Aphthous Ulcers (Canker Sores, Aphthous Stomatitis) are small areas of erosion or damage to the cells lining the mouth or in the oral area. They may cause excessive pain at the site of ulcer. The pain may increase after eating or drinking anything spicy or hot.
Depending on the size and number of them, Aphthous Ulcers can be of three types:
Minor sores (more common): They are small in size (1 to 10 millimeters) and are usually 1 to 6 in numbers. The ulcer heals in about 7 to10 days. They do not leave scars after healing.
Major sores (less common): They are larger in size (more than 10 millimeters) and are usually 1 to 6 in numbers. They may heals in about 10 to 30 days and may leave scars.
Herpetiform ulcers (less common): They develop in groups of multiple small sores. The ulcers are small in size and they usually heal within 7-10 days.
Aphthous Ulcers may form at any age but are more common seen in teenagers. Females are affected more commonly compared to males.
Acute (symptoms develop rapidly and remain for a few days), can be genetic, can be due to deficiency of nutrients in diet, can be infectious, non-contagious.
The cells lining the mouth or the tongue are affected. There may be difficulty in eating because of the pain while eating.
The exact cause of Aphthous Ulcers is not known. However, the potential reasons are:
Allergy: Ulcers may form due to allergic reaction to certain food substances, viruses, or bacteria. In an allergic reaction, immune cells accumulate (which is called as inflammation) in the cells lining the mouth or tongue, which causes swelling and damage.
Genetic: Aphthous Ulcers are more common in people whose close relatives or parents had or have the condition. This probably occurs due to the inheritance of certain defective genes. However, such exact such genes have not been identified yet.
Nutritional Deficiency: Deficiency of nutrients such as vitamin B12 (cobalamine), folic acid, or iron may cause the ulcers.
Injury: Injury to the mouth due to hard toothbrushes, ill-fitting dentures, sharp metal braces, or hot foods may result in formation of sores. Smoking, chewing tobacco or betel nut may also irritate and damage the membranes the line the mouth. Toothpastes containing chemicals such as sodium lauryl sulfate may also cause damage.
Autoimmune Disorders: In conditions such as systemic lupus erythematosus, crohn's disease or behcet's disease, the immune cells of the body are abnormally activated. These cells may damage the cells lining the mouth resulting in ulcers.
Hormonal: Female sex hormones may have some role in causing Aphthous Ulcers. This is suggested by the evidence that the ulcers form during certain phases of the menstrual cycle.
The usual symptom is pain at the site of the ulcer. The pain worsens on eating or drinking anything spicy or hot.
In the initial stages, Aphthous Ulcers appear as small, oval or round, red colored swellings. The base of the ulcer is whitish-yellow and the edges look red. They are commonly found on the tongue, the inner side of the lips and cheeks, or at the base of the gums. The swellings usually burst within a day.
Depending on the type, Aphthous Ulcers may be single or multiple. The size may be small or large. In most cases, the sores heal within two weeks without scarring. In many cases, sores recur (occur again) after healing.
There may be other symptoms depending on the cause of the ulcers.
The diagnosis may start with verifying the medical and family history of the person. Oral examination is done with a torch to look for any presence of ulcers, their numbers and sizes.
In most cases, no further testing may be needed. However, following tests may be done to find the cause of Aphthous Ulcers.
Complete Blood Count: A sample of blood is taken and levels of hemoglobin, red blood cells (RBCs) and white blood cells (WBCs) are assessed. In the presence of any infection, the level of WBCs is usually raised.
Blood tests may be done to assess any deficiency of iron or vitamins such as cobalamine.
Tests may be done to detect abnormal antibodies such as antinuclear antibodies, if autoimmune conditions are suspected.
Biopsy: A small part of the oral tissue around the ulcer is cut using a blade. This is examination under the microscope to the presence of Aphthous Ulcers. This test also helps to rule out any type of cancer.
The aim of treatment is to relieve the symptoms, speed-up the healing, and reduce recurrence.
The person may be advised to avoid any hot or spicy liquids and food substances.
Injuries to the ulcers should be avoided.
One should smoking, or tobacco, or betel nut, at least till the ulcers heal.
Medications may be given to relieve pain. Ointments such as benzocaine or lidocaine may be applied on the site of ulcer directly or using a cotton. They may be applied several times during the day. These medications reduce irritation and prevent worsening of the pain while eating, drinking, or brushing.
Pain killer drugs such as acetaminophen or ibuprofen may be given if the pain is intense. These drugs also reduce inflammation and speed up healing.
Antibiotics such as tetracycline may be applied over the ulcer or taken orally. These medications are used to cure any bacterial infection of the ulcers.
Steroid gels or oral rinses may be advised. They reduce inflammation and speed up healing. Steroids also reduce the chances of recurrence.
Vitamins or iron tablets may be given, if their deficiency is suspected.
Mouthwash solutions containing diphenhydramine may be given to mitigate allergy, if allergy is suspected.
If the ulcers do not heal with these measures, and if they recur frequently, the doctor may prescribe oral steroids.
Bacterial infection of the ulcer may occur resulting in worsening of pain, fever and delayed healing.
Aphthous Ulcers may leave scars after healing, particularly in cases of large size ulcers.
Aphthous Ulcers may be associated with autoimmune conditions such as Systemic Lupus Erythematosus, Crohn’s Disease or Behcet's Disease.
Regular balanced diet helps. One should also avoid foods that one is allergic to.
Toothbrushes should be soft. One should not brush too vigorously as it may result in damage to the gums. Avoiding very hot foods or liquids, such as tea and coffee, also helps. If anyone is using dentures, they should be well-fitting.
One should quit smoking or tobacco chewing. These substances cause injury to the cells that line the mouth.
A person having Aphthous Ulcers should:
Avoid foods that may stick to the teeth or gums, such as potato chips. That may worsen the sores.
Avoid touching the sores with the bristles of the toothbrush while. One may also consider changing the toothpaste, if it contains substances such as sodium lauryl sulfate, which cause ulcers.
Reduce spicy foods, and hot foods or liquids such as tea or coffee. These substances can increase the pain.
Sores do not transmit from one person to another. So, one need not worry about contacting another person with the sores.
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