Do you find, irritation or difficulty in the inner lips during, drinking coffee or any other hot soups? Do you have any pale white lesions on mouth, does it causing the irritability? Yes, you are having Aphthous ulcer !!!
What is Aphthous ulcer?
Aphthous ulcers also called recurrent aphthous dermatitis or simply known as canker sore is the most common ulcerative inflammatory condition of the oral cavity, especially around the lips and under the tongue. It is a very common condition. The reported prevalence in the general population varies between 10% to 60%, with highest incidence among teenagers.
Who will get Aphthous ulcer?
It typically starts in childhood or adolescence as small recurrent ovoid or round, flat ulcers with well-defined erythematous margins and a central yellow or greyish white floor. The lesions have a recurrent nature, meaning that they are episodic once they appear for the first time in an individual.
Causes for mouth ulcer:
The exact cause or etiopathogenesis for aphthous ulcers is not known. However, it is believed that ulceration might result from a sudden response of the immune system, especially cell-mediated immune system at the site of ulceration, leading to the liberation of cell-signalling molecules or cytokines like TNF-alpha and some other interleukins, which triggers the immune response.
These cytokines cause antigen expression on the surface of oral epithelial cells.The oral epithelial cells are then recognized by T lymphocytes which then trigger by a cytotoxic response and the epithelial cells are phagocytized by immune mediated cells resulting in the formation of ulcer.
Some non-triggering agents which can cause the similar stimulation of such an immune response are,as minor injury to the inside of the mouth during brushing, during plugging out impacted particles from teeth, for example from cuts, burns or bites while eating, dental work, heartbreak, or even a stroke.
- Deficiency of minerals like zinc, vitamin B12, folate, and iron that may present with anemia, can also develope mouth ulcer.
- Smoking cessation or new smokers, allergic reaction to oral bacteria, emotional stress, hormonal changes
- Associated with pregnancy, or having a weak immune system due to certain long term chronic conditions.
These triggering factors might be different in different groups of people. People will have a single or more than a single triggering cause for the lesions.
Types of Aphthous ulcer:
Thera are three main types of aphthous ulcers, they are usual minor and the unusual major and herpetiform variants.
Minor aphthous ulcerations is the most common form and represents more than 80% of those affected. Major aphthous ulcerations represent 10% of those affected and the remaining ulcers are represented by the herpetiform type of ulcer.
Minor Aphthous ulcer:
Minor aphthous ulcerations are the most common variant and appear with the fewest recurrences and lasts only for the shortest duration of time. They are the superficial lesions and appear on the non-keratinized mucosal areas of the lips and cheeks followed by the mucosa of the soft palate, the floor of the mouth, and the ventral surface of the tongue.
The ulcers are usually the most common form of aphthous ulcerations and appear on the non-keratinized usually less than a centimeter in size and last for about 7-10 days and then heals up without scarring. It usually disappears on its own.
Major aphthous ulcer:
Major aphthous ulcer is a less common than the minor type. The ulcer as the name suggests, it is larger in size. These lesions unlike the minor form are deeper and since they are deep, they persist for a longer duration of time, heals with scarring and it is more painful. Major aphthous ulcers have the longest duration of all types of Aphthous ulcers and heal up in a period of 1 month with scarring.
Major ulcers mostly occurs over the inner side of the lips. Other areas of the mouth are also might be affected. The size of the lesion may range between 0.2 cm to several cms. The lesions are very extensive may become secondarily infected and in such cases, healing process is further delayed due to secondary infections.
Herpetiform type:
The herpetiform type most commonly affects women. This form consists of the largest number of lesions or ulcer. The lesions occurs as small size ulcers with extremely painful lesions in the oral mucosal layer having a size of about 1-3 mm in diameter.
The lesions will heal within the period of 7 - 10 days. These lesions resemble herpetic ulcers only in appearance. But unlike herpetic ulcers, they do not develope the vesiculation and the lesions will not the herpes virus.
Treatment for mouth ulcer: (Aphthous ulcer)
1) There is no specific treatment suggested for aphthous ulcers. Minor ulcers will go automatically within a week, without any treatment.
2) Salt water gargling or provide iodine gargling can increase the healing. For major lesions which is not settling for many days needs biopsy to rule out any pre malignant lesions like leukoplakia.
3) Symptoms like burning sensation and pain can be relieved with the use of corticosteroids and analgesics.
4) Secondary infections can be prevented by antibiotics. Recurrences of the lesions can be reduced by identifying and avoiding the trigger agent.
5) If the ulcer starts bleeding and extremely painful constant the doctor immediately.
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