: dozens of small deep ulcers that coalesce, non-scarring, resolve within one month, commonly misdiagnosed as herpetic gingivostomatitis, so testing to rule out herpes simplex is reasonable; minor over 70% of cases, major 10%, herpetiform 10%. An unknown antigen is thought to stimulate keratinocytes, causing cytokine secretion and leukocyte chemotaxis; TNF-alpha is significantly increased in the saliva of RAS patients. SLS was postulated to denature the oral mucin layer; a randomised trial found SLS-free products helped ulcer healing but did not reduce the number of aphthae or episodes. Several studies report a protective effect of smoking; a cross-sectional survey concluded it is protective only at very high nicotine levels that form a protective keratin layer over the mucosa. Deficiencies of vitamin B12, folate and iron have been associated with aphthous stomatitis; IBD, coeliac disease and malabsorption commonly associated; oral lesions of coeliac disease may precede gastrointestinal symptoms by several years, so screening should be done even without gastrointestinal lesions; oral lesions in up to 20% of Crohn's disease. Behcet's disease: a vasculitis with oral and genital ulceration, aphthosis the presenting sign in 80%, anterior or posterior uveitis, skin lesions such as erythema nodosum. Recurrent fever with ulcers prompts workup for autoinflammatory syndromes such as PFAPA and cyclic neutropenia. First-line treatment is topical, systemic only as necessary (full text PMC5367879; PMID 28360966). pmc.ncbi.nlm.nih.gov/articles/PMC5367879
5. Slebioda, Z., Szponar, E., & Kowalska, A. (2013). Recurrent aphthous stomatitis: genetic aspects of etiology. Postepy Dermatologii i Alergologii, 30(2), 96-102. Prevalence 5-20% depending on method and group; an enhanced immunologic response to triggers such as mechanical injury, stress or bacterial and viral antigens; higher prevalence in relatives and polymorphisms in proinflammatory cytokine genes suggest a genetic background (abstract, PMID 24278055). 10.5114/pdia.2013.34158
6. Zhao, Y., & Feng, W. (2026). Relative risk of oral manifestations with celiac disease: a systematic review and meta-analysis. BMC Gastroenterology, 26. 22 observational studies; pooled prevalence of oral manifestations in coeliac disease 21.41%; recurrent aphthous stomatitis RR 2.45 (95% CI 1.67-3.60), dental enamel defects RR 2.49, xerostomia RR 5.99; oral signs support screening for coeliac disease in at-risk people (abstract, PMID 42021157). 10.1186/s12876-026-04860-z
7. Alli, B. Y., Erinoso, O. A., & Olawuyi, A. B. (2019). Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a systematic review. Journal of Oral Pathology & Medicine, 48(5), 358-364. Four double-blind crossover RCTs (124 participants), two in the main meta-analysis: SLS-free dentifrice reduced the number of ulcers, ulcer duration, number of episodes and ulcer pain compared with SLS-containing; better trials still required (abstract, PMID 30839136). 10.1111/jop.12845