Aphthous Ulcers - Symptoms, Causes, Treatment and Prevention

Aphthous Ulcers (also known as aphthous stomatitis, canker sores), are a common and painful problem and can make eating and talking difficult. . An aphthous ulcer is an ulcer that forms on the mucous membranes (on the soft tissues in your mouth or at the base of your gums) -- like on the inside of the lips and cheeks or below the tongue. 

Aphthous Ulcers are benign in nature, non-contagious and can occur as single ulcers or in clusters.

Recurrent aphthous ulcers do not create much of a concern and go away on their own in a week or two, but at times, they could be associated with significant health problems. Aphthous ulcers that occur in conjunction with symptoms of genital ulcerations, uveitis, arthritis, conjunctivitis, fever should be brought to your doctor’s attention at the earliest as this will prompt a search for any cause or origin of this condition. 

What causes an Aphthous ulcer?

The exact reason why aphthous ulcer develops is not yet known. What most researchers and practitioners think is that the immune system is disturbed by some external factor and reacts abnormally against a protein in mucosal tissue which causes Aphthous ulcer.

Possible triggers for developing Aphthous ulcer:

• Accidental - An injury due to dental work, harsh brushing or physical activity

• Emotional stress and lack of sleep

• Toothpaste that contains sodium lauryl sulfate

• Self-inflicted bite

• Shortage of vitamin B, iron, and folic acid

• Hormonal changes during menstruation

• Viral infections

• Conditions like HIV/AIDS can suppress the immune system

• Bacteria present in the mouth can cause an allergic reaction and trigger ulcers

• Existing health issues like Crohn's disease, Celiac disease, Behcet’s disease can also trigger reoccurrence of Aphthous ulcer

Aphthous ulcers are of three types: minor aphthous, major aphthous and herpetiform aphthous. However, each of this type has different symptoms.

Symptoms and types of an aphthous ulcer

Minor aphthous ulcers

These are the most common ones. They are mostly small in size, less than 5 mm in diameter and can form as a single aphthous ulcer or in a cluster. These typically do not cause much pain. 

Symptoms: 

• Usually small ulcers

• Oval-shaped with a red edge

• Heal in one to two weeks

Major aphthous ulcers

These are 5 mm or larger and occur in pairs or as a single ulcer. They are not very common. These are quite painful while eating or drinking.  

Symptoms:

• Are larger and deeper than minor aphthous sores

• Have irregular edges when they become large, but when they are small they would look similar to minor aphthous ulcers

• Extremely painful

• Takes up to six weeks or months to heal and can leave extensive scarring

Herpetiform ulcers

Since these ulcers look like herpes in appearance, they have derived the name Herpetiform., but they are not caused by the herpes simplex virus. Herpetiform ulcers occur when several lesions fuse and form large ulcers that are irregularly shaped. 

Symptoms:

• Often occur in clusters of 10 to 100 sores or can merge into one large ulcer

• Ulcers with irregular edges

Aphthous ulcers treatment

There is no cure for aphthous ulcers, but one can lessen pain and discomfort and promote healing. In most cases, the ulcers will disappear without treatment. If the ulcer needs your doctor’s attention, treatment will be based on the severity of the ulceration, the affected person’s general health and the location. 
  

• Anti-inflammatory treatment aphthous ulcers

Topical anti-inflammatory pastes which can be purchased over-the-counter can be applied directly to the area where the ulcer has erupted. This type of treatment is more applicable and result oriented in the minor variety. The pastes should be applied around two and four times per day, make sure to follow the exact recommendations given by the pharmacist or your doctor.

• Antiseptic and Antibiotic treatment for aphthous ulcers

Antiseptic mouthwash containing chlorhexidine can be part of the treatment. This can be used twice per day or as per the doctor’s recommendations 
Also, in some cases, the doctor may prescribe topical or oral antibiotics, such as minocycline or tetracycline, which have been effective in treating ulcers. They are mostly administered in mouthwash form, where the antibiotic has to be dissolved in water, gargled and spat out. This must be done at least 2-3 times a day for several days or until you see the result. 

This antibiotic mouthwash, containing tetracycline, cannot be administered to children below the age of 8. If need be, make sure to get your doctor’s recommendation, as using this can discolour their teeth. 

Other treatments for aphthous ulcers

When the ulcers are unresponsive to the above treatments, other treatments need to be administered which may include oral steroids, local anaesthetics benzocaine and lignocaine (lidocaine) to reduce pain or other local numbing agents; and nutritional supplements (containing folate, zinc or vitamin B-12) and topical medication such as calcineurin inhibitors: pimecrolimus or tacrolimus.

Besides all the above, there are several home remedies you may try if the ulcer is not major: 

Home remedies for aphthous ulcers

• Rinse your mouth with saltwater

• Apply milk of magnesia to the ulcer after rinsing

• Application of ice packs or cubes to the affected area

• Teething ointments that contain an anaesthetic to numb pain and manage pain and discomfort (we advise you to always contact your dentist before choosing to use this ointment)

• Work on reducing your stress

• Avoid hard foods

• Make sure to intake nutritional supplements such as Vitamin B-12 capsules, Vitamin D capsules, zinc tablets. 

Prevention

As mentioned earlier, Aphthous ulcers can often recur, but you can reduce the frequency of reoccurrence by following these tips:

• Avoid salty and acidic foods or spicy food as they can irritate your mouth.

• Intake plenty of fruits, vegetables and whole grains that will provide nutritional supplements

• Follow good oral hygiene habits. However, avoid toothpaste and mouthwash that contains sodium lauryl sulfate

• If you wear braces or other dental appliances, check with your orthodontic about waxes that you can use to cover sharp edges

• Work on learning stress-reduction techniques such as meditation and guided imagery

• Quit smoking, as the nicotine in cigarettes can worsen the ulcers

Most aphthous ulcers will go away on their own in a week or two. But do not neglect a doctor’s visit if you notice severe symptoms. Sores that don't seem to heal could possibly detect an underlying condition. Talk to our mouth ulcer specialist in Bangalore to understand and know more about your oral health condition and the correct treatment. 

Sakra World Hospital is the best dental hospital in Bangalore having the best dentist in Bangalore experienced in treating any kind of dental conditions. Book an appointment now!