Recurrent mouth ulcers are also known as recurrent aphthous ulcers or recurrent aphthous stomatitis, which is named after the Greek word “aphthous” (burning pain) because of the obvious burning pain. It is commonly referred to as “mouth fire” or “mouth sores”. Is the most common oral mucosal disease, its prevalence in the oral mucosal disease of the first, national epidemiological surveys show that every 5 people in at least 1 person has had mouth ulcers. It can occur in both men and women, at any age, and in any race. The disease is characterized by recurrent ulcers in various parts of the oral mucosa, not accompanied by other signs of disease, with periodic, recurrent, self-limiting characteristics, ulcers burning pain is obvious. Prevalent in lips, tongue, cheeks, soft palate and other poorly keratinized parts. It is not contagious. Ulcer attacks are mild and occur once every few months, but in severe cases, they occur continuously, one after another, with no intermission, hindering diet and speech, and affecting the quality of life of patients. The etiology and pathogenesis of the disease are still unknown. Histopathologic manifestations of non-specific inflammation. Most scholars believe that the occurrence of oral ulcers is the result of a combination of factors. Immunity, genetics and environment may be the “triple factor” for the development of oral ulcers, i.e., the genetic background and appropriate environmental factors (including psycho-neurological fitness, psychological and behavioral status, life, work and social environment, etc.) can trigger an abnormal immune response and characteristic lesions of oral ulcers appear. With one or more factors active, alternating, overlapping on the body immunity decline, immune dysfunction, which also caused frequent attacks of recurrent oral ulcers. 1, immune: some patients show immunodeficiency, some patients show autoimmune response, causing tissue destruction and the onset of the disease. 2, heredity: if one or both parents suffer from recurrent oral ulcers, their children are more prone to the disease than the general population. 3, heredity: one or both parents suffer from recurrent oral ulcers, their children than the average person. Disease or symptom related, such as digestive system diseases gastric ulcer, duodenal ulcer, chronic or prolonged hepatitis, colitis, etc., in addition to anemia, paranoia, dyspepsia, diarrhea, fever. The role of bacteria on mouth ulcers has been proposed for many years, and the bacteria closely associated with mouth ulcers are Streptococcus haematobium and Helicobacter pylori. Mouth ulcers can be triggered by an imbalance in the body’s production and scavenging rates of superoxide radicals, an imbalance in the ratio of thromboxane B2 and 6-keto prostaglandins, and a decrease in overall levels. Microcirculatory disorders result in slow blood flow, low blood flow, and dilated capillary venous end tubes, resulting in local ischemia and hypoxia thus causing mucosal membrane damage and ulcer formation. However, most of the patients are healthy and have no history of systemic diseases.4, their own spiritual and emotional problems: such as lack of sleep, excessive fatigue, mental stress, work pressure, changes in the menstrual cycle and so on. Yin-deficiency constitution people become the patent of the symptom.5, vitamin or trace element deficiency: such as lack of trace elements zinc, iron, lack of folic acid, vitamin B12 and malnutrition, high copper, etc., can reduce immune function, increase the possibility of recurrent oral ulcers.6, it has been reported that smoking cessation can also induce oral ulcers.7, toothpaste in the composition of the 12-alkylsulfate sodium (SLS) may stimulate the mucous membranes, inducing Mouth ulcers. Diagnosis is mainly based on history and clinical manifestations, and there are no precise laboratory indicators that can be used as a diagnostic basis. Recurrent oral ulcers are recurrent round or oval ulcers with the characteristics of “yellow, red, concave, and pain”, i.e., the surface of the damage is covered with a yellow or grayish-white pseudomembrane; the periphery is surrounded by a red halo band of congestion of about 1 mm; the center is concave, and the base is soft; and the burning pain is obvious. Seizure cycle of about days or months, with the self-limiting nature of untreated. Disease classification 1, light: about 80%. Ulcers are usually 3-5, scattered distribution. Ulcers occur in the lips, tongue, cheeks, soft consternation and other non-keratinized or poorly keratinized mucous membranes, attached gingiva and hard palate and other keratinized open membranes rarely develop. At the beginning, the mucous membrane becomes congested and edematous in a focal way, with red dots in the form of corn grains and obvious burning pain, followed by the formation of superficial ulcers, which are round or oval, with a diameter of about 3~5 mm. the ulcers begin to heal in about 5 days, and the ulcers are completely healed in about 7 days to 10 days, leaving no scarring. The intervals vary from half a month to several months, and some patients have a recurring and prolonged situation, which may occur around menstruation or after exertion. There are usually no obvious systemic symptoms and signs.2. Heavy type: also known as recurrent necrotizing periadenitis or periadenal stomatitis. This type accounts for about 8%. It occurs in adolescence. The ulcer is deep and large, like a “crater”, can reach the submucosal glands and periglandular tissues, and the diameter can reach or be larger than 1cm, the surrounding tissues are red and swollen and slightly elevated, the base is slightly hard, and there is gray-yellow pseudomembrane or gray-white necrotic tissue on the surface. Duration is long, up to 1-2 months or longer. Usually 1-2 ulcers, but 1 or several small ulcers may appear again during the healing process. The pain is severe, and scarring may remain after healing, which can result in tissue defects such as the tip of the tongue and palate. It may be accompanied by headache, fever, localized lymph node enlargement and other systemic symptoms. The ulcers can recur again at the previously healed place.3, herpes-like ulcers: also known as stomatitis-type aphthous ulcers, accounting for about 10% or so, the diameter of the ulcers is small, about 2mm, the number of ulcers is more, up to a dozen or tens of ulcers, scattered in the distribution, like a “full of stars”, adjacent ulcers can be fused into a slice, the mucous membrane is congested with redness, the most severe pain, and increased salivary secretion. Increased salivary secretion. It can be accompanied by headache, low fever and other general discomfort, local lymph node swelling and pain and other symptoms. The pattern of attack is the same as that of mild recurrent oral ulcers, and no scar is left after healing. Disease identification 1, erosion: in the clinical manifestations of erosion and superficial ulcers are different. Oral ulcers can be caused by systemic or local factors, a variety of ulcers, although intraepithelial or subepithelial, superficial or deep, acute or chronic, benign and malignant points, but there is a depression; regular shape, round or oval; clear boundaries, and the surrounding normal mucous membranes, “clear”. And oral erosion, clinical manifestations and normal mucosal surface flush congestion and erosion, and no depression, covered with exudative pseudomembrane, shape variety, and irregular, and the surrounding normal mucosa between the boundary is unclear. Secondly, the course and healing of the two are different. Ulcers are generally shorter, once healed, “dry and sharp”, shallow and benign ulcers heal without scarring, but deep into the muscle layer of the ulcers and malignant oral ulcers are the exception. Vesicles are generally longer, recurrent, and “sloppy” in their healing process, but vesicles generally do not leave a scar. Finally, the two appear differently under the microscope. Ulcers show a break in epithelial continuity, while erosions are more superficial without a break in epithelial continuity. When ulcers and erosions are less typical, identification can be difficult, but with careful observation, they can generally be distinguished. It is worth suggesting that these two lesions can be transformed into each other or both exist at the same time. 2, herpes simplex: prevalent in infants and young children, the early clusters of small blisters as the main manifestation of the blisters will be blended into a larger vesicle or irregular ulcers after the blisters are broken. Recurrence and triggers have a clear relationship, recurrence is often accompanied by sore throat, fatigue and other prodromal symptoms, during the onset of the disease is often accompanied by obvious general discomfort. Severe recurrent oral ulcers should be differentiated from cancerous ulcers, tuberculous ulcers, traumatic ulcers and necrotizing salivary gland chemosis. Disease treatment at present there is still no effective method of eradicating the disease. The principle of treatment is to eliminate the cause of the disease, strengthen the body, and treat the symptoms in order to reduce the number of recurrences, prolong the interstitial period, alleviate the pain, and promote healing. Treatment advocates a combination of systemic and local, TCM and Western medicine, physiology and psychology.1. Ulcers recur only a few times a year, each recurrence lasts only a few days, and the pain is tolerable. Find relevant triggers and control them. Help the patient to summarize safe and effective treatment modalities and continue to use them.2. The ulcers recur monthly, each lasting 3 to 10 d, and the pain interferes with eating and daily oral cleaning. Discuss possible triggers with the patient and control them. Apply corticosteroids in the prodromal stage of ulcers (tingling, swelling, etc.) to terminate their development. Compound chlorhexidine gargle, dexamethasone gargle containing 0.05 mg/5 ml (3 times daily), or topical high potency corticosteroids such as oral ointment containing 0.05% clobetasol propionate or flucytosine acetate (3 times daily) can be used. Instruct patients in proper oral hygiene. For more persistent cases, short-term systemic application of adrenocorticosteroid hormone, not more than 50mg/d (preferably in the morning), can be used orally for 5d.3. Painful ulcers with episodes of flare-ups. Topically with strong adrenocortical steroids such as betamethasone, beclomethasone, clobetasol propionate, fluticasone propionate. Systemically with adrenocortical steroids, azathioprine or other immunosuppressants such as aminoglutethimide, hexacorbazone and reaction stop. Localized submucosal injections of corticosteroids such as betamethasone, dexamethasone, and triamcinolone acetonide are also feasible to shorten the duration of systemic medication. Oral hygiene for patients with poor oral hygiene know. (A) local treatment: the main purpose is to anti-inflammatory, pain relief, and promote ulcer healing.1, gargle: 0.25% gentamycin solution, 1: 5000 chlorhexidine chlorhexidine solution, 1: 5000 potassium permanganate solution, 1: 5000 furacilin solution, etc. 2, containing tablets: dumefen tablet, lysozyme tablet, chlorhexidine tablet.3, bulk: ice boron powder, tin-like powder, Qingdai powder, nourishing yin shengmisan These are the main medicines used in Chinese medicine to treat mouth ulcers. In addition, compound betamethasone spread also has anti-inflammatory, pain relief, promote ulcer healing effect. 4, film: its matrix contains antibiotics and cortisone and other drugs. Stick on the ulcer, have to reduce pain, protect the ulcer surface, promote the role of healing.5, analgesic: 0.5 ~ % 1 procaine solution, 0.5 ~ 1% dacronine solution, 0.5 ~ 1% dicaine solution, when coated in the ulcer surface, 2 times in a row, for temporary pain before eating.6, cauterization method: applicable to the number of ulcers is small, small area and the intermittent period of a long time. The method is first 2% dicaine surface anesthesia, wet, dry ulcer surface, with an area smaller than the ulcer surface of a small cotton ball dipped in 10% silver nitrate solution or 50% tincture of tritiated acetic acid or iodophenol solution, put on the ulcer surface, to the extent that the surface whitening. These drugs can make the ulcer surface protein precipitation and the formation of film to protect the ulcer surface, to promote healing. 7, local closure: for heavy recurrent aphthous ulcers. Take 2.5% prednisolone acetate suspension 0.5~1ml add 1% procaine liquid 1ml injected in the lower part of the ulcer tissue, 1~2 times a week, a total of 2~4 times. There is accelerated ulcer healing effect. 8, laser therapy: with helium-neon laser irradiation, can make the mucous membrane regeneration process is active, the inflammatory reaction decreases, promote healing. (B) systemic treatment 1, immunosuppressant: if you can be determined by the examination of autoimmune diseases, the use of immunosuppressant has obvious efficacy. Commonly used drugs for prednisone (prednisone). To prevent the spread of infection, antibiotics should be added. For severe Behçet’s syndrome, hydrocortisone or dexamethasone and tetracycline are given, which should be prohibited or used with caution in patients with gastric ulcers, diabetes mellitus, and active tuberculosis.2. Immunomodulators and enhancers (1) transfer factors, pidomorph, and levamisole are used for those who need to enhance the role of cellular immunity. (2) Vitamin drugs can maintain normal metabolic function and promote healing of lesions. Vitamin C 0.1~0.2g, 3 times a day, and compound vitamin B 1 tablet each time, 3 times a day are given during the onset of ulcer. (3) trace elements serum zinc content is reduced after zinc supplementation, the condition has improved, available 1% zinc sulfate syrup or zinc sulfate tablets. Chinese medicine treatment: can be divided into local treatment and systemic treatment: local treatment: can use nourishing yin sheng muscle powder, watermelon cream, ice boron powder and so on. Systemic treatment: the recurrent mouth ulcers are roughly divided into solid fire type and deficiency fire type based on the principle of evidence-based treatment. The solid fire type of mouth ulcers can be used to clear the stomach, guide Chi San, etc., and the deficiency fire mouth ulcers should be treated with Liu Wei Di Huang Pill, Qi Ju Di Huang Pill, etc.. Chinese patent medicines can choose to clear heat and detoxification capsule, stomatitis clear punch and so on. Prevention of mouth ulcers to a large extent with personal physical quality, try to avoid triggering factors, can reduce the incidence of. 1, pay attention to oral hygiene, avoid damage to the oral mucosa, avoid spicy and irritating food and local stimulation. 2, maintain a relaxed mood, optimism and cheerfulness. 3, to ensure that sufficient sleep time, avoid excessive fatigue. 4, pay attention to the regularity of life and nutritional balance, and to form a certain habit of defecation. Prevent constipation.