ORAL APHTOUS ULCERS

I get a lot of calls from people who have recurrent oral ulcers. The following might help..

What is an aphthous ulcer or canker sore:

It’s a small ulcer of the mouth or lips. It causes pain and discomfort while eating. These can vary in size and usually heals in 7 to 10 days. Canker sores are often self healing but can be recurrent and troublesome requiring medical attention.

How to identify them: These are small ulcers with whitish appearance with redness around it. These can be seen over the inner side of lips and tongue (including undersurface). These ulcers (sores) appear as white or gray raised areas with red halo around them.

Common locations are on mobile oral mucosa e.g. either surface of tongue, at the base of your gums, on your soft palate (the back portion of the roof of your mouth), or inside of cheeks. Other less common symptoms are fever and lymphadenopathy in the neck region.

Factors predisposing for canker sore :

• Stress is known to predispose for recurring canker sores
• Tissue damage, like from a sharp tooth or a dental prosthesis or implant
• Certain foods, such as citrus or acidic fruits and vegetables
• Consumption of food items that you are allergic to
• Use of irritants in products of oral hygiene (toothpaste and mouthwash)
• Non-steroidal anti-inflammatory drugs also can cause ulcer formation
• Helicobacter pylori bacteria infection

Things that might lead to complex and recurrent canker sores are:

• A weak immune system (e.g: HIV/AIDS, Lupus, or Behcet’s disease)
• Deficiency of vitamin B12, zinc, folic acid or iron
• Hormonal imbalances (chiefly in females)
• Other associated systemic illnesses: Celiac disease, inflammatory bowel disease, Behcet’s disease, autoimmune disease, anemia, HIV, or, in rare cases, oral cancer or leukemia.

When do i need to see doctor:

Most of the smaller oral ulcers should heal without any treatment. In some patients, lesions may come and go within four to five days, but in most individuals, they resolve in 10 to 14 days. If however you are getting recurrent oral ulcers especially in association with other systemic illnesses or allergies, consider consulting your physician for evaluation. He will take detailed history and will examine oral ulcers. Some of the common questions asked are:

• What is the site of ulcers and how often do you get these ulcers
• Is it preceded by trauma ?
• Do you have skin disorder along with oral ulcers ?
• Any other associated symptoms such as difficulty in swallowing, change in voice, noisy breathing, irritation in eyes, dryness in mouth and eyes, burning micturition, blood in urine
• History of tobacco and pan masala use
• History of any medicine use that can lead to symptoms

Treatment and prevention :

Some of the common treatments prescribed are :

• Mouthwashes and local creams: Your doctor can give you a rinse with a steroid or a painkiller or a cream that has a steroid and an analgesic like lidocaine to help with the pain.
• Systemic therapy : Aspirin and the gout drug colchicine can also help with canker sores.
• Vitamin supplementation : If your disease is because of specific vitamin deficiency, it should be corrected.
• Cautery : Laser therapy can alleviate symptoms rapidly. Cautry can also be done using chemicals like debacterol or silver nitrate to get rid of sores by making them burn.

Prevention :

Avoid foods that hurt your mouth, like food with chillies, spices, citrus fruits and acidic vegetables.

Brush your teeth with a soft-bristled brush after each meal, and floss every day. This will keep your mouth free of food particles that could cause a sore.