MOUTH – Mouth ulcers (Stomatitis / Apthous mouth / Canker sores)
The most annoying complaint of mouth is ‘mouth ulcer’ and it is the most common complaint often left untreated.
Mouth ulcer is an inflammatory and ulcerative condition of the mouth. It is medically termed as stomatitis or apthous mouth or canker sores. It is mostly superficial, shallow and non contagious. The sores are usually small, occurring in the oral mucosal lining, due to irritants or infection. It often has the tendency to recur with the precipitating factors. It occurs commonly in lips, cheeks and tongue as oval or round whitish or yellowish or grayish ulcer surrounded by reddish mucous membrane. The ulcers, on treating with medicines, or on its own go off in a week, without leaving any scar.
Incidence – Even though it can occur in all age groups, its peak incidence is during the adolescent
period, irrespective of the sex of the individual. At least 25 per cent of the people would have suffered from it at one time or the other. The incidence of mouth ulcer is also found to be more common in the urban than in the rural areas due to its relationship to habits of food, sleep and a tense life. Exam-going students often suffer from this complaint due to tension and sleeplessness.
Causes of mouth ulcer – In many cases, the causes remain unknown. Stress is supposed to be the major causative factor. Nowadays fast foods, carbonated drinks and preservatives-added, tinned foods add fuel to a hurried life to produce ulcers. Some relate it to the moon’s phases and some with exams, some with sleeplessness and some with menses. The bacterial infections (fever of scarlatina), viral infection – Herpes Simplex (gingivo stomatitis) and fungal infection – Candida (thrush) – can also resemble mouth ulcers in its initial stages.
The common external and internals factors which favour mouth ulcers are
- Unhygienic food or conditions
- Mechanical injuries from any hard food substances, cheek biting, sharp- edged teeth, dentures, etc. Many a time, patients are reluctant to replace older dentures and suffer from constant dental stomatitis.
- Foods – spicy, salty and hot foods (with a lot of chillies) can cause ulcers. Likewise sour foods and sour fruits / juices can cause ulcers – orange, lemon, pine apple, etc.
- Habit of smoking and drinking alcohol
- Chemical toothpaste which has toxic chemicals can cause mouth ulcers
- Drugs – Pain killers and Non Steroidal Anti-Inflammatory Drugs (NSAIDs)Internal factors
- Mind – Stress, anxiety and worries can cause mouth ulcers
- Deficiency of vitamins, minerals and zinc
Diseases – Systemic lupus erythematosus, AIDS, cancer, tuberculosis, diabetes, etc.
Symptoms – Depending upon the size, number, location, intensity and duration, the presenting features of mouth ulcers may vary. Clinical presentation of mouth ulcers may be usually single or clusters of shallow, whitish or pale or yellowish punched out ulcers with surrounding reddish swollen mucous membrane. The common symptom is burning and throbbing pain in the ulcers with difficulty in mastication or swallowing. There will also be excessive salivation with foul odour. Lymph node enlargement can also be noticed sometimes. Fatigue, fever, burning eructations, constipation or diarrhoea may also follow mouth ulcers.
Site or location – Depending upon the cause, the site varies. In dental stomatitis, it will be seen as delineated mucousal oedema due to the scratching of dental appliances on the roof of the mouth or on pressure spots. In case of cheek biting, it will be seen in the centre of the inner cheek. In case of bacterial or viral infection, it can be seen anywhere in the mouth. The commonest spots are inner lip (lower – more common), inner cheek, floor of the mouth and gums occasionally.
Size – The size usually varies depending upon the duration, i.e. from a dot to 1cm.
Character – The ulcers are mostly superficial, and they are painful only during intake of food. But sometimes they will be deep and very painful all the time.
Most ulcers heal within 5-7 days or at the maximum get cleared within 14 days. If it persists longer, it should be seriously investigated to rule out other serious illnesses.
Diagnosis & investigation of mouth ulcer – Mouth ulcers due to external causes can be easily found out in relation with the formation of time and incidences. In case of persistent, non-healing mouth ulcers, it should be seriously investigated for herpes, AIDS, ulcerative colitis, Crohn’s disease, cancer, tuberculosis, etc. Also, it is a must to investigate all the way, when the sufferer is a heavy smoker or tobacco chewer or aged person. The following investigations have to be done to rule out other diseases:
Scraping test – to identify candidal fungal infection
Biopsy – to diagnose cancer
Culture – to identify the bacteria or candida
Bleeding may occur when ulcer gets deepened and eroded
Septic conditions may follow the cases of chronic inflammatory ulcers where infection load infiltrates the lymph glands
Prevention – As cleanliness is next to godliness, oral hygiene prevents mouth ulcers
Nutritious diet, especially fruits, vegetables and greens
Water before and after meal
- Tension and hurried life
- Getting injuries from dentures, sharp teeth and hard brushing with hard bristled toothbrushes.
- Dentures at night.
- Habit of smoking, drinking alcohol, chewing tobacco and betel nut
- Hard food substances/snacks which may cause injury
- Onions, garlic, tomatoes, lemon, orange, pineapple
- Foods containing spices, chillies, pepper, sausages, pickles
- Aerated drinks, coffee and tea
- Tinned or preservative-added foods / snacks / toffees
- Unnecessary medications, especially pain-killers
General treatment – Usually, mouth ulcers are often left untreated since they heal on their own. They often seem to be harmless but when they recur often or become persistent then it calls for treatment. Aiming for better, quick healing and relief of symptoms, it is often treated with soothing
agents (mouth wash and gel), pain-killers and antibiotics or steroids or antiviral, depending upon the causes. Irrespective of causes, vitamins, minerals and zinc are always prescribed for having good nutritional status to have better healing and to avoid recurrences. Sometimes, even with good treatment and nutritional status it seems to be recurrent or persistent, resisting the cure, making the sufferer more frustrated.
Homeopathic approach to mouth ulcers
First of all, everyone should free life of tension and take timely nutritious meal or otherwise cure is impossible in any system of medicine. Mouth ulcers can be treated effectively in Homeopathy without any side-effects. The treatment should be started in the early phase itself. The earlier you treat, more complete and speedy will be the cure. Homeopathy, in addition to treating the disease, also improves general resistance to avoid recurrences. Recurrences arise from tendencies for mouth ulcers which cannot be rooted out merely by managing the
situation locally. Mouthwash, gel, antibiotics or anti viral will work for clearing the infection / ulcer at that time of use only. Also, on discontinuing, one can see recurrence or worsening of condition than before. Usually, treating externally won’t cure any complaint. Homoeopathic treatment believes in internal treatment and can give permanent cure to recurrent mouth ulcers. It roots out the cause and disease altogether.
In fact, Homoeopathy, unlike other systems of medicines, doesn’t concentrate in just healing the spot. Homoeopathy cares for all i.e. it reduces the pain, it heals the wound in a better way, it improves the nutritional status by improving digestion and absorption and finally it aborts the tendency to recurrences. Also, in other systems of medicines, in course of time, drug resistance may develop and it would let any one down with sufferings. Homeopathic medicines will not shut mouth ulcers like switching off, but it will taper the condition to cure by reducing the incidence and intensity by improving immunity. The outburst of mouth ulcers due to stress and nutritional status can also be improved with Homeopathy since care is total. Homeopathy can also relieve you from under-nutrition by improving digestion and absorption.
Homeopathic medicines commonly used in cases of mouth ulcers are Acid nit, Antim-crud, Apis mel, Arg Nit, Belladonna, Borax, Bryonia, Capsicum, Carbo animalis, Causticum, China, Graphites, Hepar sulph, Hydrastis, Kali bich, Kali Brom, Lycopodium, Merc sol, Nat mur, Nux Vom, Petroleum, Psorinum, Pulsatilla, Pyrogen, Rhus tox, Silicea, Sulphur, Symphytum, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.
Dr. S. Chidambaranathan, BHMS, MD (Homeo) 24 E. New Mahalipatti Road Tel: +91-452-233-8833 | +91-984-319-1011 (Mob) E-mail: firstname.lastname@example.org
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(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)