Oral Ulcers: Types, Causes, and Comprehensive Treatment Strategies

Mouth Ulcers

Write Long Answer on types and causes of oral ulcer and their treatment.

Answer. Aphthous ulcer is the most common type of nontraumatic, ulcerative condition of the oral mucosa.

Types Of Oral Ulcers

Clinically, aphthous ulcers present three recognizable forms,namely:

1. Minor aphthous ulcers

2. Major aphthous ulcers

3. Herpetiform ulcers.

“Causes Of Oral Ulcers In Mouth”

Oral Ulcers Minor aphthous ulcer

• It is the most common type of aphthous ulcer of the oral cavity and it appears episodically either as single lesion or in clusters of l to 5 lesions.
• The ulcers are very painful, shallow, round or elliptical in shape and they measure about 0.5 cm in diameter with a crateriform margin.
• The lesion is usually surrounded by an erythematous “halo” and is covered by a yellowish, firinous membrane.
• Minor aphthous ulcers mostly develop over the nonkeratinized mucosa, e.g. lips, soft palate, anterior fauces,flor of
• the mouth and ventral surface of the tongue (gland bearing mucosa), etc.
• The ulcer lasts for about 7–10 days and then heals up without scarring but recurrence is common.
• New lesions may continue to appear during an attck for about 3–4 weeks period.
• Few lesions may be present in the mouth almost continuously.

“Best Ways To Prevent Oral Ulcers”

Oral Ulcers Major Aphthous ulcers

• Major aphthous ulcers are less common than the minor form of the disease.
• These are larger, 0.5 cm in diameter and can be as big as several centimeters in diameter.
• Major aphthous ulcers are more painful lesions than the minor variety; and they persist in the mouth for longer durations as they take more time to heal.
• These lesions are considered to be the most severe among all types of aphthae and they often make the patients ill.
• Only one or two lesions develop at a time and are mostly seen over the lips, soft palate and fauces, etc.
  Besides involving the non-keratinized mucosa, major aphthous ulcers can involve the masticatory mucosa as well, such as the dorsum of the tongue and gingiva, etc.
• The ulcer appears crateriform (owing to its increased depth), and it heals with scar formation in about 6 weeks time.
• Few lesions may look like malignant ulcers, moreover sometimes these lesions occur in association with HIV infections.
• Major aphthous ulcers often become secondarily infected and in such cases, the healing process is further delayed.

“Risk Factors For Developing Oral Ulcers”

Oral Ulcers Herpetiform ulcers

• Herpetiform type of aphthous ulcers produce recurrent crops of extremely painful, small ulcers in the oral mucosa, which resemble herpetic ulcers. However, these ulcers do not develop following vesiculations and exhibit no virus-infected cells.
• Their numbers vary from few dozens to several hundred and each ulcer is surrounded by a wide zone of erythema.
• The size of these ulcers ranges between l to 2 mm in diameter only. However, on few occasions, small ulcers coalesce
• together to form large irregular ulcers.
• The ulcers last for several weeks or months.
• Children in their late teens often suffer from this disease and the lesions occur in both gland bearing mucosa as well as over-keratinized mucosa.
• The lesions usually heal up within l to 2 week time.

“Managing Oral Ulcers During Pregnancy”

Causes of oral ulcer

The exact etiology is not known and only the probable factors have been identified which are as follows:

• Genetic predisposition: The disease often affects several members of the same family and moreover identical twins are most frequently affected.
• Exaggerated response to trauma: The ulcer develops in those mucosal sites which are subjected to trauma in the past. e.g. tooth prick injury.
• Immunological factors: The disease may occur due to some autoimmune reactions, or in patients with immunosuppression, e. g. AIDS.
  Some investigators believe, then it is an immune complex-mediated Type III or cell-mediated type IV reaction.
• Microbiologic factors: The disease may be caused by herpes simplex virus Type I or S. sanguinis.
• Nutritional factors: Deficiency of vitamin B12, folate and iron, etc. often reported in patients with aphthous ulcer; moreover supplementation of these elements may cause rapid recovery.

“Dealing With Pain Caused By Oral Ulcers”

• Systemic conditions: Behcet’s syndrome, Crohn’s disease and celiac disease are associated with increased incidences of aphthous ulcer.
• Hormonal imbalance: Hormonal change during menstrual cycle may be associated with higher incidence of aphthous ulcer.
• Non-smoking: The disease almost exclusively occurs in nonsmokers or the people those who have given up smoke recently.
• Allergy and chronic asthma: Allergic manifestations to any medicines or foods (e.g. Nuts and chocolates, etc.) may lead to the development of aphthous ulcer.
• Miscellaneous factors: Stress and anxiety.

“Preventing Complications From Untreated Oral Ulcers”

Oral Ulcers Treatment

Oral Ulcers Medicinal treatment

• Topical corticosteroid i.e. 0.1% triamcinolone acetonide QDS is effctive on daily use.
• Topical anesthetics i.e. 2% viscous lidocaine, benzocaine and benzydamine hydrochloride can reduce pain.
  Topical protective emollient base can be given.
• Topical application of sucralfate 4 times a day has soothing effect on an ulcer.
• Topical tetracycline mouthwash QDS for 5 to 7 days provides good response.
• Beclomethasone spray is given in severe cases.
• In resistant cases systemic steroids can be given.
  Most commonly beclomethasone or prednisolone syrup in swish and swallow method is advised.
  In some cases prednisolone tabelet 20 to 30mg/day and beclomethasone 2 to 3 mg per day for 4 to 8 days can be given.

“Treating Recurring Oral Ulcers In Adults”

Oral Ulcers Surgical treatment

Oral Ulcers Laser surgery

Surgical removal of apthous ulcer should also be used.
Laser ablation shortens the duration and decreases the associated symptoms.
CO2 or Nd: YAG lasers are used. Laser treatment requires frequent visits.

Oral Ulcers Local Cauterization

Application of 0.5% hydrogen peroxide, 1 to 2% of silver nitrate or silver nitrate caustic stick represents several older therapeutic methods which reduce duration of solitary oral ulcer.