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Mouth Sores / Aphthous Ulcers

The most commonly occurring ulcers in the mouth are the aphthous ulcers or commonly known as canker sores.
They are of 3 types:

1. Recurrent aphthous minor
2. Recurrent aphthous major
3. Recurrent herpetiform ulcerations

These ulcers are characterised by development of pain recurring in single or multiple ulcers in the oral cavity.

1. Bacterial infection: A bacteria called L-form of an alpha hemolytic streptococcus; Streptococcus sanguis has been said
to be a causative factor.
2. Vit B12, iron or folic acid deficiency: Multivitamin deficiencies too have been seen to cause these ulcerations.
3. Immune system abnormalities.
4. Hormonal conditions: There is a relationship between the occurrence of the menstrual period and the development of aphthous ulcers. Even during the post ovulation period the occurrence of the ulcer is at its maximum. But it has been noted that during pregnancy there is a remission of these lesions.
5. Trauma: Any kind of traumatic condition precipitates the ulcers occurrence. For example, trauma from tooth brushing,
biting oneself’s tongue, lip or cheek, dental treatments including needle injections etc.
6. Allergies: People who suffer from aphthous ulcers have a history of drug allergies, asthma, hay fever or food allergies.
7. Psychological factors: Acute psychological problems, stress, inadequate sleep patterns too can be attributed to the occurrence of aphthous ulcers.

Signs and symptoms
1. The most common type of the disease is called recurrent aphthous minor or the canker sore. It is frequently seen in women than in men and majority is noticed between the age of 10-30 years. This type persists with repeated attacks over a period of many years. Some patients may have only 1-2 attacks a year, and some may have 1-2 attacks every month. They manifest itself as one or more small nodes with a margin around it, covered with a grey membrane. This lesion is extremely painful and interferes with eating for many days. The most common site are the lip and cheek area, below the tongue, palate, gingiva or pharynx. They generally persist for 7-14 days and heal gradually.

2. The recurrent aphthous major has a characteristic feature. They are large painful ulcers numbering from one to ten, present on the lips, cheeks, tongue and palate. They occur for upto six weeks and leave a scar on healing.

3. Recurrent herpetiform ulcers: They occur in large numbers, often hundred and can be seen anywhere in the mouth. They are small, shallow looking ulcers. They usually stay for 1-3 years with short remission.

The treatment for aphthous ulcers
1. Under the advice of a doctor, a mouth wash containing tetracycline (250 mg per 5ml) can be used for 5-7 days 4 times daily.
2. Mouth wash containing steroid: Dexamethasone used twice daily may also reduce pain.
3. A steroid ointment containing 1.5% cortisone can also be applied on the affected site.
4. As soon as these lesions appear certain pastes can be applied to relieve pain and speed up healing. For example, (triamcinolone acetonide), (aphthasol), benzocaine gel (local anesthetic) etc.
5. Multivitamins can be prescribed that is, folates (folic acid),Vitamin B6, B12 and zinc. Better to improve diet, and avoid acidic foods or foods that a person is allergic to.

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