Aphthous ulceration are characterised by a loss of the mucosal layer within the mouth.
This loss may be acute or chronic, localized or diffuse.
This is one of the most common oral problems presenting in primary
care and can arise as a result of a number of disorders. Some of
these relate to problems around the oropharynx but there is a wide
variety of systemic disorders that can also give rise to these
Epidemiology-Oral ulceration is a common condition. 20% of the population are believed to be affected by recurrent aphthous ulceration.
Aetiology -These lesions can
arise as a result of a vast number of (sometimes overlapping)
disorders detailed in the two sections below. The most common causes
are local trauma and recurrent aphthous ulceration. Mechanical trauma
The most common cause of oral mucosal ulceration.
It is more often caused by dentures, braces or sharp/broken teeth. It can also be due to tongue or cheek biting, scratching with fingernails, or eating rough foods. Chemical injury Thermal injury Thermal injury arises from mucosal contact with hot food or liquids. Although the palate is most commonly affected, these injuries can also occur on the lip, tongue or oropharyngeal region.
Recurrent Aphthous ulceration These are also known as 'canker sores'. The condition is characterised by clearly defined, painful, shallow round or ovoid ulcers not associated with systemic disease. They are not infective. Investigations In many instances investigations are not required and diagnosis is clinical. If history or examination suggest it then blood tests may be required. (FBC, ESR, ferritin, folate, B12, for example.) Referral for specialist secondary investigation where relevant is discussed below.
General principles Establish the cause. It is important to establish the diagnosis in each case, as many of the causes of these lesions require specific management in addition to local treatment. Local treatment aims to protect the ulcerated area, to relieve pain, to reduce inflammation, or to control secondary infection.
The available options are discussed below.
Simple mouthwashes- A warm saline mouthwash (half a teaspoon of salt in a glassful of warm water or dilute compound sodium chloride mouthwash with an equal amount of water) has a mechanical cleansing effect and may relieve the pain of traumatic ulceration. Use until the discomfort and swelling ease.
Arsenicum album: A person who breaks out in burning, painful mouth sores, and also feels anxious and tired, is likely to benefit from this remedy. Hot drinks often ease the pain, and the person feels best when keeping warm. People who need this remedy often have unhealthy, easily-bleeding gums, and tend to be extremely neat and tense.
Borax: This remedy is often helpful when canker sores feel hot and sensitive. Acidic foods—especially citrus fruits—may be irritating. Sores may break out on the inside of the cheeks, on the gums, and on the tongue. The person produces profuse saliva, yet still feels dry inside the mouth. People needing Borax are often very sensitive to noise and inclined toward motion sickness.
carbonica: This remedy is often indicated when infants and small
children have recurring canker sores. A child who needs this remedy
may also have head-sweats during sleep, and be slow to teethe or
learn to walk.
Calcarea carbonica may help with canker sores in adults who are chilly, stout, and easily fatigued.
Hepar sulphuris calcareum: If a person develops painful mouth sores that become infected—with pus formation, extreme sensitivity, and aggravation from cold drinks—this remedy may be indicated. A person needing Hepar sulph often feels extremely chilly, vulnerable, and oversensitive.
Mercurius solubilis: Bleeding gums, a swollen coated tongue, and offensive breath are seen along with canker sores when this remedy is needed. The painful, burning sores feel worse at night, and salivation is profuse, with drooling during sleep. The person tends to sweat at night and is very sensitive to any change in temperature.
Natrum muriaticum: Pearly sores that erupt inside the mouth, especially on the gums or tongue, may respond to this remedy. The mouth feels dry, and the tongue may have a tingling feeling. People who need this remedy often are troubled by cold sores around the corners of the mouth or chin, and have chapped or cracking lips. A craving for salt, strong thirst, and a tendency to feel worse from being in the sun are other indications for Natrum muriaticum.
Sulphur: This remedy may be helpful for sores that are painful, red and inflamed, with burning pain that is worse from warm drinks and aggravated by heat of any kind.
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