Mouth ulcers (canker sores)

What is it about ?

Mouth ulcers are conditions or damage to the lining of the mouth (oral lining). They can be subdivided into 4 groups depending on their cause:

• traumatic ulcers. These are injuries due to a mechanical cause (sharp tooth edges, abrasive dentures, bite of the lip or the inside of the cheek), due to heat (too hot food / boiling drink) or due to substances chemicals (eg used by the dentist).
• mouth ulcers. It is a painful ulceration preceded by a gallbladder (the gallbladder ruptures and gives way to an ulcer. Canker sores can develop as a reaction to the components of toothpaste (sodium lauryl sulfate). They can also occur with the disease. de Behçet (this is a rare autoimmune disorder where canker sores also appear on the lining of the genitals, with inflammation of the eyes or joints as well as skin lesions). Stress, diet, some drugs and hormonal changes may be influencing factors, but the origin is generally difficult to detect.
• ulcerations linked to systemic diseases: ulcerations are then the symptom of an underlying condition, such as deficiencies in the blood (iron, vitamin B12, folic acid), blood diseases, diseases of the gastrointestinal system intestinal (eg, Crohn’s disease), skin diseases (eg, herpes), infections (eg, syphilis and HIV).
• an ulcer can be a malignant tumor, this is most often seen in smokers.

What is their frequency?

On average, 12 in 1,000 people see their GP each year because of problems in the oral region. These are mouth ulcers in 27% of them. Canker sores develop mainly between the ages of 15 and 40, 48% are healed within a week.

How to recognize them?

Mechanical ulcers of the oral mucosa usually have a streaky appearance, are reddish and painful, and are located under or on the edge of a prosthesis.

Canker sores are usually less than 0.5 cm, covered with a whitish layer with a red outline. They can develop on the lining of the lips, cheeks, floor of the mouth, palate, gums, and tongue. Most canker sores heal spontaneously within a week. If there is no improvement after 2 weeks, there is a good chance that a disease is the cause of these canker sores.

In the case of systemic diseases, lesions of the oral mucosa resemble canker sores. On the other hand, these canker sores do not heal spontaneously, they reappear chronically and are also more numerous.

Malignant tumors get bigger over time. These ulcers are harder on the palpation, and the lesion often has a raised, irregular border. They also bleed easily when touched.

How is the diagnosis made?

Your doctor will first check how long you have had it, if there are any other complaints, and what medications you are taking. The diagnosis of disorders of the oral mucosa is most often made on sight. A biopsy is done for lesions that last for more than 2 weeks without noticeable improvement. A small piece of tissue is then taken from the lesion and sent to the laboratory for analysis. If an underlying disease is suspected, other examinations will also be carried out (blood test and examination of the digestive system).

What can you do ?

Have your teeth checked regularly at the dentist and ensure good daily oral hygiene. Drink enough. Always report the discomfort of a dental prosthesis, even if they are not necessarily very marked. Use toothpaste without sodium lauryl sulfate. The composition of the dough is shown on the packaging. If the ulcerations appear after taking a new medicine, ask your doctor if this could be the cause of the symptoms. If you have had mucosal lesions for more than 2 weeks or if they come back, it is best to go to your doctor.

What can your doctor do?

Most oral mucosal conditions are mild and will go away on their own. That is why the doctor will first prescribe local treatment: mouthwashes with a disinfectant (for example, chlorhexidine), ointment with cortisone or lidocaine, local pain reliever, etc. Additional examinations will only be carried out if all these possibilities do not give results. The underlying diseases will of course be treated. You may need to stop (temporarily) a medicine and replace it with another of a different composition.

Want to know more?

• Canker sore: mouth sore – mongeneraliste.be – ssmg – scientific society of general medicine

• Tips for unparalleled oral hygiene – Christian Mutuality
• Visiting your dentist – Christian Mutuality
• Chlorhexidine, to be found on this page of the CBIP, in the section ‘Otorhinolaryngology’ – Belgian Center for Pharmacotherapeutic Information

Source

Foreign clinical practice guide ‘Ulcers of the oral mucosa’ (2000), updated on 23.03.2017 and adapted to the Belgian context on 01.04.2017 – ebpracticenet