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Mouth ulcers Causes, Symptoms and Treatment

The canker sores are small superficial ulcers that are most often formed on the mucous membranes inside the mouth  : on the inside of the cheeks, the tongue, and the inner side of the lips, the palate or the gums. Canker sores can also appear on the genitals, but rarely. It will be here only about canker sores in the mouth.

When mouth ulcers occur repeatedly, it is called aphtosis. The word stomatitis means that there is an inflammation of the mucous membranes of the inside of the mouth.

The mouth sores are common: about 17% of the population is affected at some point in his life. Often, the first outbreak of canker sores occurs during childhood . Then, the symptoms return at certain times, and then disappear definitively during the thirties.

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Canker sores can manifest themselves in a variety of ways.

  • Minor form  : 1 to 5 oval-shaped ulcers (2 mm to 1 cm in diameter) that heal naturally in 7 to 14 days without leaving a scar. Canker sores occur in this form in 80% of cases.
  • Major or troublesome form  : ulcers of larger size (more than 1 cm in diameter), with irregular contour, which can take 6 weeks to heal and often leave scars.
  • Herpetiform or miliary form  : from 10 to 100 tiny ulcers (less than 3 mm in diameter) with irregular contours that regroup little by little, then form an ulcerative zone, which persists for 1 to 2 weeks without leaving a scar.

Evolution

The pain usually lasts 2 to 5 days. The healing of ulcers may however require 1 to 3 weeks.

Diagnostic of Mouth ulcers

The mouth ulcer is a round or oval wound, painful, occurring by outbreaks.

To make the diagnosis of a canker sore, the doctor relies on several characteristics:

  • the yellowish (“fresh butter”) or greyish background,
  • the infiltrated base (we can take the mouth ulcer between the fingers and we feel that the whole area is discreetly indurated),
  • the edges are clear and surrounded by a bright red halo.

When symptoms similar to mouth ulcers occur recurrently , it is best to consult a doctor . He will carry out a complete medical examination, which will enable him to make a diagnosis.

If, in addition to sores, redness of the eyes, joint pain, persistent diarrhea or abdominal pain is present, it is important to consult without delay .

Ulcer-like ulcers can be caused by a chronic disease , such as inflammatory bowel disease (Crohn’s disease or ulcerative colitis), celiac disease or Behçet’s disease .

On the other hand, canker sores may look like mucositis  : an inflammation of the lining of the mouth that sometimes creates small lesions. Individuals with compromised immune systems (such as HIV infection or cancer treatment) are more likely to have ulcers that could be confused with mouth ulcers.

Causes of Mouth ulcers

The causes of stomatitis are not yet well established. Canker sores are not infectious, so not contagious . Several factors, including heredity, could contribute to this.

However, scientists have noted factors that tend to trigger the symptoms in sufferers .

  • A small wound inside the mouth. It can be caused by improper denture fitting, oral surgery, overly energetic use of the toothbrush, nicking of the cheek, etc.
  • Physical fatigue and stress These often precede the appearance of canker sores.
  • Allergies or sensitivities The literature links the recurrence of mouth ulcers with food allergies or sensitivities (eg, coffee, chocolate, eggs, nuts, cheese, high acid foods and preservatives). such as benzoic acid and cinnamaldehyde).
  • Dietary deficiency of vitamin B12, zinc, folic acid or iron.
  • A smoking cessation. Canker sores can occur during smoking cessation.
  • An infection with the bacterium Helicobacter pylori , the same bacteria that can cause an ulcer in the stomach or small intestine.
  • Some drugs. Nonsteroidal anti-inflammatory drugs (ibuprofen and others), beta-blockers(propranolol and others) and alendronate (for osteoporosis) can cause canker sores.
  • Hormonal changes related to the menstrual cycle , possibly. Canker sores tend to appear during menstruation, but this link is uncertain.

Note. The use of a toothpaste containing sodium dodecyl sulfate (called sodium lauryl sulfate ), an ingredient found in most toothpastes, may increase the risk of having canker sores. It would make the inside of the mouth more vulnerable to injury by removing the protective layer that lines it. However, this hypothesis remains to be verified. A few small clinical trials suggest that the use of toothpaste without sodium dodecyl sulfate reduces the frequency of mouth ulcers. However, a more recent clinical trial concluded that the type of toothpaste used had no influence on canker sores.

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Symptoms of canker sores

The thrust of canker sore is often preceded by a sensation of tingling in the affected area.

  • One or more small ulcers inside the mouth. The center of the ulcers is whitish, and their outline is red.
  • The canker sores cause a sharp pain comparable to a burning sensation (besides, the word aphtis comes from the Greek aptein , which means “to burn”). Evil increases when you talk or eat, especially during the first few days.

Notes . Ulcers do not leave scars.

People at risk

  • The women.
  • People whose parents have or have had canker sores.

Prevention of mouth ulcers

Measures to reduce the frequency of canker sores
  • Have good oral hygiene . Use a soft bristle toothbrush . Floss between the teeth once a day. Furthermore, some studies have shown a reduction in recurrent aphthous stomatitis in affected individuals using mouthwash antibacterials.
  • Avoid talking while eating and chewing slowly to avoid injuring the oral mucosa. The lesions make the mucous membranes more vulnerable to the appearance of canker sores.
  • Try to find out if you have food intolerances or sensitivities and, if necessary, remove the foods in question.
  • If necessary, check with your dentist or denturologist that the dental prostheses you are wearing are properly adjusted.
  • Avoid the use of sodium dodecyl sulphate dentifrice, although this is controversial.

Medical treatment of canker sores

The sores usually heal on their own, so treatment is not always necessary.

If needed, some medications can help relieve pain.

  • mouthwash medication can relieve pain and inflammation . Some contain cortisone or prednisone, anti-inflammatories, erythromycin, antibiotic, lidocaine, local anesthetic or diphenhydramine (Benadryl), an antihistamine with anesthetic effect. These pharmaceutical substances also accelerate the healing of canker sores and prevent them from increasing in size. They are obtained by prescription.
  • gel , an ointment or anesthetic liquid . Several types of products are in pharmacy, over-the-counter. Applied to ulcers, they protect the lining and relieve pain. For example, Orabase, Oralmedic and Zilactin, clove-based gels (Pansoral). It is also possible to use sucking tablets (Aphtoral combining chlorhexidine / tetracaine / ascorbic acid). Other products, more concentrated, are obtained on prescription (Lidocaine gel). Other products, more concentrated, are obtained on prescription.
  • Tablets of aspirin or acetaminophen (Tylenol, Acet, Tempra, etc.) can also help relieve pain.
    Attention . It is better not to take no steroidal anti-inflammatory drugs (ibuprofen and others), which can contribute to the problem.
  • Some medications that were not originally intended to treat canker sores may be beneficial. This is the case, for example, with colchicines (a medicine usually used to treat gout). These drugs are taken orally in tablet form.
  • For someone with very serious and recurrent mouth ulcers, other treatments such as oral cortisone can be used , but this is rare because of the side effects.
  • If nutrient deficiency, corrected by taking supplements of vitamins or minerals .

If an ulcer is slow to heal, the doctor may suggest a biopsy. He then takes some tissue from the ulcer for the purpose of examining it under a microscope. The analysis of the tissue will make it possible to know if the lesion is of cancerous origin or not.

More tips to reduce pain

  • Put an ice cube in your mouth and let it melt on the ulcer.
  • Avoid eating foods and drinks that irritate the mucous membranes. This is the case of those that are acidic (coffee, citrus, pineapple, tomatoes, etc.), hard (such as toast, nuts and pretzels) or spicy.
  • If rinse the mouth with one of the solutions following, and then spit it out:
    – 1 tbsp. baking soda and 1 tbsp. of salt dissolved in 120 ml of water.
    – 1 C. hydrogen peroxide in ½ liter of water (2 cups).
    These solutions reduce pain. Use 4 times a day if possible.
  • Brush the canker sores gently with a little milk of magnesia a few times a day.
  • Apply to the lesion a thin layer of paste composed of baking soda and water.

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