Those sore little spots that are so common in the mouth are usually ulcers; breaks in the epithelium or layer of tissue that forms the surface of any organ. Mouth ulcers may have many different causes, and it is important to diagnose them correctly so as to apply the right treatment.
The commonest form of mouth ulcer is the aphthous variety. These ulcers usually form on the inside of the cheeks and under the tongue, but may be present on the gums and surface of the tongue.
They often come in crops of several at a time and tend to recur frequently over several months and then disappear. The cause of these ulcers is unknown, although they are often associated with nervous tension.
No evidence of any infection has ever been found. Untreated, they run a course over two to three weeks before disappearing.
A variety of different treatments have been employed at different times, usually without effect. Antibiotic drugs make no difference. Cortisone, either locally or generally, has also produced little benefit. A soluble salicylate gel is available, and this can relieve the pain but doesn’t seem to hurry up the healing.
Cauterizing the ulcers by applying some caustic substances can help. We have found that touching the ulcers with a silver nitrate stick results in them being pain-free by the next day and usually healed in a few days.
Many women develop ulcers in the genital area at the same time as those in the mouth. The cause of this is unknown, and the ulcers may represent cases of Behcet’s Syndrome.
This is a disorder of unknown cause that should have at least two of three criteria. These are mouth ulcers, genital ulcers, and inflammation of the eyes. Behcet’s Syndrome does seem to respond to cortisone whereas aphthous ulceration does not.
A single ulcer in the mouth may be due to irritation from a sharp denture or a broken tooth. In that case, attention to the cause will result in rapid healing.
Some nervous individuals may bite their cheeks and so cause ulcers. Irritable drugs or strong chemicals used to wash the mouth may also produce local irritation and then ulceration.
The heavy metals such as mercury or other chemicals may cause mouth irritation and ulceration in those who work with them.
Vincent’s infection of the mouth, or “trench mouth,” is an infection involving the gums. It is due to two different germs and mainly affects young adults. It may appear like a throat infection but does not respond to the usual antibiotics. The drug metronidazole, which is also used for treating trichomonal vaginal infection, clears the mouth rapidly.
Thrush, which is due to a yeast organism, Monilinia, is more common in infants when these other conditions are not common. However, it may follow the use of antibiotics or cortisone for some other condition.
Thrush infection of the mouth is common, but not serious, a complication of the use of the new cortisone inhaler sprays used in the prevention of asthma.
The old fashioned method of painting the lesions with a dye, gentian violet, is still effective in treating thrush, but rather messy. Local application of the drug nystatin in cream or lotion form is rapidly effective.
The herpes simplex virus not only causes cold sores but may also lead to ulcers in the mouth. This virus may cause genital infection as well. It is believed there are two similar strains of the virus, one causing the infections on the skin, the eye or the mouth, and the other causing the genital lesions. But the general one can also be responsible for infection on the reproductive organs.
The herpes lesion usually starts as a small blister which then breaks down to form an ulcer. Cortisone is usually effective in herpes simplex lesions (except when these occur in the eye).
The drug idoxuridine is effective in aborting herpes sore if it is used early enough. Once the ulcer is fully developed it is of little use except in the eye.
There are some other causes of mouth ulcers which are not the common ones but may still need to be considered.
Lichen planus is a skin condition that may also show itself with ulcers in the mouth. These are usually long and large rather than the small round or irregular ulcers of the other conditions. Lichen planus responds rapidly to the use of cortisone applied locally.
The Stevens-Johnson Syndrome is a generalized disease that causes a rash and may involve the mucous membranes, including the mouth. It is thought to be an allergic-type reaction to various drugs.
Hand, foot, and mouth disease (different from the disease that affects animals, especially cattle) is a viral infection. No treatment is available, but the disease is usually mild and clears quickly.
Leukoplakia is a condition in which white thickened plaques appear on the tongue or mucous membrane of the cheek.
This is a precancerous condition and must be carefully checked.
Cancer itself may also occur in the mouth. It usually starts as a small lump that breaks down to form an ulcer. It may not be painful and therefore may be allowed to progress before advice is sought.
Chewing tobacco or betel nut is not a common habit in this country. Both these forms of drug use may lead to the formation of ulcers in the mouth.
The basis of proper treatment lies in making the correct diagnosis, and this applies to mouth ulcers as to any other medical condition, whether severe or mild. Conditions that do not respond to simple treatment or those which tend to persist or come back are the ones that should make us seek a medical opinion.
As you may have gathered, not all of the causes of mouth ulcers are influenced by treatment. However, reassurance that the condition is not serious is the most important part of any treatment.