PAINFUL ORAL LESIONS: What Can I Do?
APHTHOUS ULCERS – CANKER SORES
HERPES SIMPLEX – FEVER BLISTERS/COLD SORES
What Can I Do?
By: Jerry A. Douglas, DMD
Anyone that has ever experienced a severe aphthous ulcer (canker sore/cold sore), or ulcerative gingivitis knows how painful and uncomfortable this oral condition can be. Most people have their first bout with canker sores between the ages of 10 and 20. Women are more likely than men to have recurrent canker sores. Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients. This partially explains why the disorder is often shared by family members.
Fever blisters are different than canker sores or cold sores. They are caused by a virus, Herpes Simplex, Type I, and are very contagious. This virus remains in the body once an individual is infected and there is no cure for Herpes. You should avoid all physical contact with these lesions and avoid kissing during an outbreak of Herpes Simplex. The lesions spread very easily. Most children become infected from their parent that has active lesions. Children can spread the virus by rubbing an active lesion and touching other children. After the initial infection by the Herpes Virus, recurring lesions usually are less painful in most people.
The scientific literature states that the etiological agent for canker sores is basically unknown. Canker sores are not contagious. More than one cause is likely, even for individual patients. Canker sores do not appear to be caused by viruses or bacteria, although an allergy to a type of bacterium commonly found in the mouth may trigger them in some people. The sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue. There is strong scientific data that suggests these painful and troublesome lesions are the result of a bacterial imbalance and tissue invasion by certain bacteria. Some believe they are the result of digestive acids, stress related, activated and initiated by chemical or spices in food or activated by too much sun. There is some evidence that says hormonal imbalances with secondary factors initiate the lesions. Female sex hormones apparently play a role in causing canker sores. Many women have bouts of the sores only during certain phases of their menstrual cycles. Most women experience improvement or remission of their canker sores during pregnancy. Both emotional stress and injury to the mouth can trigger outbreaks of canker sores, but these factors probably do not cause the disorder. Many believe the theory that certain foods such as milk, hot coffee, chocolate, cheese, vinegar, citrus fruits, whole wheat and nuts high in amino acid arginine initiate these lesions.
Fever blisters, being different than canker sores, are caused by the Herpes Virus, Type 1, and most people are infected by the age of 10 years. Once a person is infected there are several factors that initiate recurring lesions. The scientific community believes emotional stress, illness, injury, systemic disorders that cause fever, mate, sexual habits and a lot of exposure to sunlight weakens the body's natural defenses and will activate the herpes virus. It is well documented that many women experience active fever blisters only during the menstrual cycle. There is scientific data that indicates the herpes virus is inherited. You can experience symptoms with an outbreak of the Herpes Virus such as fever, sore throat (swollen neck glands), headache or flu type symptoms with general aches. There is ongoing research on the initiating factors and control of Herpes Simplex.
Science continues to research these aggravating lesions and what causes them. British studies show that, in about 20 percent of patients, canker sores are due partly to nutritional deficiencies, especially lack of vitamin B 12, folic acid and iron. Similar studies performed in the United States, however, have not confirmed this finding. In a small percentage of patients, canker sores occur with gastrointestinal problems, such as an inability to digest certain cereals. In these patients, canker sores appear to be part of a generalized disorder of the digestive tract. Many individuals have the lesions on a regular basis, or experience the lesions on a seasonal basis. Some experience the lesions on a yearly basis with no explainable reason of what initiated the outbreak of the lesions. Chronic oral lesions that could be the result of multiple systemic infectious diseases such as chronic venereal diseases, tuberculosis and parasitic diseases have a very negative effect on the immune system, and could be a source for transmission of the pathologic viruses or bacteria to your mate or sexual partners. Controlling the oral lesions is one of the first steps toward good health and reducing the chance for transmission of pathologic diseases and ulcers.
Fever blisters can be controlled to a certain degree once a person is infected by avoiding contact with individuals with active lesions and maintaining good personal hygiene. If you are infected with the Herpes Virus, keep a personal history of what occurred the week prior to recurring lesions, what did you eat, drink, who did you have physical contact with, what medication did you take, have you been under a lot of stress and did you experience anything different from your daily routine? This will help you determine the triggering factor that initiates the Herpes Virus in your body, then you can determine and plan ways to eliminate the initiating factor that activates the Herpes Virus. If the sun initiates an outbreak of the fever blisters, there is good news for this. The National Institute of Dental Research has confirmed that sunscreen on lips can prevent sun-induced Herpes Lesions. A protection factor of 15 was used in the NIDR studies.
One method of treatment you can use to help alleviate the pain and promote the healing of oral lesions is oral rinses that are very effective and safe. How do I select the best rinse to use? Consult your health professional or do research on your own to help you select the best product for you to use. Everyone should consider the following four things in selecting an oral rinse. 1. Consumer Safety 2. Effectiveness 3. Easy to use 4. Environmental compatibility. If you can say yes to all of the above, then use the oral rinse. Is the daily use of mouth rinses necessary? The answer to that question is yes for most individuals. Some individuals need an antimicrobial to keep the oral bacterial environment balanced. The oral bacterial imbalance can be the result of medications, stress, diet, mate, alcohol, drugs, tobacco or other contributing factors. The oral bacterial imbalance can have a very negative effect on an individual's general health as well as their oral health if it is left unattended for a prolonged period of time. Daily ingestion of the pathogens (bad bacteria) in the oral cavity can contribute to heart disease, diabetes, immune disorders, stroke, weight loss, low pre-term birth weight and oral diseases such as gingivitis, periodontal disease and oral lesions. Good health starts with good oral health. Regular visits to a dental health provider and proper daily oral hygiene habits are essential in maintaining good oral health. Consult your Dentist or Hygienist on the proper preventive plan for you.
Most individuals with immunosuppressed conditions or symptoms experience several systemic disorders when taking their medication. Some of these disorders, nausea, vomiting and difficult swallowing can have a very negative effective on the bacterial environment of the oral cavity. The bacterial imbalance will help initiate gingival (gum) inflammation, geographic (inflamed) tongue, aphthous stomatitis (canker sores or cold sores), candida albicans (thrush infection), tissue desquamation (sloughing) and herpetic lesions as well as other oral disorders. The severity and duration of any of these tissue conditions or lesions depends on many factors, diet, stress, oral health of your mate, medication and daily oral hygiene habits. A daily regimen to prevent oral lesions in susceptible individuals is very beneficial toward good general health.
For any remedy to be effective it must provide two things, the ability to kill the bacteria, fungus or virus that infects the canker sores/fever blisters and promote healing. Experiment until you find a treatment that works for you. There are several oral care products available over the counter (OTC) that provide some relief. Most of the OTC products that contain alcohol, camphorbenzocaine or eucalypol in a liquid or gel form have not proven to be effective in reducing the pain or promoting healing without numerous applications on a daily basis. These products also sting or burn with the initial application. If you use these products and the burning or stinging persists, consult a health professional. For some people the oxygenating agent, hydrogen peroxide found in Orabase, Peroxyl, Orajel Perioseptic, Gly-oxide and Lactona Vince Gum and Mouth Care Powder provide a quick source of oxygen to the inflamed tissue that lasts for a very short duration and provide very limited, if any, tissue healing properties. Some people mix hydrogen peroxide 3% with tap water, 1 part to 1 part (50-50) and rinse with this solution. This may not be a good practice, in my opinion. When you mix hydrogen peroxide and tap water the flourine in the water reacts with the hydrogen peroxide to form a weak hydrofluric acid. This could increase the severity of the oral condition. Some individuals rinse with 3% hydrogen peroxide. This is not a good practice either. The acidic PH of 3% hydrogen peroxide (3.5 to 4.5PH) will cause tissue burn in most individuals if used frequently on a long term basis. If you are going to mix hydrogen peroxide with water, you should use distilled water only. Oxygenating agents will prolong the healing of some oral lesions depending on the etiological agent that caused the lesion to develop. Most of the bacteria and viruses that initiate oral lesions require oxygen. Oxygenating agents help this type of bacteria and viruses remain vital and delay healing the lesion. The combination of glycerin and hydrogen peroxide helps in some cases but does not prevent the lesion from recurring. The peroxide kills some bacteria and the glycerin coats the lesion which helps protect the lesion from being irritated when you drink or eat. There are a number of topical anesthetic products that help control the pain, but they do not promote healing. Most of these products are available in pharmacies and major retail stores.
Many health professionals, caregivers, patients and a large percentage of the general public believe OTC (over the counter) mouth rinses, holistic remedies and home remedies are beneficial. If you choose to use an OTC mouth rinse, holistic formulated rinse or home remedy, check the alcohol content and safety before using anything. Any mouth rinse with 5% or more alcohol should be used with caution with daily use treating oral lesions. Using a high alcohol rinse could cause the lesion to progress into a hyperkeratotic condition that would require medical attention. The high alcohol rinses also alter the bacterial balance in the oral cavity prolonging the duration of any lesions. Everyone ingests a percentage of the alcohol in the oral rinse they use in daily hygienic care, please take the time to check the ingredients of any oral rinse you choose to use in treating oral lesions.
There have been reported cases of canker sores being treated with a wet black tea bag due to the effect the tannin in the tea has on the lesion. Goldenseal, a natural herb, can be used as a mouth rinse when made into a strong tea. There have not been any documented scientific studies using these natural remedies, but the holistic medical community reports moderate success with these two remedies. An old Midwest remedy that works for some people is a teaspoon of potassium chloride in a cup of distilled water and rinsing with this solution several times a day. Do not swallow this rinse. Daily ingestion of too much potassium chloride can have an adverse effect on the heart.
There is a new product that is showing a lot of promise in the treatment of gingival (gum) inflammation, geographic (inflamed) tongue, aphthous stomatitis (canker or cold sore), candida albicans (thrush infections), herpetic lesions and fever blisters, Prevention Mouth Rinse. The manufacturer has completed all of the safety studies under FDA protocol proving the product is very safe. There are three strengths; Everyday, Orthodontic and Periodontal. All three strengths have the same ingredients and have shown clinical success in treating oral lesions. The Periodontal Strength is the most concentrated. This rinse has zinc chloride, an excellent antimicrobial for oral use as well as promote tissue healing; sodium citrate, a dynamic anti-inflammatory when complexed with zinc; EDTA sodium, a powerful antioxidant that strengthens and improves cellular integrity and hydrogen peroxide. The Periodontal Strength Part A has clinically rendered large aphthous ulcers asymptomatic within hours and promoted healing within two to three days. This product has shown the ability to stop fever blisters if used often once the initial symptoms begin. If you feel itching, tingling or burning in the lip, start treating that area with Prevention Periodontal Mouth Rinse immediately. Rinse the area with a cotton ball or Q-Tip four or five times a day for the first two days, then follow the manufacturer's directions. There has been very positive data collected to date using this method to control and help heal fever blisters. The product is relieving the pain within hours and promoting healing within three days.
To treat an oral lesion inside the mouth, take a cotton Q-Tip and paint the affected area 3 to 4 times per day or as often as you wish with the Prevention Periodontal Part A. Once the lesion begins to heal, rinse as instructed by the manufacturer. Rinse daily with the rinse after the lesions are healed. Prevention Mouth Rinse will keep the lesions from recurring in most individuals. There are controlled cases of individuals that have not experienced oral lesions in three years. These patients had oral lesions every month. Many times these lesions became so painful the individuals could not eat or drink. The Greene LeBaron Aids Project Dental Clinic in Los Angeles, California has seen Prevention Mouth Rinse control and heal aphthous ulcers (12mm in size) in two to three days.
There are a few prescription drugs that will help treat oral lesions, such as the chlorhexidine glucanate rinses, Nystatin, Betadine based rinses, Clotrimazole, Ketoconazole, Fluconazole, and a few antibiotic based rinses. Research and clinical use has not proven any of them to be extremely effective for long term use by individuals with immune deficiency disease or symptoms. Many of the prescription drugs produce side effects in individuals that use the drugs on a long-term basis. There is a new prescription drug for oral ulcers, Aphthasol (Amlexanox Oral Paste) 5%. The manufacturer states they do not know the mechanism of action by which this product accelerates the healing of aphthous ulcers (cankers sores). The manufacturer states side effects with the use of this product. Ask your pharmacist about the side effects if you decide to use this product. Nursing mothers should use caution and consult your health professional and pharmacist before using this product. If you use a prescription drug, please ask the pharmacy for a medical safety data sheet for the drug you are using. Take the time to read the side effects paragraph. Check regularly for any of the listed side effects. If you start developing one of the side effects, consult a health professional immediately.
Mouth rinses containing the antibiotic tetracycline may reduce the unpleasant symptoms of canker sores and speed healing by preventing bacterial infections in the sores. Clinical studies at the National Institute of Dental Research have shown that rinsing the mouth with tetracycline several times a day usually relieves pain in 24 hours and allows complete healing in 5 to 7 days. The U.S. Food and Drug Administration warns, however, that tetracycline given to pregnant women and young children can permanently stain childrens' teeth. Both steroid and tetracycline treatments require a prescription and the care of a dentist or physician. Dental health professionals are concerned with the daily ingestion of tetracycline by pregnant women, nursing mothers and young children due to the adverse effect this drug has on developing teeth.
If you try controlling and treating your oral lesions with any type of OTC or prescription product and the lesions are not responding to your treatment, consult a health professional as soon as possible. Always read the medical safety data sheet on all prescription drugs and any OTC product that you might have concerns regarding their daily use. Always consult your health professional or pharmacist if you do not understand the medical safety data.
Things To Do To Help Prevent Canker Sores and Other Oral Ulcers
References:
1. Prevention's Healing with Vitamins
Alice Feinstein, Rodale Books, 1996
2. National Institute of Dental Research
3. National Oral Health Information Clearing House
1 NOHIC Way, Bethesda, MD, 20892-3500
4. Block Drug Company
(800) 652-5625
5. Complete Book of Vitamins and Minerals
Wings Books, 1992
6. National Institute of Dental and Craniofacial Research 1993-1999,
31 Center Drive MSC 2190, Bldg. 31, Room 5B49, Bethesda, MD 20892-2190
7. Data on file, Prevention Laboratories
(800) 473-1205
Prevention Mouth Rinse