Mouth ulcer

Oral ulcer
Classification and external resources
Mouth ulcer on the lower lip
ICD-9	528.9
DiseasesDB	22751
MedlinePlus	001448
MeSH	D019226

A mouth ulcer (/ˈʌlsər/, from Latin ulcus and that from Greek "ἕλκος" - elkos, "wound"^[1]), oral ulcer, or, in American English, canker sore is an open sore inside the mouth, or rarely a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. The types of ulcers are diverse, with a multitude of associated causes including: physical abrasion, acidic fruit, infection, other medical conditions, medications, and cancerous and nonspecific processes. Once formed, the ulcer may be maintained by inflammation and/or secondary infection. Two common types are aphthous ulcers and cold sores or fever blisters. Cold sores around the lip are caused by the herpes simplex virus.^[2][3]

Epidemiology and frequency

Mouth ulcer is a very common oral lesion. Epidemiological studies show an average prevalence between 15% and 30%^[4][5]. Mouth ulcers tend to afflict women more than men and people less than 45 years. Mouth ulcers occur most frequently among 16-25 year olds.^[6], and they rarely occur in anyone over 55.^[6] The frequency of mouth ulcers varies from less than 4 episodes per year (85% of all cases) to more than one episode per month (10% of all cases) including people suffering from continuous RAS^[5].

Causes

Trauma

Minor physical injuries

Trauma to the mouth is a common cause of ulcers. A sharp edge of a tooth, accidental biting (this can be particularly common with sharp canine teeth, or Wisdom teeth), sharp, abrasive, or excessively salty food, poorly fitting dentures, dental braces or trauma from a toothbrush 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).^[2]

These ulcers also commonly occur after dental work, when incidental abrasions to the soft tissues of the mouth are common. A dentist can apply a protective layer of petroleum jelly before carrying out dental work in order to minimize the number of incidental injuries to the soft mucosa tissues.

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.^[7]

Smoking Cessation

It is fairly common for smokers to experience multiple mouth ulcers within a week of cessation. The duration varies between individuals, and can range from a month to years. Oral nicotine supplements has shown some reduction in the occurrence.^[8][9]

Infection

Viral, fungal and bacterial processes can lead to oral ulceration. One way to contract pathogenic oral ulcerations is to touch your chapped lips without having washed your hands first. The reason that this happens is that the bacteria from your hands sinks into the tiny, open cuts caused by your chapped lips.^[2]

Viral

The most common is Herpes simplex virus which causes recurrent herpetiform ulcerations preceded by usually painful multiple vesicles which burst. Varicella Zoster (chicken pox, shingles), 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.^[3]

Bacterial

Bacterial processes leading to ulceration can be caused by Mycobacterium tuberculosis (tuberculosis) and Treponema pallidum (syphilis).^[3]

Opportunistic activity by combinations of otherwise normal bacterial flora, such as aerobic streptococi, Neisseria, Actinomyces, spirochetes, and Bacteroides species can prolong the ulcerative process.^[10]

Fungal

Coccidioides immitis (valley fever), Cryptococcus neoformans (cryptococcosis), Blastomyces dermatitidis ("North American Blastomycosis") are some of the fungal processes causing oral ulceration.^[3]

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.^[3]

Aphthous ulcers are thought to form when the body becomes aware of and attacks chemicals which it does not recognize.

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 such as amalgam 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.^[3] Similarly deficiencies in vitamin B12, zinc^[11] have been linked to oral ulceration.

Acidic food such as citrus fruit may cause mouth ulcers.^[12]

A common cause of ulcers is Coeliac 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, baked goods, beers etc. and substituting gluten-free varieties where available. Artificial sugars (Aspartame/Nutrisweet/etc) such as those found in diet cola and sugarless chewing gum, have been reported as causes of oral ulcers as well.

Inhaled Corticosteroids

Use of Inhaled Corticosteroids without rinsing the mouth out afterwards (increasing the risk of oral thrush) may cause oral ulcers.

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 by tobacco.

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
• Infectious mononucleosis

Prevention

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 1 milliliter are more than sufficient. Ideally, the first treatment should occur within 3 hours.

Treatment

Symptomatic treatment is the primary approach to dealing with oral ulcers. If their cause is known, then treatment of that condition is also recommended. Adequate oral hygiene may also help in relieving symptoms. Typical antihistamines, antacids, corticosteroids or applications meant to soothe painful ulcers may be helpful, as may be oral analgesics such as paracetamol or ibuprofen and local anaesthetic lozenges, paints or mouth rinses such as benzocaine and avoiding spicy or hot foods may reduce pain. Rinsing the mouth out with brine (warm salted water) may help. Ulcers persisting longer than three weeks may require the attention of a medical practitioner.^[13]

Coconut milk has also been shown to prevent canker sores in rats in a 2008 study.

See also

• Aphthous ulcer (Canker sores)
• Chancre
• Herpes simplex virus
• Magic mouthwash
• Squamous cell carcinoma
• Stomatitis

References

External links

• Mouth ulcer at the Open Directory Project