Mouth Ulcers - an overview

Why Do you get mouth ulcers frequently? Why do teenagers get mouth ulcers? what are the various causes of mouth ulcers? How to treat them and how to prevent their occurrence? These , and any other question related to mouth ulcers will be answered in this article in detail. :)
Mouth ulcers, also known as canker sores, are a frequent problem in many people. The ulcer is basically nothing more then just a break in the mucous membrane or epithelium of the lips, the tongue, the inner sides of cheeks. Its the cause of this breakage of epithelium which is the real problem.

These can be divided into

~~ Trauma / Injury leading to Ulcers :

• Chemical injury - includes strong acids or alkali that damage the epithelium and cause a break in it. Most common cause here is the frequent consumption of alcohol and tea.
  
  
• Physical injury - includes injury by a sharp tooth, by some dental fixture, by some sharp object in food like a fish bone, ill-fitting braces, food containing crystals, or trauma from a toothbrush. These ulcers have a rapid healing rate if the source of trauma or irritation is removed or fixed.

~~ Infection leading to ulcers :

• Viral - The most common viral ulcer is caused by herpes simplex virus, which causes multiple painful ulcers mainly in inner lips and cheeks, preceded by multiple painful vesicles that erupt and form ulcerations. Varicella Zoster(chicken pox) Coxsackie A virus and HIV also cause similar ulcerations.
  
  
• Bacterial - The two most common bacterial causes of canker sores are Mycobacterium Tuberculosis and Treponoma Pallidum. Oportunistic infections from normal flora of human mouth can lead to a delay in healing process of these ulcers. Normal bacterial flora in mouth contains the following two clinically important organisms - Streptococci and Actinomyces
  
  
• Fungal - coccidiodis immitis, cryptococcus neoformans, and blastomyces dermatitidis are the three main fungal organisms responsible for causing mouth ulcers or canker sores. These are mainly opportunistic infections which occur after some physical trauma or in immuno-compromised patients.
  
  
• Protozoan - Entamoeba histolytica is a protozoan that's sometimes found in mouth ulcers, so it may be a possible cause of these too.

~~ Stress Related Ulcers :
These ulcers are mainly seen in patients with the following conditions

1. Stress / Anxiety
2. Lack of proper Sleep
3. Physical and Mental Exhaustion due to workload
4. Depression
5. Phobias other mental conditions
6. Worrying for upcoming Exams

Okay these ulcers are not frequently preceded by a painful vesicle. and the only cause of pain is tooth touching the ulcer bed. Stress ulcers are mostly multiple in number and heal rapidly as soon as the stressful situation is dealt with. The exact cause of these ulcers is not properly understood but yes, it is established that these ulcers are due to excessive secretion of some hormones in stress situation.

~~ Immune System Related Ulcers :

• Immunodeficiency as seen in HIV, or in cancer patients under-going chemotherapy can lead to repeated occurrence of mouth ulcers. The main cause of these ulcers is Opportunistic Infection by fungal and bacterial organisms which are a part of normal flora of mouth. So if someone is having repeated episodes of mouth ulcers, he should get his immune system checked. :(
• Auto-Immune conditions can lead to mouth ulcers.
• Allergy - a contact with some known allergen like amalgam can lead to desquamation of epithelium and ulceration.

~~ Oral Cancers presenting as ulcers :sometimes cancer of lips, and tongue can present as an ulcer too

~~ Dietary Causes of ulcers :Deficiencies of vitamin B12 and Vitamin C are strongly associated with mouth ulcers due to the fact that they are required in proper wound healing.

Coeliac disease or gluten enteropathy has been strongly related with mouth ulcers. In this disease, a diet containing wheat , barley or rye will lead to the formation of chronic mouth ulcers. The treatment for this condition is to follow a strictly gluten free diet.

~~ Use of Inhaled Corticosteroids causing ulcers:inhaling corticosteroids, as in asthma, and not rinsing mouth afterwards, leads to formation of mouth ulcers. These type of ulcers are accompanied by oral candidiasis, and are really common in asthmatic patients.

~~ Some Medical Conditions that have mouth ulcers as a sign :

1. Coeliac Disease
2. Crohns Disease
3. Leukoplakia
4. Oral lichen planus
5. neutropenia
6. lupus erythmatosus
7. Behcets Disease
8. Bullous Pemphigoid
9. Oral candidiasis
10. Ulcerative colitis
11. Oral cancers
12. Infectious mononucleosis
13. Post-Menstrual Ulcers Of mouth
14. Gingivostomatitis

PREVENTION :
Ulcers causes by trauma can be prevented by avoiding the particular agent that causes that trauma.Ulcers caused by infection can be prevented by having a proper mouth hygiene, Brushing the teeth daily and using anti-septic mouth wash for at least 1 minute and not more then 70 seconds everyday.
TREATMENT :Symptomatic treatment for ulcers is the mainstay of treatment. If a diagnosis is established then the cause of them is also treated accordingly. Topical antihistamines, corticosteroids and antacid applications are used to soothe out the ulcer. Popular drugs like OraJel, Polyfax, and Bonjela gel are usually available over the counter for application on ulcers. These drugs soothe out and reduce the pain in ulcers.