Mouth ulcer

A mouth ulcer (from Latin ulcus) is the name for the appearance of an open sore inside the mouth caused by a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. The types of mouth ulcers are diverse, with a multitude of associated causes including: physical or chemical trauma, infection from microorganisms or viruses, medical conditions or medications, cancerous and sometimes nonspecific processes. Once formed, the ulcer may be maintained by inflammation and/or secondary infection.

Symptoms

The symptoms preceding the ulcer may vary according to the cause of the ulcerative process.

Typically mouth ulcers may begin with a tingling or burning sensation at the site of the future mouth ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer.

The mouth ulcer appears as a white or yellow oval with an inflamed red border. Sometimes a white circle or halo around the lesion can be observed. The grey, white, or yellow coloured area within the red boundary is due to the formation of layers of fibrin, a protein involved in the clotting of blood. The ulcer, which itself is often extremely painful, especially when agitated, may be accompanied by a painful swelling of the lymph nodes below the jaw, which can be mistaken for toothache.

Causes

There are many processes which can lead to mouth ulceration. In some cases they caused by an overreaction by the body's own immune system. Factors that appear to provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies and deficiencies in vitamin B12, iron and folic acid. Some drugs, such as nicorandil, have been linked with mouth ulcers.

Apthous ulcers are thought to form when the body becomes aware of and attacks chemicals which it does not recognize. The presence of the unrecognized molecules garners a reaction by the lymphocytes, which trigger a reaction that causes the damage of a mouth ulcer.

Trauma

Minor physical injuries:

Trauma to the mouth is a common cause of mouth ulcers. Physical trauma, such as toothbrush abrasion, poking with sharp food, accidental biting (this can be particularly common with sharp canine teeth), or dental braces can cause mouth ulcers by breaking the mucous membrane. Other factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. Sometimes the precise cause is unknown.

A sharp edge of a tooth, or poorly fitting dentures, trauma from a tooth brush the mucosal lining of the mouth may be injured and this may result in an ulcer. These ulcers usually heal rapidly if the source of the injury is removed (for example, if poorly fitting dentures are removed or replaced).

Chemical injuries

Chemicals held or that come in contact with the oral mucosa may cause tissues to become necrotic and slough off creating an ulcerated surface such as Asprin or alcohol

Infection

Viral, fungal and bacterial processes can lead to oral ulceration.

Viral

The most common is Herpes simplex virus which causes recurrent herpetiform ulcerations preceded by usually painful multiple vesicles which burst. Herpes Zoster (shingles), Varicella Zoster (chicken pox), Coxsackie A virus and its associated subtype presentations, are some of the other viral processes that can lead to oral ulceration.

Bacterial

Bacterial processes leading to ulceration can be caused by Mycobacterium tuberculosis (tuberculosis) and treponema pallidum (syphilis)

Another possible cause of mouth ulcers may be opportunistic activity by combinations of otherwise normal bacterial fauna, such as aerobic streptococci, Neisseria, Actinomyces, spirochetes, and bacteroides ^*. According to small-scale experiments by at least one patent applicant (Hau, US Patent No. 6,248,718), topical preparations of high doses of penicillin resulted in accelerated healing of mouth ulcers.

Fungal

Coccidioides immitis (valley fever), cryptococcus neoformans (cryptococcosis), Blastomyces dermatitidis ("North American Blastomycosis") are some of the fungal processes causing oral ulceration.

Immune system malfunction

Immunodeficiency

Repeat episodes of mouth ulcers can be indicative of an immunodeficiency, signalling low levels of immunoglobulin in the mucous membrane of the mouth. Chemotherapy is a common cause of mouth ulcers.

Autoimmunity

Autoimmunity is also a cause of mouth ulceration.

Dietry

Vitamin C deficiencies may lead to scurvy which impairs wound healing, which can contribute to ulcer formation. Similarly deficiencies in vitamin B12, iron and folic acid has been linked to oral ulceration

A common cause of ulcers is gluten intolerance, in which case consumption of wheat, rye, or barley can result in chronic mouth ulcers. If gluten intolerance is the cause, prevention means taking most breads, pastas, cakes, pies, cookies, scones, biscuits, beers etc. out of the diet and substituting gluten-free varieties where available. Artificial sugars, such as those found in diet cola and sugarless gum, have been reported as causes of mouth ulcers as well. They can also be linked to an increased intake of acids such as ascorbic acid (Vitamin C) or citric acid. In this case the sores disappear after intake decreases (for example, by substituting ascorbate salts for ascorbic acid).

Cancer

Medical Conditions associated with mouth ulcers

The following medical conditions are associated with mouth ulcers:

Treatment for severe cases

Treatments based on antibiotics and steroids such as Dexamethasone Elixir are reserved for severe cases, and should be used only under medical supervision. Tetracycline suspension is a common antibiotic prescribed for mouth ulcers. Some doctors may also prescribe a local anesthetic, such as lidocaine, for cases of multiple or severe mouth ulcers. If it does not heal within a week, a doctor or dentist may cauterize it using a silver nitrate applicator or laser. This procedure immediately burns off the ulcer, causing it to completely disappear within a few hours or two to three days.

In very severe cases, a doctor may prescribe a steroid treatment. One such steroid is methylprednisolone (usually in a dose-pack), taken orally for a period of 7 days. Alternatively, the doctor may directly inject a steroid into the site of the ulcer (this treatment is performed with kenalog. Between 0.2 and 0.4 cc of kenalog is injected into the site of the ulcer, which will usually be completely healed 72 to 96 hours after the injection).

Some dentists recommend a sulfuric acid solution for treating mouth ulcers, such as debacterol.

Another choice doctors have is to prescribe Aphthasol (amlexanox oral paste, 5%), the only Food and Drug Administration (FDA) approved treatment specifically indicated for Aphthous ulcers.

The miracle cures that are advertised should be viewed with skepticism. However, aqueous sulphuric acid products as listed above can provide significant pain relief, if not treating the underlying causes.

Prevention

In some cases, switching toothpastes can prevent mouth ulcers from occurring, with some being able to reduce the occurrence of ulcers by approximately 80%. Sodium dodecyl sulfate (sometimes called sodium lauryl sulfate or simply SLS), a detergent found in most toothpastes, is thought to increase the incidence of mouth ulcers. Using toothpaste free of this compound has been found to help many people by reducing the amount and size of ulcers and in some cases, completely stopping them. A few individuals have noticed that switching to a toothpaste with baking soda prevented re-occurrence of mouth ulcers.

Many people have found that taking Lysine-L supplements can help to reduce the frequency of mouth ulcer appearances. Additionally, zinc deficiency has been observed in people with recurrent mouth ulcers, and zinc supplementation decreased recurrence of the mouth ulcers ^*.

Some people have reported that the frequency of mouth ulcer occurrences decreased greatly after a particularly large amalgam tooth filling was replaced by some other kind of dental restoration. However, the connection between amalgam fillings and mouth ulcers is not universally accepted, and such replacement can be costly.

Dental braces are a common physical trauma that can lead to mouth ulcers and can be treated with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but since such trauma is usually accidental, this type of prevention is not usually practical.

Alternative medicine

Chinese medicine points to one's diet or emotions as potential causes of such symptoms of 'heat in the mouth'. Greasy/fried foods or 'energetically hot' food (for example: spicy food, alcohol, potato chips) may also trigger mouth ulcers. Emotions such as anger, frustration, resentment, or stress can also impede the proper flow of one's energy and create 'heat' in the body, with such manifestations as mouth ulcers, red eyes, sore throats, insomnia or constipation. In order to neutralize this 'hot energy' certain, 'energetically cool' foods such as herbal teas and certain fruits and vegetables must be consumed. Some other examples of such 'cooling' foods include coconut juice (surprisingly the kernel is opposite and is classified 'hot'), green bean soup, and ginseng tea.

References

External links

Oral pathology | Otolaryngology

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