Mouth ulcer

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

A mouth or oral ulcer (/ˈʌlsər/, from Latin ulcus and that from Greek "ἕλκος" - elkos, "wound"^[1]) is an open sore in the mouth, or rarely a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. The types of mouth 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 ("canker sores") and cold sores (fever blisters, oral herpes). Cold sores around the lip are caused by viruses.^[2][3]

Epidemiology and frequency

Mouth ulcer is a very common oral lesion. Epidemiological studies show an average prevalence between 15% and 45%.^[4][5] Mouth ulcers tend to be more common in women and those under 45. 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 fewer 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 recurrent aphthous stomatitis (RAS).^[5] People over 45 years of age are the most affected by continuous mouth ulcers. ^[7]

Causes

Trauma

Minor physical injuries

Trauma to the mouth is a common cause of bacterial introduction. 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, hot drinks, 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.^[8]

Smoking Cessation

It is fairly common for smokers to experience mouth ulcers within a week of cessation. The duration varies between individuals, and can range from a month to years. Oral nicotine supplements have shown some reduction in the occurrence.^[9][10]

Infection

Viral, fungal and bacterial processes can lead to oral ulceration. One way to contract pathogenic oral ulcerations is through the contact of chapped lips with unwashed hands. The reason for this is that bacteria sinks into the miniscule, open cuts caused by the 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.^[11]

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. Alternative materials may well bring about other types of allergy.^[12]

Dietary

Vitamin C deficiencies may lead to scurvy which impairs wound healing, which can contribute to ulcer formation.^[3] Similarly deficiencies in iron, vitamin B12, zinc^[13] have been linked to oral ulceration.

Acidic food such as citrus fruit may cause mouth ulcers.^[14]

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. Topical antihistamines, antacids, corticosteroids or applications meant to soothe painful ulcers may be helpful, as may be oral analgesics such as paracetamol or ibuprofen^{[citation needed]} and local anesthetic lozenges, paints or mouth rinses such as benzocaine^{[citation needed]} and avoiding spicy or hot foods may reduce pain. Rinsing the mouth out with brine (warm salted water) or rubbing salt or garlic on the sore area may help to cure an ulcer. Ulcers persisting longer than three weeks may require the attention of a medical practitioner.^[15]

Aphthous ulcer can be treated by Silver nitrate, Amlexanox paste. For more information check the Aphthous_ulcer#Treatment.

See also

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

References

1. ^ ἕλκος, Henry George Liddell, Robert Scott, A Greek-English Lexicon (on Perseus Digital Library)
2. ^ ^{a b c} "Mouth ulcers". North East Valley Division of General Practice. http://www.disability.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mouth_ulcers?open. Retrieved 2006-06-18. 
3. ^ ^{a b c d e f} Sapp, J. Phillip; Lewis Roy Eversole, George W. Wysocki (2004). Contemporary Oral and Maxillofacial Pathology. Mosby. ISBN 0-323-01723-1. ^{[page needed]}
4. ^ J.M. Casiglia, G.W. Mirowski, C.L. Nebesio (October 2006). "Aphthous stomatitis". Emedecine. 
5. ^ ^{a b} T. Axéll, V. Henricsson (1985). "The occurrence of recurrent aphthous ulcers in an adult Swedish population". Acta Odontologica Scandinavica. 
6. ^ ^{a b} Study on 10,000 people suffering from mouth ulcers, March 2010.
7. ^ http://www.aftazen.co.uk/discover-our-study-on-mouth-ulcers
8. ^ Herlof, Bente Brokstad; Barkvoll, Pål (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontologica Scandinavica 54 (3): 150–153. doi:10.3109/00016359609003515. PMID 8811135. 
9. ^ Ussher M, West R, Steptoe A, McEwen A (March 2003). "Increase in common cold symptoms and mouth ulcers following smoking cessation". Tobacco Control 12 (1): 86–8. doi:10.1136/tc.12.1.86. PMC 1759110. PMID 12612369. http://tobaccocontrol.bmj.com/cgi/pmidlookup?view=long&pmid=12612369. 
10. ^ McRobbie H, Hajek P, Gillison F (August 2004). "The relationship between smoking cessation and mouth ulcers". Nicotine & Tobacco Research 6 (4): 655–9. doi:10.1080/14622200410001734012. PMID 15370162. 
11. ^ Lesion-directed dry dosage forms of antibacterial agents for the treatment of acute mucosal infections of the oral cavity, US Patent Office Full-Text and Image Database, 19 June 2001.
12. ^ Dtsch Med Wochenschr. 1993 Apr 2;118(13):451-6. [Mercury sensitization in amalgam fillings. Assessment from a dermatologic viewpoint]. [Article in German] Brehler R, Panzer B, Forck G, Bertram HP. Source Tooth-paste chemicals may cause allergic reaction which leads to ulceration. Try switching your tooth paste, and wash well. Zentrum für Dermatologie und Venerologie, Universität Münster.
13. ^ Orbak R, Cicek Y, Tezel A, Dogru Y (March 2003). "Effects of zinc treatment in patients with recurrent aphthous stomatitis". Dental Materials Journal 22 (1): 21–9. PMID 12790293. 
14. ^ "Dr Luisa Dillner's Guide to… mouth ulcers". The Guardian: p. g2-15. 30 March 2010. http://www.guardian.co.uk/lifeandstyle/2010/mar/29/luisa-dillner-guide-mouth-ulcers. 
15. ^ Van Voorhees, BW (2007-01-18). "Mouth Ulcers - Treatment". MedlinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/001448.htm#Treatment. Retrieved 2008-05-08. 

External links

• Mouth ulcer at the Open Directory Project
• http://www.mouth-ulcers.org mouth ulcers