Randy Jacobs, M.D. Patient Education

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Apthous Ulcers




What are they?

Canker sores (aphthous stomatitis) are painful recurrent ulcers or erosions of the mouth which most commonly appear on the lips, gums, inner cheeks, tongue, palate, and throat. They can also occur on the esophagus and genitalia. About 20% of the population has had apthous ulcers. They may appear as small, shallow depressions in the mucosa (lining of the mouth) with sharp borders covered by a gray membrane and surrounded by an intense red halo. Tingling or burning sometimes precedes them by 24 hours. During the first 2 to 3 days, canker sores are extremely painful and can interfere with eating or speaking. Most lesions heal without scarring within 2 weeks, but these lesions may last 4 to 35 days.


What causes them?

The exact cause of canker sores is not known, but there is definitely an autoimmune response in which the body attacks its own mucosa. Stress appears to be the most common predisposing factor a number of causative factors have been cited including stress, infectious agents, and circulating growth factors. They differ in appearance from fever blisters, and the treatment differs too. When this episode of canker sores is over, you may expect that they will recur at some variable time in the future. If you find that the medication prescribed this time is very helpful, save any left over or get some more at the start of the next episode and start using it right away. The sooner treatment starts, the more likely it is to be helpful.


What are they associated with?

Apthous ulcerations can be associated with Behcet's Syndrome, low iron, Vitamin deficiency of B12, folate, B1, B2, and B6, Chronic Ulcerative Colitis, Chron's Disease, Lupus, Malabsorption Syndromes, and HIV.



Activity in Daily Living: There are no restrictions. Stay as active as strength and feeling of well-being will allow. Diet: Changing the diet will neither help nor hurt. Since hot of cold foods may make the mouth hurt more, you may feel better taking soups or milk shakes through a straw. Good nutrition is important for healing.



Your medicines must be fitted to your own particular need. Do not use any medicine (not even medicine you buy without prescription) without telling your doctor. If drugs are prescribed, carefully follow the instructions on the label. There are a number of medications which can give relief and sometimes hasten healing. Medicines include tetracycline (liquid) used as compresses. The tetracycline (250 to 500 mg) is dissolved in one ounce of water. This is applied with gauze to the ulcers for 10 to 20 minutes 4 to 6 times per day. Nothing should be taken by mouth for 30 minutes following. Tetracycline therapy should continue for 5 to 7 days. Early tetracycline therapy is important. Some doctors feel that the tetracycline inhibits growth of streptococci and other bacteria. Topical steroids can help in between tetracycline applications.  Kenalog in Orabase is fine at least four times per day. Nystatin Suspension may be needed four times a day to prevent yeast overgrowth. Topical anesthetics such as elixir of Benadryl and viscous Xylocaine can be helpful. If topical anesthetic solution are used over too large an area, a disturbing "cotton mouth" feeling and loss of taste may result. Prednisone may be used in severe cases. Please inform Dr. Jacobs if you have any history of recurrent herpes, oral yeast infections, pemphigus, leukemia, lymphoma, sprue, Behcet's Syndrome, low iron, Vitamin deficiency of B12, folate, B1, B2, and B6, Chronic Ulcerative Colitis, Chron's Disease, Lupus, Malabsorption Syndromes, or HIV.



A careful check on the association of the sores with the intake of specific foods may help locate a cause. Look for reactions to foods such as chocolate, citrus, acidified foods (vinegar, pickles), salted nuts, potato chips, and others. Encourage fluids, the best tolerated of which are milk, liquid Jell-O, ice cream, custards, and syrup of wild cherry (from your druggist) in water. Drinking through a straw may help in some cases. Gum care with 2 per cent hydrogen peroxide OTC on a cotton applicator may be helpful three times a day. Rinse mouth with salt solution of 1/2 tsp. salt to 8 ounces of water 4 times or more daily after eating. Though apthae are not necessarily contagious, you can avoid transmission by boiling or using disposable eating utensils. Boil anything that has come into contact with the saliva. A record of daily weight, fluid intake, and urine output will help determine whether you are becoming dehydrated. NOTIFY OUR OFFICE IF ANY OF THE FOLLOWING HAPPENS: Temperature over 102 F rectally in children, 101 F orally in adults, or failure to improve after 14 days.



Do 1 through 7 at least four times per day:

1. 2% hydrogen peroxide rinse

2. Salt water rinse

3. Tetracycline compress

4. Wait 30 minutes

5. Kenalog in orabase

6. Wait 30 minutes

7. Nystatin Suspension

8. As needed: Elixir of Benadryl or Viscous Xylocaine for pain control.