Introduction To Mouth Ulcers
Many people suffer from recurrent ulcers in the mouth. These can be extremely painful. The most common form is called minor aphthous ulceration. Teenagers are most commonly affected, though many experience their first lesions well outside this age range. Usually one to five small ulcers appear (less than 1mm in diameter) on the inside of lips or cheeks, floor of the mouth or tongue. The ulcers tend to be concentrated towards the front of the mouth. Prior to the ulcers appearing, the patient may experience a burning or prickling sensation.
The ulcers are painful, particularly if the tongue is involved and may make speaking and eating difficult. The course of these ulcers varies from a few days to a little over two weeks, but most commonly they last for about 10 days. Some minor trauma such as vigorous toothbrushing or an irregular filling can be precipitating factors.
There is evidence also that abnormalities of the immune system are associated with aphthous ulceration. A more severe form called major aphthous ulceration can affect any part of the oral mucosa including the soft palate, tonsillor area and can extend into the oropharynx. The ulcers are larger than those seen in and last longer, up to periods of months in some cases.
There are other forms of oral ulceration for example the ulceration may be part of a syndrome involving ulceration of the eyes, the nervous systems & joints.
Prevention & Treatment of Mouth Ulcers
Because the cause is largely unknown, prevention can be difficult. In our experience, Orabase tends to work quite well as a protective barrier for aphthous ulcers – Orabase is available over the counter at your local pharmacy. The trick is to apply it as soon as you feel the ulcer starting.
For more severe ulcers or larger/major aphthous ulcers a steroid in the orabase (previously we would have prescribed ‘Adcortyl in Orabase’ but this is unfortunately no longer available in Ireland) is good – we tend to prescribe Kenalog in these cases. Of course, good oral hygiene will help reduce the likelihood of secondary infection when ulcers are present.
For cold sores we recommend an anti-viral cream e.g. Zovirax (also available over the counter). As with the Orabase, the idea is to apply the cream as soon as you feel that “tingling /burning” sensation coming on. Local anaesthetic lozenges and mouthrinses (e.g. Diflam Oral Rinse) have been used as a last resort to give the patient some relief for example, when eating.
In some females there is complete remission from aphthous ulcers during pregnancy. Hence hormonal therapy has been tried but we believe the success has been varied.
