Events that may trigger a recurrence of aphthous ulcers:
(1) menstruation in women
(2) significant imbalance or exposure to hormones
(3) significant emotional stress or anxiety
(4) oral trauma
(5) discontinuation of cigarette smoking or tobacco use
(6) certain foods, especially if the patient shows reaction on patch testing
where:
• If gluten-containing foods trigger the ulceration, then celiac disease should be considered.
Events that may result in clinical improvement
(1) Some women may notice improvement during pregnancy or when taking oral contraceptives.
(2) cigarette smoking or use of smokeless tobacco
(3) avoidance of foods identified as triggering an outbreak
