Canker sores are ulcerative lesions of the oral cavity that can occur at the level of the jugal mucosa (the lining of the cheeks and lips), the tongue, the soft palate or at the base of the gums. Unlike herpetic lesions that affect the outside of the lips, thrush is confined to the inside of the oral cavity and is not contagious.
In most cases, mouth ulcers create painful discomfort during eating and speaking, but they are self-limiting and spontaneously remit within 7-14 days of onset.
Aphthous stomatitis can be caused by an exacerbation of the oral flora, favored by dental calculus, irritation caused by alcohol consumption, chemicals, excessive smoking or poor oral hygiene. However, there are also situations in which mouth ulcers may be accompanied by cutaneous, ocular, digestive or respiratory manifestations that complete the clinical picture of the development of mouth ulcers.
In the presence of extensive, persistent or recurrent aphthous lesions that prevent the patient from eating and oral hydration or those that are accompanied by high fever, it is recommended to see a doctor as soon as possible, for specific treatment and prevention of long-term complications, i.e. the appearance of extensive scarring of the oral mucosa.
Causes of mouth ulcers
Mouth ulcers have multifactorial causes and can manifest themselves in the following:
- Injuries caused by orthodontic appliances, unfinished dentures and fillings, or those due to accidental biting of the jugal mucosa
- Excessive tooth brushing, use of toothpaste containing sodium lauryl sulfate
- pH imbalances of the oral cavity
- Exacerbations of bacterial flora residing in the oral cavity, Helicobacter pylori infection
- Insufficient dietary intake of vitamin B12, folic acid, iron and zinc
- Sensitivity to certain food groups: coffee, chocolate, strawberries, eggs, cheese, nuts, spicy and/or acidic foods
- Hormonal disorders especially in females
- Infections that predispose to decreased immune system function: HIV/AIDS, Crohn’s disease, ulcerative colitis, celiac disease, Behcet’s disease
Mouth ulcers in children (infants) are caused by an immune deficiency, food allergies during the diversification period, bacterial or viral infections or lesions caused by accidental biting of the jugal mucosa. In this category of patients, mouth ulcers can lead to water-electrolyte imbalances and nutritional deficiency as a result of the infant’s refusal to eat in the presence of painful discomfort accentuated at the lesional level.
Types of thrush
Depending on the appearance of the lesions and the duration of their development, canker sores can be classified as follows:
- Minor oral thrush – this type of thrush accounts for about 85% of cases of aphthous stomatitis and manifests itself as small lesions with a surface area of about 1 cm, oval, bordered by an erythematous outline. Minor aphthous ulcers are frequently caused by microlesions caused by orthodontic appliances or dentures. Minor mouth ulcers heal after about 2 weeks and do not cause scarring of the oral mucosa and/or gums.
- Major canker sores – Major canker sores are lesions with a more extensive surface and depth and represent about 10% of all cases of canker sores. The evolution of major canker sores can extend up to 1 month, during which time the patient experiences marked painful discomfort and eating difficulties, especially if the lesions extend to the oropharynx.
- Herpetiform canker sores – this type of herpetic stomatitis is not caused by herpes virus infection and has no characteristic vesicular appearance. In most cases, the course of herpetiform canker sores involves multiple ulcerations that tend to converge, resulting in extensive lesions that can take up to 15 days to heal. The ulcerations are painful, and the recurrence of this type of herpetiform stomatitis is higher than for minor and major canker sores.
First symptoms
The appearance of lesions specific to aphthous stomatitis is preceded in most cases by a burning sensation or local itching, which manifests itself 1-2 days before the ulcers form.
Diagnosis of mouth ulcers
The diagnosis of aphthous stomatitis is established by the dentist following a clinical examination of the patient. In rare cases, the doctor may request a biopsy of the oral mucosa to exclude other pathologies that may develop into ulcerative lesions similar to those found in aphthous stomatitis.
Canker sore treatment
In most cases, the evolution of aphthous stomatitis is self-limiting, healing spontaneously without medication). However, there are also cases where symptomatic treatment may be necessary to reduce pain and etiological treatment to address the causes of mouth ulcers. Mouth ulcers that cause severe painful discomfort in the patient’s oral cavity during feeding, or those with a long evolution prone to frequent recurrences, require specific treatment that may include disinfectant solutions, immunostimulant preparations, food supplements and antibiotics.
Pain caused by aphthous ulcerations can be relieved by symptomatic treatment with topicals, gels, toothpastes, mouthwash or 2% xylin sprays to reduce symptoms associated with aphthous stomatitis.
Antiseptic treatment may include gentian violet bandages and gargling with weak antiseptic solutions 3-4 times a day to decrease the microbial load in the oral cavity, which promotes the duration of ulceration. Oral medication is administered as indicated by the dentist and may include steroids, sucralfate or colchicine. In certain situations, the doctor may recommend antibiotics such as tetracyclines, but this type of treatment is not recommended for children under 12 years of age.
Treatment of aphthous stomatitis with laser or classical surgery is carried out by the dentist to reduce the period of evolution of ulcerations in the oral cavity, and decrease the patient’s symptoms and the risk of recurrence of aphthous lesions. Chemical cauterization of aphthous lesions can be performed with topical solutions such as Debacterol or silver nitrate.
Vitamin supplements based on vitamin B6, B12, zinc or folate are recommended for patients with nutritional deficiency of these compounds, as they accelerate the healing process and reduce the risk of recurrence of oral thrush.
Methods of preventing canker sores
Prevention methods for aphthous stomatitis include:
- Avoiding difficult-to-chew foods and spicy, cold, very hot or acidic foods, which can cause traumatic damage to the oral mucosa
- Maintaining proper oral hygiene including brushing, flossing and mouthwash. It is recommended to use super soft toothbrushes to avoid trauma to the gums and to change them periodically to prevent bacteria from multiplying on their surface.
- Removal of removable dentures at night and proper hygiene before application
- Remedy fillings, defective prosthetic or orthodontic appliances that irritate the gums and jugal mucosa
- Regular scaling in dental surgeries to prevent the multiplication of bacteria in the oral cavity
- Adopting a balanced diet containing optimal vitamin intake
- Avoiding alcohol consumption and smoking
References:
- Oral thrush, Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533
- Oral thrush in adults, National Health Service – https://www.nhs.uk/conditions/oral-thrush-mouth-thrush/
- What are the symptoms of oral thrush and how to treat it, Medical News Today – https://www.medicalnewstoday.com/articles/178864
