Skin Diseases

An aphthous ulcer or canker sore is a type of mouth ulcer which presents as a painful open sore inside the mouth, caused by a break in the mucous membrane. The condition is also known as aphthous stomatitis, and alternatively as “Sutton’s Disease,” especially in the case of multiple or recurring ulcers.

Canker Causes

• The exact cause of aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid. Some drugs, such as nicorandil, also have been linked with mouth ulcers. In some cases they are thought to be caused by an overreaction by the body’s own immune system.
• Trauma to the mouth is the most common trigger of aphthous ulcers. Physical trauma, such as that caused by toothbrush abrasions, laceration with sharp foods or objects, accidental biting (particularly common with sharp canine teeth), or dental braces can cause mouth ulcers by breaking the mucous membrane. Other factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. The large majority of toothpastes sold in the U.S. contain Sodium lauryl sulfate (SLS), which is known to cause aphthous ulcers in certain individuals. Using a toothpaste without SLS will reduce the frequency of aphthous ulcers in persons who experience aphthous ulcers caused by SLS. However, some studies find no connection between SLS in toothpaste and mouth ulcers.
• Artificial sugars, such as those found in diet cola and sugarless gum, have been reported as causes of aphthous ulcers as well. They can also be linked to an increased intake of acids such as ascorbic acid (one form of Vitamin C) or citric acid. In this case the sores disappear after intake decreases (for example, by substituting ascorbate salts for ascorbic acid).
  Another possible cause of aphthous ulcers may be opportunistic activity by combinations of otherwise normal bacterial flora, such as aerobic streptococci, Neisseria, Actinomyces, spirochetes, and bacteroides. According to small-scale experiments by one patent applicant Hau , topical preparations of high doses of penicillin resulted in accelerated healing of mouth ulcers.
• There is a commonly held belief that another cause of aphthous ulcers is gluten intolerance (Coeliac disease), whereby consumption of wheat, rye, barley and sometimes oats can result in chronic mouth ulcers. However, two small studies of patients with Coeliac disease have demonstrated no link between the disease and aphthous ulcers. If patients with aphthous ulcers do happen to have gluten intolerance, they may experience benefit in eliminating breads, pastas, cakes, pies, scones, biscuits, beers and so on from their diet and substituting gluten-free varieties where available.
• Although the exact cause is not known, aphthous ulcers are thought to form when the body becomes aware of and attacks molecules which it does not recognize.The presence of the unrecognized molecules garners a reaction by the T-cells, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory T-cells.
• Repeat episodes of aphthous ulcers can be indicative of an immunodeficiency, signalling low levels of immunoglobulin in the mucous membrane of the mouth Certain types of chemotherapy cause mouth ulcers as a side effect. Mouth ulcers may also be symptoms or complications of several diseases listed in the following section. The treatment depends on the believed cause.

Canker Prevention

• Regular use of mouthwash may help prevent or reduce the frequency of sores.
• In some cases, switching toothpastes can prevent mouth ulcers from occurring with research looking at the role of sodium dodecyl sulfate (sometimes called sodium lauryl sulfate, or simply SLS), a detergent found in most toothpastes. Using toothpaste free of this compound has been found in several studies to help reduce the amount, size and recurrence of ulcers.
• Dental braces are a common physical trauma that can lead to mouth ulcers and can be treated with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but since such trauma is usually accidental, this type of prevention is not usually practical.
• Take caution when brushing or flossing teeth, and be extra careful when using a toothpick.
   Nutritional therapy.
• Zinc deficiency has been reported in people with recurrent mouth ulcers.The few small studies looking into the role of zinc supplementation have mostly reported positive results particularly for those people with deficiency,although some research has found no therapeutic effect.

Canker SoreTreatment

Any mouth sore that does not heal after two weeks should be looked at by a dentist or an oral surgeon as it could be a sign of a more serious condition such as oral cancer.

• Aphthous ulcers normally heal without treatment within 1 to 2 weeks. Good oral hygiene should be maintained, and spicy, acidic, and salty foods and drinks are best avoided, as they may irritate existing ulcers. Strong mouthwash such as Listerine has also been known to cause irritation because of its strong ingredients, and many oral care professionals discourage the use of it while having a mouth ulcer.
• Pain can be treated with several pain-relieving gels, such as Anbesol, Bonjela, Campho-Phenique, Orabase B, Zilactin, or Kanka, available in drugstores. Some people claim that such gels also accelerate the healing of their ulcers.
• A dental laser can be used to treat an aphthous ulcer. Immediate and lasting pain relief is achieved, and the ulcer will heal in a few days.
  Another purported remedy is the use of the prescription steroid Dexaltin Oral Paste. Triamcinolone Acetonide dental paste can be very effective; the steroid reduces the immune system’s response in the area of the ulcer. It is available by prescription only.
• A recent study of the Oral-B product Amosan suggests that it may reduce anaerobic bacteria, such as those found in oral wounds. The study did not, however, demonstrate the efficacy of the product in treating mouth ulcers.
• Tincture of benzoin can be used as a protectant for recurring aphthous ulcers, by forming a layer over the sore and protecting it from further irritation.
• Debacterol is available for individual use. This on being applied directly to the wound cauterizes the ulcer and instantly provides permanent pain relief.
• The timing of treatment can be critical for a significant reduction of the length of time of the pain caused by the ulcer. If repeated antiseptic mouthwash treatments are applied as early as possible, preferably within 12 hours of the initial symptoms, i.e., the onset of tingling or burning sensations, then the subsequent intense pain will only last 1–2 days, instead of the usual 7-10 days Although the ulcer will continue its normal course of healing within 7-10 days, early treatment limits the pain to just the first cou of days.
• Since this type of ulcer is highly recurrent, people suffering from it can usually recognize the telltale signs of another imminent onset, and therefore the chance of reducing or even eliminating the pain associated is good if treated early. Unfortunately, if treatment is delayed until 24 hours after the start of intense pain, only temporary relief of up to several hours can be achieved per treatment.

Home remedies

Some home remedies that have been suggested include:

• Licorice Root (Glycyrrhiza) may help heal canker sores if the medicated disks are applied early on
• Antacid techniques suggested include the following:
• Make a paste of baking soda and water; apply directly to the ulcers
• Make a mix of half milk of magnesia and half Benadryl, and hold in the mouth for up to 3 minutes.
• Swab the ulcers with Milk of Magnesia

Canker Sore Treatment for severe cases

• Treatments based on antibiotics and steroids such as Dexamethasone Elixir are reserved for severe cases, and should be used only under medical supervision. Tetracycline suspension is an antibiotic commonly prescribed for mouth ulcers. Some doctors may also prescribe a local anesthetic, such as lidocaine, for cases of multiple or severe aphthous ulcers. If it does not heal within a week, a doctor or dentist may cauterize it using a laser to burn off the ulcer, causing it to completely disappear within a few hours or two to three days.
• In very severe cases, a doctor may prescribe a steroid treatment. One such steroid is methylprednisolone (usually in a dose-pack), taken orally for a period of 7 days. Alternatively, the doctor may inject a steroid directly into the site of the ulcer (this treatment is performed with kenalog. Between 0.2 and 0.4 ml of kenalog is injected into the site of the ulcer, which will usually be completely healed 72 to 96 hours after the injection).
• Patients in whom ulcers do not respond to local treatment may benefit from a short course of pulsed prednisone.
• Some dentists recommend a sulfuric acid solution for treating mouth ulcers, such as debacterol.

Please do not misunderstand the canker sore with cold sore