Mouth ulcer
Encyclopedia
A mouth or oral ulcer (ˈʌlsər, from Latin
ulcus and that from Greek
"ἕλκος" - elkos, "wound") 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 ulcer
s ("canker sores") and cold sores (fever blisters, oral herpes). Cold sores around the lip are caused by viruses.
between 15% and 45%. Mouth ulcers tend to be more common in women and those under 45. Mouth ulcers occur most frequently among 16-25 year olds, and they rarely occur in anyone over 55. 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). People over 45 years of age are the most affected by continuous mouth ulcers.
, or Wisdom teeth), sharp, abrasive, or excessively salt
y 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).
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.
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.
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.
) and Treponema pallidum (syphilis
).
Opportunistic activity by combinations of otherwise normal bacterial flora, such as aerobic streptococi, Neisseria, Actinomyces, spirochetes, and Bacteroides species can prolong the ulcerative process.
), Blastomyces dermatitidis ("North American Blastomycosis
") are some of the fungal processes causing oral ulceration.
, a parasitic protozoan, is sometimes known to cause mouth ulcers through formation of cysts.
s 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.
, 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.
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.
s, such as amalgam
, can lead to ulcerations of the mucosa. Alternative materials may well bring about other types of allergy.
deficiencies may lead to scurvy
which impairs wound healing, which can contribute to ulcer formation. Similarly deficiencies in iron
, vitamin B12
, zinc
have been linked to oral ulceration.
Acidic food such as citrus fruit may cause mouth ulcers.
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
, antacid
s, corticosteroid
s or applications meant to soothe painful ulcers may be helpful, as may be oral analgesics such as paracetamol
or ibuprofen
and local anesthetic lozenge
s, 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) 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.
Aphthous ulcer
can be treated by Silver nitrate, Amlexanox paste. For more information check the Aphthous ulcer#Treatment.
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
ulcus and that from Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
"ἕλκος" - elkos, "wound") is an open sore in the mouth, or rarely a break in the mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
or the epithelium on the lips or surrounding the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of 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
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
and/or secondary infection. Two common types are aphthous ulcer
Aphthous ulcer
An aphthous ulcer , also known as a canker sore, is a type of mouth ulcer which presents as a painful open sore inside the mouth or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious...
s ("canker sores") and cold sores (fever blisters, oral herpes). Cold sores around the lip are caused by viruses.
Epidemiology and frequency
Mouth ulcer is a very common oral lesion. Epidemiological studies show an average prevalencePrevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
between 15% and 45%. Mouth ulcers tend to be more common in women and those under 45. Mouth ulcers occur most frequently among 16-25 year olds, and they rarely occur in anyone over 55. 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). People over 45 years of age are the most affected by continuous mouth ulcers.
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 teethCanine tooth
In mammalian oral anatomy, the canine teeth, also called cuspids, dogteeth, fangs, or eye teeth, are relatively long, pointed teeth...
, or Wisdom teeth), sharp, abrasive, or excessively salt
Salt
In chemistry, salts are ionic compounds that result from the neutralization reaction of an acid and a base. They are composed of cations and anions so that the product is electrically neutral...
y 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).
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
Petroleum jelly
Petroleum jelly, petrolatum, white petrolatum or soft paraffin, CAS number 8009-03-8, is a semi-solid mixture of hydrocarbons , originally promoted as a topical ointment for its healing properties...
before carrying out dental work in order to minimize the number of incidental injuries to the soft mucosa tissues.
Chemical injuries
Chemicals such as aspirinAspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
or alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
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.
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.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.Viral
The most common is Herpes simplexHerpes simplex
Herpes simplex is a viral disease caused by both Herpes simplex virus type 1 and type 2 . Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever...
virus which causes recurrent herpetiform ulcerations preceded by usually painful multiple vesicles which burst. Varicella Zoster (chicken pox, shingles), Coxsackie A virus
Coxsackie A virus
Coxsackie A virus is a cytolytic coxsackie virus of the Picornaviridae family, an enterovirus .-Diseases:...
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 (tuberculosisTuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
) and Treponema pallidum (syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
).
Opportunistic activity by combinations of otherwise normal bacterial flora, such as aerobic streptococi, Neisseria, Actinomyces, spirochetes, and Bacteroides species can prolong the ulcerative process.
Fungal
Coccidioides immitis (valley fever), Cryptococcus neoformans (cryptococcosisCryptococcosis
Cryptococcosis, or cryptococcal disease, is a potentially fatal fungal disease. It is caused by one of two species; Cryptococcus neoformans and Cryptococcus gattii. These were all previously thought to be subspecies of C...
), Blastomyces dermatitidis ("North American Blastomycosis
Blastomycosis
Blastomycosis is a fungal infection caused by the organism Blastomyces dermatitidis...
") are some of the fungal processes causing oral ulceration.
Protozoans
Entamoeba histolyticaEntamoeba histolytica
Entamoeba histolytica is an anaerobic parasitic protozoan, part of the genus Entamoeba. Predominantly infecting humans and other primates, E. histolytica is estimated to infect about 50 million people worldwide...
, a parasitic protozoan, is sometimes known to cause mouth ulcers through formation of cysts.
Immune system
Many researchers view the causes of aphthous ulcerAphthous ulcer
An aphthous ulcer , also known as a canker sore, is a type of mouth ulcer which presents as a painful open sore inside the mouth or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious...
s 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 immunodeficiencyImmunodeficiency
Immunodeficiency is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Immunodeficiency may also decrease cancer immunosurveillance. Most cases of immunodeficiency are acquired but some people are born with defects in their immune system,...
, signaling low levels of immunoglobulin in the oral mucous membranes. Chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
, HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, and mononucleosis
Infectious mononucleosis
Infectious mononucleosis is an infectious, widespread viral...
are all causes of immunodeficiency with which oral ulcers become a common manifestation.
Autoimmunity
AutoimmunityAutoimmunity
Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which allows an immune response against its own cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease...
is also a cause of oral ulceration. Mucous membrane pemphigoid, an autoimmune reaction to the epithelial basement membrane
Basement membrane
The basement membrane is a thin sheet of fibers that underlies the epithelium, which lines the cavities and surfaces of organs including skin, or the endothelium, which lines the interior surface of blood vessels.- Composition :...
, causes desquamation
Desquamation
Desquamation , also called skin peeling, is the shedding of the outermost membrane or layer of a tissue, such as the skin.-Skin:Normal, nonpathologic desquamation of the skin occurs when keratinocytes, after moving apically over about 14 days, are individually shed unnoticeably...
/ulceration of the oral mucosa.
Allergy
Contact with allergenAllergen
An allergen is any substance that can cause an allergy. In technical terms, an allergen is a non-parasitic antigen capable of stimulating a type-I hypersensitivity reaction in atopic individuals....
s, such as amalgam
Amalgam (dentistry)
Amalgam is an alloy containing mercury. The term is commonly used for the amalgam employed as material for dental fillings, which consists of mercury , silver , tin , copper , and other trace metals...
, can lead to ulcerations of the mucosa. Alternative materials may well bring about other types of allergy.
Dietary
Vitamin CVitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...
deficiencies may lead to scurvy
Scurvy
Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic...
which impairs wound healing, which can contribute to ulcer formation. Similarly deficiencies in iron
Iron
Iron is a chemical element with the symbol Fe and atomic number 26. It is a metal in the first transition series. It is the most common element forming the planet Earth as a whole, forming much of Earth's outer and inner core. It is the fourth most common element in the Earth's crust...
, vitamin B12
Vitamin B12
Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...
, zinc
Zinc
Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...
have been linked to oral ulceration.
Acidic food such as citrus fruit may cause mouth ulcers.
Treatment
Symptomatic treatmentSymptomatic treatment
Symptomatic treatment is any medical therapy of a disease that only affects its symptoms, not its cause, i.e., its etiology. It is usually aimed at reducing the signs and symptoms for the comfort and well-being of the patient, but it also may be useful in reducing organic consequences and sequelae...
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
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
may also help in relieving symptoms. Topical antihistamines
Histamine antagonist
A histamine antagonist, commonly referred to as antihistamine, is a pharmaceutical drug that inhibits action of histamine by blocking it from attaching to histamine receptors.- Clinical effects :...
, antacid
Antacid
An antacid is a substance which neutralizes stomach acidity.-Mechanism of action:Antacids perform a neutralization reaction, increasing the pH to reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous...
s, corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s or applications meant to soothe painful ulcers may be helpful, as may be oral analgesics such as paracetamol
Paracetamol
Paracetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies...
or ibuprofen
Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
and local anesthetic lozenge
Throat lozenge
A throat lozenge, cough drop, troche, or cough sweet is a small, medicated tablet intended to be dissolved slowly in the mouth to temporarily stop coughs and lubricate and soothe irritated tissues of the throat , possibly from the common cold or influenza...
s, paints or mouth rinses such as benzocaine
Benzocaine
Benzocaine is a local anesthetic commonly used as a topical pain reliever, or in cough drops. It is the active ingredient in many over-the-counter anesthetic ointments...
and avoiding spicy or hot foods may reduce pain. Rinsing the mouth out with brine
Brine
Brine is water, saturated or nearly saturated with salt .Brine is used to preserve vegetables, fruit, fish, and meat, in a process known as brining . Brine is also commonly used to age Halloumi and Feta cheeses, or for pickling foodstuffs, as a means of preserving them...
(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.
Aphthous ulcer
Aphthous ulcer
An aphthous ulcer , also known as a canker sore, is a type of mouth ulcer which presents as a painful open sore inside the mouth or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious...
can be treated by Silver nitrate, Amlexanox paste. For more information check the Aphthous ulcer#Treatment.
See also
- Aphthous ulcerAphthous ulcerAn aphthous ulcer , also known as a canker sore, is a type of mouth ulcer which presents as a painful open sore inside the mouth or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious...
(Canker sores) - ChancreChancreA chancre is a painless ulceration formed during the primary stage of syphilis. This infectious lesion forms approximately 21 days after the initial exposure to Treponema pallidum, the gram-negative spirochaete bacterium yielding syphilis. Chancres transmit the sexually transmissible disease of...
- Herpes simplex virusHerpes simplex virusHerpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
- Magic mouthwashMagic mouthwashMagic mouthwash and magic swizzle are terms referring to a number of different mouthwash formulations. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis caused by radiation therapy or chemotherapy...
- Squamous cell carcinomaSquamous cell carcinomaSquamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
- StomatitisStomatitisStomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth...
External links
- http://www.mouth-ulcers.org mouth ulcers