Oral Ulcer

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An Oral 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 oral 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. Two common oral ulcer types are aphthous ulcers (canker sores) and cold sores. Cold sores are caused by the herpes simplex virus.

Current Research

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Causes

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There are many processes which can lead to ulceration of the oral tissues. In some cases they are 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. Oral ulcers are also a common result of ceased cigarette smoking, affecting about two out of five quitters. Some drugs, such as nicorandil, have also been linked with oral ulcers. Some recreational drugs cause mouth ulcers.

Trauma

Minor Physical Injuries

Trauma to the mouth is a common cause of oral ulcers. A sharp edge of a tooth, accidental biting (this can be particularly common with sharp canine teeth), sharp or abrasive food (particularly if left overnight), poorly fitting dentures, dental braces or trauma from a tooth brush may injure the mucosal lining of the mouth resulting in an ulcer. These ulcers usually heal at a moderate speed if the source of the injury is removed (for example, if poorly fitting dentures are removed or replaced).

Sugar Injuries

Eating large amounts of sugar can also lead to oral ulcers. These are not a general worry because these subside within a day or two unless large volumes of sugar continue to be present in a person's diet.

Chemical Injuries

Chemicals such as aspirin or alcohol that are held or that come in contact with the oral mucosa may cause tissues to become necrotic and slough off creating an ulcerated surface. Sodium lauryl sulfate (SLS), one of the main ingredients in most toothpastes, has been implicated in increased incidence of oral ulcers.

Infection

Viral, fungal and bacterial processes can lead to oral ulceration.One way to cause oral ulceration by this is to touch your chapped lips without washing your hands first.

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. HIV creates immunodeficiencies which allow opportunistic infections or neoplasms to proliferate.

Bacterial

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

Opportunistic activity by combinations of otherwise normal bacterial fauna, such as aerobic streptococci, Neisseria, Actinomyces, spirochetes, and Bacteroides species can prolong the ulcerative process.

Fungal

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

Protozoans

Entamoeba histolytica, a parasitic protozoan is sometimes known to cause mouth ulcers through formation of cysts.

Immune System

Many researchers view the causes of aphthous ulcers as a common end product of many different disease processes, each of which is mediated by the immune system.

Aphthous 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 an oral ulcer.

Immunodeficiency

Repeat episodes of mouth ulcers can be indicative of an immunodeficiency, signaling low levels of immunoglobulin in the oral mucous membranes. Chemotherapy, HIV, and mononucleosis are all causes of immunodeficiency with which oral ulcers become a common manifestation.

Autoimmunity

Autoimmunity is also a cause of oral ulceration. Mucous membrane pemphigoid, an autoimmune reaction to the epithelial basement membrane, causes desquamation/ulceration of the oral mucosa.

Allergy

Contact with allergens can lead to ulcerations of the mucosa.

Dietary

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

A common cause of ulcers is Celiac disease, in which case consumption of wheat, rye, or barley can result in chronic oral ulcers. If gluten sensitivity is the cause, prevention means following a gluten-free diet by avoiding most breads, pastas, cakes, pies, cookies, scones, biscuits, beers etc. and substituting gluten-free varieties where available. Artificial sugars, such as those found in diet cola and sugarless chewing gum, have been reported as causes of oral ulcers as well.

Cancer

Oral cancers can lead to ulceration as the center of the lesion loses blood supply and necroses. Squamous cell carcinoma is just one of these.

Medical Conditions Associated with Mouth Ulcers

The following medical conditions are associated with mouth ulcers:

• Behçet's disease
• Bullous pemphigoid
• Celiac disease (gluten sensitivity)
• Crohn's disease
• Gingivostomatitis
• Leukoplakia
• oral lichen planus
• Lupus erythematosus
• Neutropenia
• Oral thrush
• Ulcerative colitis

Prevention

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The majority of the types of ulceration require treatment of the underlying cause of the oral ulceration for successful prevention; controlling imbalances in vitamins and minerals related to ulceration, managing or restricting the disease processes has shown to reduce the ulcerative process. For trauma related cases, avoiding the offending source will prevent ulceration, but since such trauma is usually accidental, this type of prevention is not usually practical.

Individuals who have a high incidence of opportunistic bacterial infections subsequent to an accidental oral injury (biting etc.) can prevent the injury from becoming infected by directly bathing the wound with an anti-bacterial mouthwash for one minute every 12 hours for 2 days; it is important to use a small vessel to contain the solution as most antibacterial mouth washes that remain in the mouth for a full minute will have detrimental effects such as a prolonged impairment to the sense of taste and the potential loss of otherwise desirable flora. Quantities around 1ml are more than sufficient. Ideally, the first treatment should occur within 3 hours.

Treatment

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Treatments based on antibiotics and steroids are reserved for severe cases, and should be used only under medical supervision.

Some doctors may also prescribe a local anaesthetic, such as lidocaine or benzocaine, for cases of multiple or severe oral ulcers.

Some people benefit from using an over-the-counter topical gel, like Bonjela, which may contain substances such as choline salicylate to help reduce the pain and inflammation associated with oral ulcers.

Also, putting baking soda directly on the sore and taking l-Lysine has been shown to help with healing and pain.

Holding milk in the mouth over the sore can have a temporary soothing effect upon the sore.

Brushing the teeth and rinsing the mouth with Euthymol toothpaste provides relief for a period of a few hours.

Hydrogen peroxide applied locally reduces infection and often improves healing (recommended by Mayo Clinic for cancer patients who's treatment increase the occurance of cold sores).

Licorice extract has been used and is now commercially available as "CankerMelts."

In Australia, Vegemite is a common remedy used, directly applied to the ulcer as well as being eaten regularly.


(adapted from Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Oral_ulcer)