Mouth ulcers – what a pain!

These mysterious and painful lesions impact 1 out of 5 people

By Dr. Stephanie McGann, DMD, FAGD, Columnist, The Times

UTStephCollogoYesterday, when I told my husband what this month’s column would be on, he looked puzzled.  I know there are new and exciting high tech and wonderful things to write about and yet, every week we see people who are suffering and just don’t know why.

If you are one of the many folks who are prone to mouth ulcerations, you know what I mean. Some people refer to these common ulcerations as canker sores. The ulcer starts with an open raw patch inside the mouth that can come seemingly from nowhere and be a real pain. What we don’t know for sure is why some people get them and why others don’t.  Studies show that 1 in 5 people will develop these ulcerations during their life. Some unlucky few seem to get them all the time.

The most common type of ulcer is the aphthous ulcer.  These can occur almost anywhere inside the mouth.  They can affect kids and adults and females are affected slightly more often than males.  Minor aphthous ulcers (also called canker sores) are smaller than a dime, they last 7-10 days and the pain level can vary. Major aphthous ulcerations are larger, may be larger than the size of a quarter and can last from a week to a few months.  These larger ulcerations can be extremely painful and can make everyday life difficult. A third type called herpetiform (not related to herpes) is a cluster of tiny pinhead-sized ulcerations. Apthous ulcers are not contagious.

The ulcers can occur at any age but most frequently occur between the ages of 10 and 40. The frequency of outbreaks tends to lessen with age.  Some children are prone to them and get them regularly.

What causes aphthous mouth ulcers?

The cause is unknown; the ulcers develop for no apparent reason in people who are healthy.   While there is no one cause of these uncomfortable ulcerations, some people get them on a regular basis. These cases are called recurring apthous stomatitis.  Sometimes the ulcers may come as a result of a trauma, such as from a poorly fitting dental applicance, irritation from orthodontic brackets, an injury from a hard toothbrush or overzealous brushing.  Females may find that the ulcers are related to their hormonal cycle. In some cases poor nutrition has been linked to the development of aphthous ulcers. Certain food sensitivities may trigger an aphthous ulcer. Heredity may play a role as some families get ulcers more frequently. Stress or anxiety is said to trigger aphthous mouth ulcers in some people. Tell your doctor if you have any other symptoms in addition to the mouth ulcers. Rarely, severe mouth ulcers can occur after taking a medicine you are allergic to. Sometimes a blood test or other investigations are advised if other causes of mouth ulcers are suspected.

What are the treatments for aphthous ulcers?

While there is no cure for apthous stomatitis, there is treatment designed to ease pain and heal the open sore. Small ulcerations usually resolve in 7-10 days with good oral hygiene, over-the-counter pain relievers, and topical analgesics.  A few larger ones may last significantly longer and require more aggressive measures to speed their healing.

Things you can do to help heal an ulcer quickly: Avoid spicy foods, acidic food or beverages, and very course crunchy foods that can be irritating to the open tissues.  If you think a dental appliance or denture is responsible, see your dentist right away. If a new medication is suspected of causing  the ulcers, let the prescriber know immediately. Always use warm salt water to rinse the tissues and keep the mouth clean.

There are a number of ways to block the pain. A barrier paste such a OraBase will cover and protect the lesion.  If your dentist has a dental laser, then ask him or her to evaluate the lesion- some lasers can stimulate the tissues, speed healing and cause a protective scab to form over the area, blocking the pain from an open sore.  An over-the-counter benzocaine rinse or ointment will help ease the pain temporarily. For severe pain and large ulcers, prescription pain relievers, lidocaine or steroids may be prescribed.

When should I see a doctor?

Any sore that does not heal within two weeks should be evaluated by a physician or dentist.  If an unusual odor or foul taste is present, that can be a sign of an infection in the ulcer that may require additional treatment.  For folks who get recurring cases of aphthous stomatitis, a physician more order blood tests to rule out any underlying health concerns that may contribute to this condition.

The best advice for people who are susceptible to apthous ulcers, avoid any known triggers, eat right, and take a multivitamin if indicated.  Ask your dentist what you should do if you feel an ulcer developing.

Dr. Stephanie McGann is a resident of the Unionville area and along with her partner, Dr. Marie Scott, operates The Brandywine Smile Center, a family-friendly dental practice in Concordville. She is a Fellow of the Academy of General Dentistry.

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