CANKER SORES

[Anonymous]

Canker Sore Causes

No one knows what causes canker sores. The vast majority of people who develop canker sores do not have another problem as the cause.

* Both hereditary and environmental causes of the disease have been suggested, but the exact cause is not clear.

* A number of factors have been suggested to precipitate outbreaks in susceptible individuals; however, none has been proven to be the cause in all people.

o oral trauma

o hormonal changes related to the menstrual cycle

o anxiety or stress

o smoking cessation

o heredity

o drugs (including anti-inflammatory drugs, such as ibuprofen [Motrin], and beta-blockers, such as atenolol [Tenormin])

o food allergies or sensitivities (chocolate, tomatoes, nuts, and acidic foods such as pineapple, and preservatives such as benzoic acid and cinnamaldehyde)

o toothpastes containing sodium lauryl sulfate

o deficiencies of iron, folic acid, or vitamin B12 (although supplementation with iron or vitamins has not been shown to decrease the likelihood of ulcer resolution)

* Some studies have suggested an association with Helicobacter pylori, the same bacteria that cause peptic ulcers. Recent studies have suggested that treatment of the Helicobacter pylori infection may improve symptoms or completely stop recurrent disease in some patients.

* Recurrent canker sores have been associated with inflammatory bowel diseases, such as Crohn disease and ulcerative colitis. In these cases, the development of canker sores may signal a flare-up of the bowel disease.

* Celiac, or abdominal, sprue, a disease of the intestines caused by sensitivity to gluten, causes malabsorption and is associated with development of canker sores. Gluten refers to a group of proteins found in wheat, barley, and rye.

* Behçet’s disease is a condition characterized by canker sores, genital sores that resemble canker sores, and inflammation of the eye.

* Infection with the AIDS virus also has been associated with canker sores.

* It is a common misconception that canker sores are a form of herpes infection. This is not the case

        

[sushantpatel_doc]

Canker Sore Symptoms and Signs

Canker sores occur in several forms. They can involve any area of the mouth except for the top of the tongue, lips, and hard palate.

* Minor canker sores (which account for the majority of aphthous ulcers) are oval and less than 10 mm (1/3 inch) across. Most are 2-3 mm with a white center. They are painful but clear up within three to 14 days without scarring. It is unusual for them to become infected.

* Major canker sores consist of deep ulcers measuring greater than 1 cm (1/3 inch). These ulcers, which are very painful, have irregular margins and often last for three to six weeks. They tend to heal with extensive scarring.

* A third form of canker sores, termed "herpetiform," resemble herpes infections and consist of many small shallow punched-out lesions, pinhead-sized (1-3 mm) in diameter, or less than 1/10 of an inch. Clusters of these sores may merge together to form large irregular ulcers. They last from seven to 10 days.

* Canker sores commonly come back. Some people have a few outbreaks a year, while others can have them almost all the time

        

[sushantpatel_doc]

Canker Sore Medical Treatment

Although there is no cure for canker sores, treatment can decrease symptoms, reduce the likelihood that they will return, and prolong periods of remission. Your doctor has a number of treatments available:

* Silver nitrate can be applied directly to the lesion. A medical provider who is experienced in application should do this; however, the nitrate sticks can be purchased over the Internet. There is a randomized trial demonstrating the efficacy of this treatment. There is almost immediate relief of pain and the lesion heals over the next three to five days. Many patients do not like the burnt taste that they get in their mouth immediately after the procedure but love the total relief of pain within a few hours.

* Debacterol is a combination of sulfonated phenolic compounds and sulfuric acid that works in a very similar manner to the silver nitrate. It chemically abrades/burns the ulcer. This causes almost immediate relief of the pain and causes the lesion to heal over the next three to five days. It is only available by prescription, but it can be applied by either a dentist or physician. It only has to be applied once.

* Prescription medications: If over-the-counter medications do not help, your doctor may prescribe one of a number of medications:

o Triamcinolone Acetonide Dental Paste USP (Kenalog in Orabase): This can be applied up to three times a day, preferably after meals or at bedtime.

o Amlexanox (Aphthasol): This can be applied up to four times a day, after each meal and at bedtime. There is little evidence that the medication actually decreases pain or speeds healing.

o Tetracycline suspensions (Achromycin, Nor-tet, Panmycin, Sumycin, Tetracap) used as a mouthwash can relieve pain and accelerate healing; however, their use does not prevent recurrence. Also, use for more than five days may cause problems with reactions and yeast infections in the mouth.

o Viscous lidocaine: This is a 2% gel that is applied to the affected area up to four times a day. In order to avoid toxicity, patients should avoid swallowing the medication and should not use the medication more than four times a day.

o Sucralfate slurry (Carafate, a prescription medication used to treat peptic ulcers): This treatment is not recommended by many experts and there are limited studies supporting its use. You mix one tablet in 5-10 milliliters (1-2 teaspoons) of water. The slurry is swished around the mouth and spit out four times a day.

o The doctor may prescribe folic acid, iron, or vitamin B12 supplements if you are deficient in these. In such cases, you may require several months of therapy to improve. No benefit has been shown, however, from taking these vitamins if you are not deficient.

o Corticosteroids: In extremely severe cases, doctors may consider giving oral doses of corticosteroids, if they believe the benefits of treatment exceed the risks of oral steroids. Risks of steroid therapy include weight gain, weakening of the immune system, brittle bones, increase in gastric acidity leading to ulcers, and others.

o Thalidomide (Thalomid): In extremely severe cases, doctors may consider using thalidomide. Unfortunately, its severe adverse effects limit its use, and it is only FDA approved for treatment of major aphthous ulcers in HIV-positive patients.

o Other potential medications. A long list of medications has been tried and may be used to treat aphthous ulcers in carefully selected patients. Each of these has significant potential adverse effects, and many are quite expensive. These include colchicine, pentoxifylline (Trental), Interferon, Cimetidine (Tagamet), clofazimine (Lamprene), anti-TNF-α agents, infliximab (Remicade), etanercept (Enbrel), levamisole (Ergamisol), and dapsone

        

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