Mouth Ulcers

 Mouth Ulcer: Causes and Treatment

Dr K S Prasanna, Dermatologist, Institute of Applied Dermatology, Kasaragod, Kerala

We often suffer from, or we know the people who suffer from, mouth ulcers. Aphthous ulcer is the medical term for mouth ulcers. The word aphthous in medicine is derived from a Greek word Aphtha, which means ulceration. It is seen in around 25%of general population. It can cause a great deal of pain and suffering to those who suffer from it. Recurrent Aphthous stomatitis is a common ulceration disorder of oral cavity. It is believed to be the result of immunologically mediated damage to epithelial cell. This abnormal immune response may be triggered or influenced by trauma, iron, folate or vitamin B12 deficiency, hormonal fluctuations, psychological stress, infections, food hypersensitivity or genetic factor.

The cause is not known. Genetic and environmental factors contribute to its occurrence. It is familial. Other postulated factors include mucosal trauma (tooth brush injury, sharp tooth or local anesthetic injection), food hypersensitivity, drugs, stress, and hormonal changes (in some women ulcer comes just before their menstrual cycle and with ulcer disappears completely during pregnancy). It comes in 3 forms-1. Minor (small ulcer) 2. Major (large) and 3. Herpetiform(grouped) Minor Aphthae-Small ulcers, round to ovoid, shallow, painful ulcers that are usually less than 5mm. Seen mostly on lips, and cheeks. About 80% of ulcer are of this type. It occurs singly or up to 5 in number. Most common site of involvement of the oral mucosa are the inner aspect of lips, cheeks and lateral

margin of tongue. The ulcer lasts for 4-14 days with rate of recurrence ranging from 1-4 months in an irregular pattern. In some women ulcer occurs in just before their menstrual period. Major Aphthae-Large ulcer, more than 10mms, lasts for one month, seen on lips, cheeks, tongue, pharynx, palate and gum. Ulcers are usually deeper, persists for up to 6weeks and may heal with scarring. Major aphthae are associated with considerable pain and are sometimes accompanied by fever and malaise. Around 10% of patients have this form of ulcer. These ulcers can stay for months. Herpetiform- These are recurrent crops of tiny ulcers, up to 100 in number. It can affect any part of the mouth, including gums. Small 1-2mm, but all join together, lasts for 7-10days. Seen on lips, cheeks, tongue, pharynx and floor of mouth. Always look for local trauma such as sharp tooth. Complete detailed checkup is mandatory. Investigate to rule out Vitamin B12, folate and iron deficiency. Change to a sodium laurel sulfate free toothpaste. Avoid smoking. Check diet for intake of Benzoates, cinnamaldehyde, chocolate and sorbic acid.

Treatment

The primary goal of therapy is promotion of healing, management of pain and nutrition, and prevention of recurrence. Application of a thin film of mild topical corticosteroid gel (as prescribed by your doctor) as early as possible in the course of an outbreak, will significantly reduce pain. But it should be used only for a short period. Topical analgesics may be included for transient relief of pain. If a cause is identified  like trauma by a sharp tooth, it should be corrected. VitaminB12,iron or folate deficiency, if identified should be replenished. Although it is a benign self-limited condition, this disease cause pain and discomfort and interferes in eating, speaking, and swelling which leads to poor quality of life. Oral ulcers are not contagious. Early and effective treatment of these ulcers minimizes the discomfort in speaking and painful swallowing. However, even without treatment these ulcers usually go away within 2 weeks. If it doesn`t go away after 2weeks, then consult your doctor.