Mouth sores are like
little cuts or ulcers in the mouth. Various types of sores can appear anywhere
within the mouth, including the inner cheeks, gums, tongue, lips, or palate.
Some sores may be raised, usually filled with fluid (in which
case they are called vesicles or bullae, depending on the size), whereas others
may be ulcers. An ulcer is a hole that forms in the lining of the mouth when
the top layer of cells breaks down and the underlying tissue shows through. An
ulcer appears white because of the dead cells and food debris inside the hole.
Types-
Canker sores. Small ulcers with a white or gray base and a red
border. They are also known as apthous ulcers. Unlike cold sores, canker sores
appear inside the mouth. And, they are not contagious. There may be only one
canker sore or several and they often return. Their exact cause is uncertain
but some experts believe that immune system problems, bacteria or viruses may
be involved.
Cold sores. Cold sores can usually be found on or around the
lips, and sometimes on the cheek, nose or even the eyes. Cold sores are itchy,
painful blisters that eventually burst and scab. They last for about 1-2 weeks
but usually reoccur.
Leukoplakia - Leukoplakia is a whitish patch that can be found
on the inside of the cheeks, on the gums or on the tongue. Leukoplakia is due
to an excess of cell growth which can be caused by a number of factors
including tobacco smoking or chewing, the habitual chewing the inside of the
cheeks, dentures or braces that do fit properly or any other constant
irritation to the inside of the mouth.
Candidiasis - Candidiasis is also known as thrush or
moniliasis, and is a fungal or yeast infection of the mouth caused by yeast
reproduction in the mouth. People with dry mouth can easily contract
Candidiasis due to lack of saliva which helps kill certain bacteria in the
mouth. Candidiasis forms as small whitish bumps on the inside of the mouth.
Causes-
1. 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, 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).
It is also common for these ulcers to 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.
2. 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.
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.
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 flora, 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.
3. 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.
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.
4. Allergy
Contact with allergens such as amalgam can lead to ulcerations
of the mucosa.
5. Dietary
Vitamin C deficiencies may lead to scurvy which impairs wound
healing, which can contribute to ulcer formation.[2] Similarly deficiencies in
vitamin B12, zinc have been linked to oral ulceration.
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.
6. Flovent
Use of flovent without rinsing the mouth out afterwards may
cause oral ulcers.
7. 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.
8. 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
Symptoms-
Symptoms usually begin with pain or burning, followed in 1 to
2 days by an ulcer. There is never a blister. Pain is severe-far more so than
would be expected from something so small-and lasts 4 to 7 days. The ulcers
almost always form on soft, loose tissue such as that on the inside of the lip
or cheek, on the tongue, the floor of the mouth, the soft palate, or in the
throat. Ulcers appear as shallow, round or oval spots with a yellow-gray center
and a red border. Most ulcers are small, less than ½ inch (1¼ centimeters) in diameter, and often appear in clusters of two or three and usually disappear by themselves within 10 days and do not leave scars. Larger ulcers are less common; these are irregularly shaped, can take many weeks to heal, and
frequently leave scars. People with a severe outbreak may also have a fever, swollen lymph nodes in the neck, and a generally run-down feeling.
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. An age
old remedy is applying a small amount of vinegar to the ulcer, this relieves
pain for a short amount of time. Ulcers persisting longer than three weeks may
require the attention of a medical practitioner.
Role of homoeopathy
There are many homeopathic medicines for the treatment of them
depending on the cause and severity of the condition. It can cure aphthae and also help in
reducing recurrences. Homoeopathic medicines help in
boosting the natural healing processes of the patient to treat and prevent
them. Moreover, homeopathy can treat diseases harmlessly for keeping us in good
health.
Please E-mail dr_ramanand@rediffmail.com for any questions/treatment