Mouth ulcers are a common complaint and generally not serious but are often painful. However they can be a sign of illness and occasionally malignant forms occur.
How Mouth Ulceration Occurs
Whatever the cause, mouth ulceration occurs because of a failure in normal tissue turnover. All tissues in the body are constantly being replaced – some quicker than others. Skin for example, because of its constant contact with the environment, the outer layer has to be replaced frequently. Bone on the other hand turns over more slowly.
The mouth (gums, palate and tongue) is lined with a special kind of skin called a mucous membrane. It does not have the hard layer of normal skin and is covered in a thin fluid layer.
Tissue turnover in mucous membranes is quicker than in the skin because eating causes a fair amount of damage to the cells lining the mouth so they need to be replaced rapidly.
In addition, the fluid covering the mucous membrane has anti-bacterial qualities- this being the first line of defense of the digestive system in warding off infection.
Cells in the outer layer of mucous membrane are replaced by new cells migrating up from the lower levels. Anything that slows down the production and migration of new cells or damages the outer membrane too much or too frequently will lead to ulceration.
Factors That Prevent Mucous Membrane Replacement
Local factors like frequently eating hard foods may put strain on cell replacement. Similarly very spicy or acidic food will do the same. Anything that causes inflammation in the mouth, infections for example, will hinder the healing processes that repair the mucous membrane. Repeated or constant inflammation of the mucous membrane can lead to the development malignant ulcers.
Systemic problems, that is those arising from diseases in other parts of the body, will sometimes give rise to mouth ulcers simply due to energy or resource deficit. Infection or inflammatory disease in other parts of the body can put a strain on the body's cell production processes and leave insufficient resources for replacement of mucous membrane cells. Any condition which compromises the immune system can lead to ulcers e.g. chemotherapy, radiotherapy and AIDS.
Common Causes of Mouth Ulcers
- Aphthous Ulcers: by far the most common. The cause is unknown but they tend occur when the patient is run down. They are more likely to present in young people and some individuals seem particularly susceptible. They consist of small greyish lesions which are very painful. Usually resolve in a week. Occasionally they occur as larger, more numerous and persistent ulcers.
- Ulcerative gingivitis: probably due to a bacterial infection. The gums bleed and become painful, sometimes accompanied by fever.
- Herpes simplex: the usual manifestation is cold sores around the mouth but will sometimes show up as ulceration of the gums.
- Autoimmune disease: a range of these can produce mouth ulceration. Reiter's syndrome and Bechet's disease both types of inflammatory arthritis, and Crohn's disease are examples.
- Drugs: a number of medicinal preparations can cause ulcers - sulphonamides, penicillin and cytotoxic drugs are a few examples.
Treatment of Aphthous Ulcers
Although benign, aphthous ulcers can be distressing for those who suffer from them particularly if they are a frequent occurrence. There are many treatments available which seem to work for some and not others so the best thing is try a number and see which works for you.
Various products are on the market ranging from pastes, gels and mouth washes. Most work by coating the ulcer thereby preventing it from coming into contact with food. Some contain a local anaesthetic. Lysine, an amino acid (can be obtained from health food shops) has been found helpful by some.
There are few studies on the efficacy of mouth ulcer treatments but a review by the Cochrane Collaboration found evidence of benefit in patients whose mouth ulcers were triggered by chemotherapy and radiotherapy. Chinese herbal medicine, sucking ice cubes and the drug amifostine were all found by the reviewers to provide relief.
This article is for information only. If you have any health concerns you should consult the appropriate health professional. In particular if you have any ulcers associated with one or more of the following you should seek advice from your doctor or dentist. : bleeding, are not painful, last more than two weeks, are hard to the touch or grow in size.
Resources
The Cochrane Collaboration.org
Medicine. Eds. Souhami and Moxham Pub. Churchill Livingstone 2002
Mouthulcers.org
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