Mouth ulcers, aphthous ulcers, canker sores - call them what you will, they hurt!

Mouth ulcers - some people get them, some don't. They're a pain.

First things first - get your ulcers checked out by your dentist. Most ulcers are just a nuisance but some are very important. Get a diagnosis first. Then read this!

OK - we've assumed that the ulcers you've got are the type that arrive, cause you hassle for few days, then heal and disappear. Then when you've just got back to normality, you get another one or even a crop of them.

First - what is an ulcer? Your skin is meant to keep your bodily contents in and the outside world and the things that may harm you out. That's why burns are bad news - removing the skin by burning allows infection in BUT more importantly the burnt area allows fluid to leak out. That's also why burns victims are covered in cling film to keep the fluid in. They can lose massive amounts of fluid through the burnt area and ultimately die due to fluid loss.

Ever wondered why burns are quoted as percentage of the body area affected? It's so that a calculation can be made of the fluid loss.

 

So, you've got a temporary hole in your skin which is letting in everything from outside - particularly bacteria. Your body doesn't like bacteria getting in, so you get inflammation. And with inflammation you get pain.

Working on the principle that the pain from the ulcer is caused by bacteria getting through the ulcer, then the best treatment is to stop the bacteria getting in. You've two choices - physically cover the ulcer or kill the bacteria. Years ago, we used to use a paste that protected the ulcer and also contained steroids to reduce the inflammation. But, I'm convinced the way forward is to kill the bacteria. This comes from personal experience of being on holiday with a wife with a mouth ulcer that was large enough to give her a swollen lip. We bought a tube of Corsodyl Gel and within 24 hours it was cured. Corsodyl Gel is chlorhexidine gluconate, the same stuff that surgeons scrub their hands with. The idea is to rub a small blob with the end of a finger onto the ulcer for a minute twice per day. That'll kill the bacteria.

If an ulcer doesn't clear up in a week, GET IT CHECKED. Also an ulcer that does not hurt needs to be checked.

Why do I get mouth ulcers?

To be blunt - some people just get them. They just do.

BUT some people  Do have a reason.

  • One major culprit is Sodium Lauryl Sulphate (sometimes spelt Laureth and Sulfate). Some people are allergic to Sodium Lauryl Sulfate, causing dermatitis. SLS is a foaming agent that is found in shampoo and soaps, to enhance "the experience". For some reason, toothpaste manufacturers insist on adding it to toothpaste to make it foam more. As a dentist, I never understood why we'd want to be overwhelmed by foam when brushing our teeth.

            There are toothpastes available that are Sodium Lauryl Sulphate free. Look carefully at the                      ingredients of the Sensodyne range. Some of their range are SLS free (but not all). At the time of             writing, the Sensodyne Pronamel is definitely Sodium Lauryl Sulphate free - follow this link to the                MHRA report on Pronamel.  I'm told they're working towards a completely SLS free range so to find which products are currently okay, you will need to check on the pack.

  • If you're vitamin B12 deficient, folate deficient or anaemic you can be more prone to aphthous ulcers. But why would you be deficient in either of them? If you're a female of childbearing age, you've around a 40% chance of being anaemic at any one time. We have iron in our blood in the form of Haemoglobin, but we also have stocks of iron stashed in the tissues in the form of something called Ferritin. If you're tested for anaemia and just the blood iron level is checked you may show up as okay but have empty stocks. So, the blood test needs to test for Ferritin levels as well. So, if you're just before a period, you may test as OK, but just after the period you may then test as anaemic because you have empty stocks. To build up those stocks of Ferritin isn't a case of a two week course of iron tablets. Realistically, you need to work at it for a year. But, to be able to absorb any iron you eat in food, or even as a supplement, you need vitamin B12 and folate. Without the right combination you can't make something called intrinsic factor. Without intrinsic factor you can take as much iron as you like, but you can't absorb it. So, eat a balanced diet with plenty of vegetables to get the B12 and folate. (Some people just can't make intrinsic factor - they're unable to absorb iron and have to have iron injected - this is called pernicious anaemia). Vegetarians can be prone to anaemia because of their diet - take not of the B12 and folate problem.
  • We see patients who are allergic to citrus fruits, such as oranges. But this group also include tomatoes. Removing them from the diet often improves the recurrent aphthous ulcers.

© Hesslewood Lodge Dental Practice, 16th November 2015