Aphthous Ulcers

9 mins read

How To Treat Cantankerous Canker Sores
Aphthous ulcer is more commonly known as a canker sore. It is a sensitive and often painful inflammation found only in the mouth. They are very common, especially with teenagers. They look like small white bumps that can appear in anywhere in the mouth like the cheeks and gums. There are three kinds of aphthous ulcers, the minor sores (smallest), the major sores, (largest) and the herpetiform ulcers. The herpetiform ulcers are clusters of minor ulcers, making them seem larger but, individually, they are even smaller than the minor sores.

Causes
The exact cause as to why these aphthous ulcers develop is difficult to ascertain is because the body is a complex organism. However, the following factors are believed to have a possible influence on the development of aphthous ulcers:

  • Heredity:Some studies suggest the aphthous ulcers can be inherited. This is based on the findings that families who have a history of aphthous ulcers show a greater incidence of its occurrence in their children. Furthermore, it has been shown that 40% of people who experience aphthous ulcers have a previous family history of aphthous ulcer incidence.
  • Disturbed Immune System:Some of the more recent studies suggest that aphthous ulcers are caused by a disturbed immune system. Various imbalances in the immune system are thought to be a cause of the development of these sores.
  • Nutritional Deficiencies:Inadequate nutrients are also believed to be a possible cause. Research has shown that those people who are deficient in iron, vitamin B, and folic acid will have greater chance of getting aphthous ulcers.
  • Stress:It is theorized that lack of sleep and stress can also contribute to the development of aphthous ulcers.
  • Allergies:It is also possible that allergies to certain toothpastes will trigger the development of these canker sores.
  • Skin Damage:The skin inside the mouth can easily become damaged by the teeth or burning from hot food. When the skin in the mouth is damaged, bacteria can invade the damaged skin and may cause aphthous ulcers.

Symptoms

  • Swelling: Aphthous ulcers start with the swelling of the tissues. This swelling will rupture and break into white oval spots with a red outer lining. These spots will vary in size depending on the severity of the aphthous ulcer. The center of these spots is usually white or yellowish.
  • Fever: Some people may develop a fever when aphthous ulcer is about to occur. However, fever is a rare symptom of aphthous ulcers. Fever generally happens only when there are other diseases or maladies associated with the development of aphthous ulcers.
  • Swollen Lymph Nodes: If aphthous ulcers become infected, the lymph nodes swell, and a fever will occur. Swelling is your body’s way of protecting itself–the body traps the infection in the lymph nodes to prevent it from spreading elsewhere. The size of the swelling of the lymph nodes is related to the severity of the aphthous ulcer infection.
  • Pain: People with aphthous ulcers will feel pain when they eat something acidic or citrus. Salt and spicy foods can also cause pain and discomfort. The center of the sore is most sensitive.

Treatments
Normally, aphthous ulcers will disappear within a few weeks even if people do nothing about them. However, if they are getting worse, or haven’t disappeared in a few weeks, these are medically-tested treatments:

  • Topical Ointments: There are topical medications available for treating aphthous ulcers like benzocaine, a pain reliever, which can be bought easily in any drugstore without a prescription. These ointments should be applied on the sores directly. They can help to reduce the irritation of the Aphthous ulcers when eating. However, according to various reports some of these ointments may prove to be toxic when used in large amounts. Be careful when buying and use common sense when applying these ointments.
  • Mouthwash: One type of mouthwash used for canker sores is diphenhydramine suspension (Benadryl Allergy liquid and others). This is a liquid analgesic (pain reliever), although its pain relief is temporary. These mouthwashes can be bought over-the-counter. Rinse but don’t swallow them.
  • Home Remedies: Some people find that sucking on zinc lozenges helps speed recovery.  Vitamin C and vitamin B may also speed recovery, especially if the canker sore is caused by nutritional deficiency or a weakened immune system. Sage and chamomile mouthwash are sometimes recommended by a naturopathic doctor. To make, add 1 small glass warm water, 1 tsp brandy or vodka, 1 drop sage and 1 drop chamomile essential oils and gargle three times daily.
  • Immunosuppressants: For extreme cases of aphthous ulcer, immune-suppressant drugs or steroids – either ingested orally, or as a mouthwash, may be necessary. However, these types of drugs may have serious side effects and are prescribed if other types of treatment have failed.

Alternative Therapy

  • Aphthous ulcers of recurrent nature, most commonly known as recurrent aphthous stomatitis (RAS) is the most common of oral cavity lesions. Use of natural products which have strong anti-inflammatory and anti-microbial activity have been seen to provide benefits over conventional allopathic treatments.
  • Ayurveda targets to treat these painful lesions with the use of several herbs and plants. Studies have shown that 2% aloe vera gel applied topically over the sore helps in alleviating the pain [1]. This tropical plant has anti-inflammatory and immunostimulant properties which help in healing the wound.
  • Studies have shown that —which is the main active pigment found in turmeric and ginger— has strong anti-oxidant, anti-inflammatory, immunomodulatory and analgesic properties which can be effectively used treat canker sores in alternative to steroids [2,3].
  • Pomegranate or Punica granatum has been known for its anti-inflammatory and anti-cancer properties. This flavonoid rich fruit has demonstrated potent anti-microbial and anti-oxidant properties which may be advantageous in the treatment of RAS [4]. Pomegranate is also rich in anthocyanin, the red dye which imparts color to the fruit, which is known for its astringent and wound healing benefits [5].
  • Homeopathy also directs to certain natural products which can be useful in treating canker sores especially reducing the discomfort and inflammation [6]. Arsenicum album, Nux vomica, Mercurius solubilis, Natrum muriaticum, Borax, Calcarea carbonica etc. have been studied in treating mild to severe RAS [7].
  • Certain home remedies may also help in relieving the pain and preventing the sores from recurring. A spray made by mixing peppermint and eucalyptus oil cane help in alleviating the discomfort resulting from swelling [6]. Both the oils are known to have anti-inflammatory and astringent properties which can help to tighten the tissues around the wound and also reduce the pain [8].
  • Eugenol, the active component found in clove is known for its pain killer properties [9,10]. Dabbing a mixture of clove oil and olive oil over the sore for 5-8 minutes can help in relieving pain and numbing relief.

 Prevention

  • Nutritious Diet: Inadequate nutrition or vitamin deficiency may be a factor in the development of Aphthous ulcers. A healthy, balanced diet will lead to a healthier body and stronger immune system.
  • Regular Exercise: Exercising will be very good for general health. Exercise helps detoxify the body, through sweating, and strengthen the immune system.
  •  Good Dental Hygiene: Brush and floss regularly. It might sound obvious, but good dental hygiene will help canker sores and help prevent a number of other diseases, even ones in the rest of the body. For example, good dental hygiene can also help prevent heart disease.
  • Change Toothpaste: If you are prone to canker sores, some people find that changing to a toothpaste that does not contain SLS (sodium lauryl sulfate), which can irritate sensitive mouths, can help.
  • Be Careful With Foods: If you are prone to cankers, try to avoid foods that irritate the mouth. Avoid foods like nuts, spicy and salty foods, and foods that are acidic.

Conclusion
Aphthous ulcers are common, especially if you are stressed out, run down, or tired. The good news is that it can be the body’s way of telling you to slow down, and make time for your mind and body. Try making time to eat nutritious food and exercising regularly. Some people find that naturopathic remedies help with the symptoms and speed recovery of canker sores. If aphthous ulcers reoccur regularly or do not disappear after a couple of weeks, make an appointment with your doctor.

References

1. Babaee N, Zabihi E, Mohseni S, Moghadamnia AA. Evaluation of the therapeuticeffects of Aloe vera gel on minor recurrent aphthous stomatitis. Dent Res J(Isfahan). 2012 Jul;9(4):381-5. PubMed PMID: 23162576; PubMed Central PMCID:PMC3491322.

2. Deshmukh RA, Bagewadi AS. Comparison of effectiveness of curcumin with triamcinolone acetonide in the gel form in treatment of minor recurrent aphthous  stomatitis: A randomized clinical trial. Int J Pharm Investig. 2014 Jul;4(3):138-41. doi: 10.4103/2230-973X.138346. PubMed PMID: 25126527; PubMed Central PMCID: PMC4131385.

3. Nagpal M, Sood S. Role of curcumin in systemic and oral health: An overview. J Nat Sci Biol Med. 2013 Jan;4(1):3-7. doi: 10.4103/0976-9668.107253. PubMed PMID: 23633828; PubMed Central PMCID: PMC3633300.

4. Ghalayani P, Zolfaghary B, Farhad AR, Tavangar A, Soleymani B. The efficacy of Punica granatum extract in the management of recurrent aphthous stomatitis. J Res Pharm Pract. 2013 Apr;2(2):88-92. doi: 10.4103/2279-042X.117389. PubMed PMID: 24991610; PubMed Central PMCID: PMC4076909.

5. Noda Y, Kaneyuki T, Mori A, Packer L. Antioxidant activities of pomegranate fruit extract and its anthocyanidins: delphinidin, cyanidin, and pelargonidin. J  Agric Food Chem. 2002 Jan 2;50(1):166-71. PubMed PMID: 11754562.

6. Landová H, Daněk Z, Gajdziok J, Vetchý D, Stembírek J. Oral mucosa and therapy of recurrent aphthous stomatitis. Ceska Slov Farm. 2013 Winter;62(1):12-18. PubMed PMID: 23578262.

7. Belenguer-Guallar I, Jiménez-Soriano Y, Claramunt-Lozano A. Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent. 2014 Apr 1;6(2):e168-74. doi: 10.4317/jced.51401. eCollection 2014 Apr. Review. PubMed PMID: 24790718; PubMed Central PMCID: PMC4002348.

8. Kothiwale SV, Patwardhan V, Gandhi M, Sohoni R, Kumar A. A comparative study of antiplaque and antigingivitis effects of herbal mouthrinse containing tea tree oil, clove, and basil with commercially available essential oil mouthrinse. J Indian Soc Periodontol. 2014 May;18(3):316-20. doi: 10.4103/0972-124X.134568. PubMed PMID: 25024544; PubMed Central PMCID: PMC4095623.

9. Kumar G, Jalaluddin M, Rout P, Mohanty R, Dileep CL. Emerging trends of herbal care in dentistry. J Clin Diagn Res. 2013 Aug;7(8):1827-9. doi: 10.7860/JCDR/2013/6339.3282. Epub 2013 Aug 1. PubMed PMID: 24086929; PubMed Central PMCID: PMC3782986.

10. Vanin AB, Orlando T, Piazza SP, Puton BM, Cansian RL, Oliveira D, Paroul N. Antimicrobial and antioxidant activities of clove essential oil and eugenyl acetate produced by enzymatic esterification. Appl Biochem Biotechnol. 2014 Oct;174(4):1286-98. doi: 10.1007/s12010-014-1113-x. Epub 2014 Aug 8. PubMed PMID: 25104002.

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