What do you need to know about Aphthous ulcers?

Aphthous ulcers

Aphthous ulcers are very painful ulcerative lesions in the inner lining of the oral cavity. These can occur in any part of the oral cavity but usually found in the gum between the teeth and inner lip. The percentage of the affected people from the aphthous ulcers is around 30%. They are neither deep nor dangerous lesions. These ulcers have grey/white centre surrounded with reddish thin halo, and round or oval in shape. There are usually two types of aphthous ulcers; Minor aphthous ulcer with a diameter of <10 mm and major aphthous ulcer with a diameter of >10 mm.

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Who is prone to the aphthous ulcers?

Any individual can suffer from aphthous ulcers. However, adolescents, young adults and women (just before their menstrual period) suffer most.

Why do aphthous ulcers occur?

The exact reason is not known yet but there a theory. It is thought that a microbe (virus/bacteria) makes ulcers in the inner lining of the oral cavity when the body immunity is low. Some factors are associated with an increased incidence of the ulcers. Those are:

• Physical and/or psychological stress
• Fatigue, exhaustion etc
• Premenstrual tension
• Local injuries such as from rough/sharp dentures, dental work, hot food, brushing teeth or teeth biting the mouth
• Chemical irritations from certain food items such as citrus fruits, salted nuts, acid foods, chocolate etc

What are the symptoms of aphthous ulcers?

An individual may feel that she/he is eating something acidic while the food may not be acidic at all. There may be burning or tingling sensation hours before the appearance of actual lesions. The ulcers usually remain most painful during the first 3 days of onset which make eating, drinking or speaking most uncomfortable. The pain may persist longer period in some individuals who warrant investigations.

Is aphthous ulcer a serious disease?

Aphthous ulcers are not listed as a serious problem. In most of the instances, the ulcers heal without any marks within 10 to 14 days with a few exceptions for major ulcers. Usually, no tests/investigations are required for it.  If any ulcers last longer than 3 weeks then only a blood test or biopsy is required.

What are the treatment options for the aphthous ulcers?

In most of the cases, the ulcer heals spontaneously without any treatment. If a patient can ignore the pain then no need for any treatment! If any obvious reasons are found such as sharp or rough teeth, the patient should see a dental surgeon.

If pain is more, and can’t be tolerated, a short course of painkillers can be taken. A few topical preparations are available (e.g. lignocaine gel), which, if applied before a meal, numb the base of the lesions. Hence, the pain is reduced during the meal.

A number of techniques are out there which augment the healing. Rinsing of the mouth with salt-water (1 tsf of salt to 0.5L of warm water) on a regular basis is one the ways. Instead of salt, 0.2% chlorhexidine solution can be used to wash the oral cavity.  The teabag method is another proven technique where a wet, squeezed-out, black teabag is directly applied to the ulcer at least 3-4 times daily. The tea contains tannic acid which augments the healing process.

There are various steroid preparations in the market which help in quick healing, hence quick pain relief.  Topical steroids paste, cream, ointment and spray, all preparations can be tried to alleviate the symptoms and to heal the ulcers rapidly. The local agents should be applied at least 3-4 times per day. Examples of the topical steroids are a paste of 0.1% triamcinolone, hydrocortisone or betamethasone 0.5% cream/ointment, beclomethasone spray etc.

Vitamin B12 /vitamin B complex can be given (The deficiency of this vitamin is found in the patient with recurrent aphthous ulcers but the causal link is not well established).

Advice regarding eating and drinking:

If anyone suffers from the aphthous ulcers very frequently,  he or she should search for any food items which aggravate the ulcers, and (If any) should avoid the foods. Spicy food, very hot tea/coffee, acidic foods (e.g. vinegar) should be avoided during the problems. Yoghurt,  icecream, custard, fluids or liquid food items are preferable. Sipping liquids through a straw may help to bypass the ulcers. 

Sources:

• Various medical textbooks especially John Murtagh-John Murtagh’s Patient Education-McGraw-Hill (2012)