Ulcer of Oral Cavity

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Ulcer of Oral Cavity

The Ulcer of Oral Cavity:

Definition of Ulcer of Oral Cavity

A mouth ulcer (aphtha) is an ulcer that occurs on the mucous membrane of the oral cavity.[1]

Overview

Overview of Ulcer of Oral Cavity

Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause.

Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually or multiple ulcers may appear at once. Once formed, an ulcer may be maintained by inflammation and/or secondary infection.

The two most common causes of oral ulceration are local trauma and aphthous stomatitis condition characterized by recurrent formation of oral ulcers for largely unknown reasons.

Mouth ulcers often cause pain and discomfort and may alter the person’s choice of food while healing occurs. [1]

Causes

Causes of Ulcer of Oral Cavity

Infections i.e.

(a) Viral- e.g. Herpangina, herpes simplex hand, foot and mouth disease

(b) Bacterial- e.g. Vincent infection, TB, syphilis

Immune disorders-Aphthous ulcer, Bechet syndrome

Trauma i.e.

(a) Physical- e.g. Cheek bite, jagged tooth, ill-fitting denture

(b) Chemical- e.g. Silver nitrate, phenol, aspirin burns

Neoplasms
Skin disorders- e.g. Erythema multiforme, lichen planus, benign mucous membrane pemphigoid, bullous pemphigoid, lupus erythematosus
Blood Disorders- e.g.Leukemia, agranulocytosis, pancytopenia, cyclic neutropenia, sickle cell anemia
Drug allergy- e.g. Mouth washes, toothpaste, etc. Additionally, Reactions to systemic drugs
Vitamin deficiencies
Miscellaneous- e.g. Radiation mucositis, cancer chemotherapy, diabetes mellitus, uremia.[1]

Sign & Symptoms

Sign & Symptoms of Ulcer of Oral Cavity

One or more painful sores on part of the skin lining the mouth.
Swollen skin around the sores.
Problems with chewing or tooth brushing because of the tenderness.
Irritation of the sores especially by salty, spicy or sour foods.
Loss of appetite.[3]

Diagnosis

Diagnosis of Ulcer of Oral Cavity

Diagnosis of mouth ulcers usually consists of a medical history followed by an oral examination as well as examination of any other involved area.
The following details may be pertinent i.e.: The duration that the lesion has been present, the location, the number of ulcers, the size, the colour and whether it is hard to touch, bleeds or has a rolled edge.
As a general rule, a mouth ulcer that does not heal within 2 or 3 weeks should be examined by a health care professional who is able to rule out oral cancer. In detail, If there have been previous ulcers that have healed, then this again makes cancer unlikely.
An ulcer that keeps forming on the same site and then healing may be caused by a nearby sharp surface, and ulcers that heal and then recur at different sites are likely to be RAS.
Malignant ulcers are likely to be single in number, also conversely, multiple ulcers are very unlikely to be oral cancer.
The size of the ulcers may be helpful in distinguishing the types of RAS, as can the location.

Other diagnostic Factors

Induration, contact bleeding and rolled margins are features of a malignant ulcer. Besides this, There may be nearby causative factor, e.g., a broken tooth with a sharp edge that is traumatizing the tissues.
Otherwise, the person may be asked about problems elsewhere, e.g., ulceration of the genital mucous membranes, eye lesions or digestive problems, swollen glands in neck (lymphadenopathy) or a general unwell feeling.
The diagnosis comes mostly from the history and examination, but the following special investigations may be involved i.e.: blood tests microbiological swabs (infection), or urinalysis (diabetes).
A biopsy with or without immunofluorescence may be required, to rule out cancer, but also if a systemic disease is suspected.
Ulcers caused by local trauma are painful to touch and sore. Furthermore, They usually have an irregular border with erythematous margins and the base is yellow.
Lastly, As healing progresses, a keratotic (thickened, white mucosa) halo may occur.[1]

Differential Diagnosis

Differential Diagnosis of Ulcer of Oral Cavity

Varicella, herpangina
Recurrent aphthous stomatitis
Bechet’s disease
Stevens-Johnson syndrome
Traumatic ulcer
Verrucous carcinoma
Primary herpetic gingivostomatitis
Recurrent herpetic stomatitis [4]

Treatment

Treatment of Ulcer of Oral Cavity

Treatment is cause-related, but also symptomatic if the underlying cause is unknown or not correctable. It is also important to note that most ulcers will heal completely without any intervention.
Treatment can range from simply smoothing or removing a local cause of trauma, to address underlying factors such as dry mouth or substituting a problem medication.
Maintaining good oral hygiene and use of an antiseptic mouthwash or spray (e.g., chlorhexidine) can prevent secondary infection and therefore hasten healing.
A topical analgesic (e.g., benzydamine mouthwash) may reduce pain. Topical (gels, creams or inhalers) or systemic steroids may be used to reduce inflammation.
An antifungal drug may be used to prevent oral candidiasis developing in those who use prolonged steroids. People with mouth ulcers may prefer to avoid hot or spicy foods, which can increase the pain.
Self-inflicted ulceration can be difficult to manage, and psychiatric input may be required in some people. For recurrent ulcers, vitamin B12 has been shown to be effective.[1]

Homeopathic Treatment

Homeopathic Treatment of Ulcer of Oral Cavity

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

The medical history of the patient,
Physical and mental constitution,
Family history,
Presenting symptoms,
Underlying pathology,
Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Ulcer of Oral Cavity:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Arsenic Alb

Basically, Suitable for people who have a lot of fears including fear of death, who are meticulous and keep finding faults in work done by others
Livid, bluish. May be white, Gangrenous
Want of appetite and hunger, Burning in mouth
Ulcers seen especially on tongue have a blue colored base
Unhealthy gums that bleed easily
Painful mouth ulcers.
Hot drinks reduce the pain
Restlessness along with pain
Worse specifically in cold temperature, after consuming cold food and drinks.

Borax

Aphthae in the mouth inside of cheeks and on tongue, which bleed easily.
Great heat and dryness of mouth. Painful red blisters on tongue.
Mouth ulcers feels hot also very sensitive
Dry mouth despite excessive salivation
In some cases, white fungus like growth may be noted in oral cavity.
Besides this, Mouth is tender to touch
Ulcers bleed easily on the slightest touch.
Forepart of palate shriveled, paining esp. when chewing. Child cries especially when nursing.

Merc-sol

Suitable for people who have low will power, are mistrustful, and feel useless.
Metallic taste in mouth.
Gums are very spongy also bleed easily.
Dribbling of saliva
Entire ulcer is red and moist.
Sore mouth with profuse salivation.
Saliva dribbles from mouth of the child.
Gums also cheeks ulcerated.
Fetid odours from mouth.
Lastly, All symptoms are worse at night.

Nitric acid

Nitric acid works well in individuals who are past middle age and those who have good appetite.
Mouth ulcers mainly in soft upper palate.
Halitosis, swelling of gums.
Tongue is clean with a furrow in center.
Symptoms worse in the evening.
Aphthae usually whitish. Additionally, Blisters and ulcers on tongue.
Pricking pain as if from a splinter.
Profuse salivation; fetid odours specifically from mouth.
Unusual craving for indigestible things like chalk, mud etc.

Mercurious corrosivus

Chronic untreated mouth ulcers.
Painful ulcers with bleeding.
Gums are swollen and spongy.
Bad odor from mouth.
Mouth clears associated with excessive pain also tenesmus in the intestine.
Green, bilious vomiting.
Stomach region is very sensitive to touch.
Symptoms increase at night and with consuming strongly acidic food.[2]

Condurango:

This remedy suits people of all ages but it is more effective in individuals who are past middle age.
Cracks and ulcers in corner of the mouth.
Angular stomatitis.
Constant burning pain felt in the mouth that may extend to the stomach.[2]