It is amazing to think that something as small and seemingly insignificant like a mouth ulcer can make life absolutely miserable for the people affected! Almost everyone will have suffered from mouth ulcers at some point or another and most of these people will have taken symptomatic medication for a couple of days until they got better.
For a smaller subset of the population, however, these mouth ulcers can be excruciatingly painful and an all too frequent occurrence.
Types Of Mouth Ulcers
- Minor Ulcers
- Major Ulcers
Minor ulcers are smaller in size, usually ranging from around 2-8mms and clear up on their own within a maximum of two weeks. Major ulcers, on the other hand, are much larger in size and can stay in the mouth for a couple of months. These major ulcers also leave behind a scar on healing.
Causes Of Mouth Ulcers
There are a number of causes that have been identified as responsible for the causation of mouth ulcers.
This is by far the most common reason for an ulcer to form in the mouth. Inadvertent trauma while chewing food, due to a rough edge of a prosthesis, sharp end of a tooth or due to eating something of extreme temperature can all be causes. The ulcers that are caused in this way are solitary or maybe a couple in number and may be acutely painful for the duration they are present. They almost always heal on their own and do not really need any medical intervention.
People who are prone to anxiety, depression or under a severe amount of mental duress often see a breakout of mouth ulcers. The exact link between stress and mouth ulcers is unknown, although he most likely theory seems to link a depression in the functioning of the immune system. This allows latent virus in the system to become active and cause ulcers.
A lot of the time, people who have recently changed their toothpaste brand or another oral hygiene product find themselves find that they develop mouth ulcers soon after. Some of the additive substances that are used for flavoring in these products can cause an allergic reaction.
If this is indeed the cause then the ulcers will be multiple and more often placed towards the palate, although they may occur elsewhere as well. An associated reaction on the gums can also be seen commonly which will result in redness, bleeding and pain in the affected region.
It can be extremely difficult to pinpoint the exact thing that is causing an allergic reaction, however, if the doctor may order a test for potential allergens if the symptoms are severe and involve other parts of the body as well.
The treatment will involve a course of antihistamines along with avoiding exposure to the identified allergen.
Management Of Mouth Ulcers
A deficiency of vitamin B12, folic acid, iron or zinc can also increase the likelihood of developing ulcers in the mouth. These vitamins and minerals play an important role in the maturation of the collagen fibers and ground matrix, which form the structure binding the cells together. They also help in the maturation process of these cells. All of these functions are compromised when there is a nutritional deficiency and thus, the natural defenses against viral infection, trauma, and other minor insults are not at maximum capacity.
If an ulcer does not heal over a long period of time or has edges that seem to be necrotized and foul smelling then immediate medical attention is warranted. The incidence of oral cancer is extremely high, especially in people who are heavy tobacco users. Usually, there will be other symptoms that appear prior to the appearance of oral cancer like whitish striations on the check, a burning sensation in the mouth and/or a reduction in the mouth opening.
Squamous cell carcinoma, which begins as a non-healing ulcer, is very aggressive and can spread quickly by causing the destruction of the nearby structures. If the doctor suspects that the ulcer may be cancerous, then a confirmatory biopsy will be performed followed b y surgical removal of the ulcer. Surgeons take a wide margin of healthy tissue around the ulcer during surgery to ensure that no cancer cells get left behind. The extent of the surgery will depend on the stage at which cancer has been caught. Some doctors may also choose to do a course of chemotherapy following the surgical treatment.
Management Of Ulcers
Non-cancerous ulcers are managed in a conservative manner and only through symptomatic treatment. The idea behind the treatment is to make the patient comfortable and pain-free as the lesion resolves on its own.
Doctors will prescribe the use of topical analgesics and topical steroid ointments to be applied to the lesion. They will also do a clinical assessment to make sure that there is no offending cusp or sharp edge that is causing recurring injury.
There may be an indication of prescription painkillers in case the patient is finding little or no relief with topical ointments.
Can Ulcers Be prevented?
This is a very common question and the answer is not very simple. It is very difficult to prevent against something that you do not know the exact cause of, however, there are some common sense practices that will help minimize the likelihood of developing ulcers. People who suffer from frequent mouth ulcers should avoid spicy food, stick to oral hygiene brands that they have been using for a long time, avoid chewing gum and other flavored mints as well as keep a high level of oral hygiene. Any cavities in the mouth should also be filled so that there is no food that is getting lodged anywhere and allowing bacterial colonies to prosper. There is nothing much else that anyone can do.