It never fails…at the most critical times, like the morning of the wedding or before an important presentation, someone gets a painful, ugly cold sore or a mouthful of ulcers.  People with recurring oral ulcers are a part of life.  In the past, the ability to relieve pain quickly and effectively has been limited.  All sorts of creams, pills and potions have all been used with minimal success.  Today dentists have more options and a greater possibility of success when it comes to treatment. 

In order to be able to manage outbreaks of oral ulcerations, you must first identify what type of lesion is present.  The two most common oral lesions that affect the general public are recurrent minor aphthous ulcers (canker sores) and herpetic oral lesions (cold sores or fever blisters). 

 Aphthous ulcers (canker sores)

Recurrent aphthous ulcers affect approximately 80% of the population.  They occur most commonly in women, starting between 10 and 20 years of age.  There is no cure for aphthous ulcers and unfortunately most people who experience them have multiple recurrent outbreaks.

Aphthous ulcers appear as small, oval or round red swellings.  They typically burst the first day and a thin gray, white or yellow membrane, edged by a red halo, then covers the ruptured sores.  The lesions are usually very painful and heal within seven to ten days when left alone.  Intervention can greatly reduce the time and pain associated with the outbreak. 

The ulceration is thought to be caused by a reaction in a person’s immune system to an unrecognized substance.  Many factors can trigger this reaction.  These include:

• Sodium lauryl sulfate (SLS) – a foaming agent in most toothpastes and mouthwash formulas.  People who are sensitive to SLS can find relief in oral care products that are made without the substance.  Brands include Rowpar, Oxyfresh, Breath Rx, Tom’s of Maine, TheraBreath and Rembrandt Extra Whitening Formula for Cold Sores.  Many of these are available through your dentist.
• A lack of nutrients – specifically a deficiency in vitamins B1, B2, B6, B12 and C, as well as zinc, folic acid, iron, selenium and calcium.
• Certain foods – Certain fruits and vegetables have been implicated, including tomatoes, lemons, oranges, figs, strawberries, apples and pineapples.  Cereal grains can also be allergens.  Oats, rye, barley and buckwheat have all been cited, as have nuts chocolate, soy and shellfish.
• Trauma to your mouth can cause ulcerations to occur
• Many medications – they include NSAIDS (non-steroidal anti-inflammatory) chemotherapeutic agents and beta blockers.
• Medical conditions can provoke outbreaks – these include AIDS, diabetes, ulcerative colitis and Crohn’s disease.
• Stress
• Hormonal changes
• Bacterial and viral agents
  

It’s easy to see why 80% of the population is affected!  As with most things, prevention is a key.  Avoidance of the above factors for those that are sensitive is important to limiting outbreaks.  Drinking plenty of water helps the tissues to be more resilient to occurrences and caffeinated drinks should be avoided as well.  Over the next few weeks I will discuss treatment for canker sores and provide further information on fever blisters, their cause and treatment.