Aphthous ulcer causes: Difference between revisions
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==Overview== | ==Overview== | ||
The exact cause of | The exact cause of aphthous ulcers is unknown. Factors that provoke them include [[stress (psychology)|stress]], [[fatigue (physical)|fatigue]], [[illness]], injury from accidental biting, [[hormone|hormonal]] changes, [[menstruation]], sudden [[weight loss]], [[food allergy|food allergies]], the foaming agent in toothpaste ([[Sodium lauryl sulfate|SLS]]), and deficiencies in [[vitamin B12]], [[iron]], and [[folic acid]].<ref>{{cite journal |author=Wray D, Ferguson M, Hutcheon W, Dagg J |title=Nutritional deficiencies in recurrent aphthae |journal=J Oral Pathol |volume=7 |issue=6 |pages=418–23 |year=1978 |pmid=105102}}</ref> Some drugs, such as [[nicorandil]], also have been linked with mouth ulcers. In some cases they are thought to be caused by an overreaction by the body's own [[autoimmunity|immune system]]. | ||
==Causes== | ==Causes== | ||
===Trauma=== | |||
Trauma to the mouth is the most common trigger of aphthous ulcers.[[Physical trauma]], such as that caused by toothbrush abrasions, laceration with sharp foods or objects, accidental biting (particularly common with sharp canine teeth), or [[dental braces]] can cause mouth ulcers by breaking the mucous membrane.<ref name="pmid8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135 }} </ref><ref name="pmid7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393 }} </ref><ref name="pmidPMID 105102">{{cite journal| author=Wray D, Ferguson MM, Hutcheon WA, Dagg JH| title=Nutritional deficiencies in recurrent aphthae. | journal=J Oral Pathol | year= 1978 | volume= 7 | issue= 6 | pages= 418-23 | pmid=PMID 105102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=105102 }} </ref> | |||
Trauma to the mouth is the most common trigger of | |||
===Drugs=== | |||
*[[Beta blockers]] | *[[Beta blockers]] | ||
*[[NSAIDs]] | *[[NSAIDs]] | ||
*[[Cidofovir]] | *[[Cidofovir]] | ||
*[[Pergolide]] | *[[Pergolide]] | ||
*[[Nicorandil]] | |||
*[[Alendronate]] | |||
===Genetic Factors=== | |||
The role of genetic factors is the best-defined underlying cause of aphthous ulcer. | The role of genetic factors is the best-defined underlying cause of aphthous ulcer. | ||
Certain genetically specific [[HLAs]] which have been identified in aphthous ulcer patients include:<ref name=HLA-Aphthous> Albanidou‐Farmaki, E., et al. "HLA haplotypes in recurrent aphthous stomatitis: a mode of inheritance?." International journal of immunogenetics 35.6 (2008): 427-432.</ref> | Certain genetically specific [[HLAs]] which have been identified in aphthous ulcer patients include:<ref name=HLA-Aphthous> Albanidou‐Farmaki, E., et al. "HLA haplotypes in recurrent aphthous stomatitis: a mode of inheritance?." International journal of immunogenetics 35.6 (2008): 427-432.</ref> | ||
| Line 37: | Line 25: | ||
*HLA-DR2 and HLA-DR7 | *HLA-DR2 and HLA-DR7 | ||
*HLA-DQ series | *HLA-DQ series | ||
=== | |||
===Allergic Factors=== | |||
It is thought that aphthous ulcer may be caused by [[hypersensitivity]] to certain environmental allergens, food substances such as milk, chocolate, cheese, nuts, tomatoes, and wheat.<ref name=Allergens-aphthous>Wray D, Vlagopoulos TP, Siraganian RP. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982; 54(4):388–95.</ref><ref name=Allergens-Aphthous-2>Pacor ML, Di Lorenzo G, Martinelli N, et al. Results of double-blind placebo- controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis. Int Arch Allergy Immunol 2003;131(4):296–300.</ref> | |||
====Gluten==== | ====Gluten==== | ||
There is a commonly held belief that another cause of | There is a commonly held belief that another cause of aphthous ulcers is gluten intolerance ([[Celiac disease]]), whereby consumption of [[wheat]], rye, barley and sometimes oats can result in chronic mouth ulcers. However, two small studies of patients with Celiac disease have demonstrated no link between the disease and Aphthous ulcers.<ref name="bucci">{{cite journal | author = Bucci P, Carile F, Sangianantoni A, D'Angio F, Santarelli A, Lo Muzio L. | title = Oral aphthous ulcers and dental enamel defects in children with celiac disease. | journal = Acta Paediatrica | volume = 95 | issue = 2 | pages = 203–7 | year = 2006 | pmid=16449028}}</ref><ref>{{cite journal | author = Sedghizadeh PP, Shuler CF, Allen CM, Beck FM, Kalmar JR. | title = Celiac disease and recurrent aphthous stomatitis: a report and review of the literature. | journal = Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics | volume = 94 | issue = 4 | pages = 474–8 | year = 2002 | pmid=12374923}}</ref> If patients with Aphthous ulcers do happen to have gluten intolerance, they may experience benefit in eliminating breads, pastas, cakes, pies, scones, biscuits, beers and so on from their diet and substituting gluten-free varieties where available.<ref name="bucci"/> | ||
====SLS containing Toothpaste==== | |||
The large majority of toothpastes sold in the U.S. contain [[Sodium dodecyl sulfate|Sodium lauryl sulfate]] (SLS), which is known to cause Aphthous ulcers in certain individuals. Using a [[toothpaste]] without SLS will reduce the frequency of Aphthous ulcers in persons who experience Aphthous ulcers caused by SLS.<ref name="pmidPMID 7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=PMID 7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393 }} </ref><ref name="pmidPMID 8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=PMID 8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135 }} </ref> | |||
However, some studies find no connection between SLS in toothpaste and mouth ulcers.<ref name="pmidPMID 10218040">{{cite journal| author=Healy CM, Paterson M, Joyston-Bechal S, Williams DM, Thornhill MH| title=The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration. | journal=Oral Dis | year= 1999 | volume= 5 | issue= 1 | pages= 39-43 | pmid=PMID 10218040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10218040 }} </ref> | |||
===Microbial Factors=== | |||
It is thought that aphthous ulcers may be caused by microbial factors such as [[Streptococcus|Streptococcus sanguis]], [[Helicobacter pylori]], [[Varicella zoster]], and [[Cytomegalovirus]]. The exact pathogenesis of aphthous ulcer caused by microbial factors is not fully understood. It is thought that oral mucosal damage in aphthous ulcer is caused by the cross reactivity between mitrocondrial heat shock protein and microbial antigens, and as a result [[T-cell mediated response]] to the [[antigens]] lead to oral mucosal damage. | |||
===Immune System=== | |||
Although the exact cause is not known, Aphthous ulcers are thought to form when the body becomes aware of and attacks [[molecules]] which it does not recognize.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> The presence of the unrecognized [[molecule]]s garners a reaction by the [[T-cell]]s, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory [[T-cell]]s.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> | Although the exact cause is not known, Aphthous ulcers are thought to form when the body becomes aware of and attacks [[molecules]] which it does not recognize.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> The presence of the unrecognized [[molecule]]s garners a reaction by the [[T-cell]]s, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory [[T-cell]]s.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> | ||
common systemic conditions that may be caused in aphthous ulcer are include: | |||
*Behcet’s syndrome | |||
*MAGIC syndrome | |||
*Cyclic neutropenia | |||
*Crohn’s disease | |||
*HIV disease | |||
Repeat episodes of Aphthous ulcers can be indicative of an [[immunodeficiency]], signalling low levels of [[immunoglobulin]] in the mucous membrane of the mouth. Certain types of [[chemotherapy]] cause mouth ulcers as a side effect. | The exact pathogenesis of aphthous ulcer caused by different systemic conditions is not fully understood. It is though that recurrent aphthous ulcer | ||
Repeat episodes of Aphthous ulcers can be indicative of an [[immunodeficiency]], signalling low levels of [[immunoglobulin]] in the mucous membrane of the mouth. Certain types of [[chemotherapy]] cause mouth ulcers as a side effect. | |||
Mouth ulcers may also be symptoms or complications of several diseases listed in the following section. The treatment depends on the believed cause.<ref name="pmidPMID 15894112">{{cite journal| author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H| title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. | journal=Immunol Lett | year= 2005 | volume= 99 | issue= 1 | pages= 57-62 | pmid=PMID 15894112 | doi=10.1016/j.imlet.2005.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15894112 }} </ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Template:SMehr
Overview
The exact cause of aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid.[1] Some drugs, such as nicorandil, also have been linked with mouth ulcers. In some cases they are thought to be caused by an overreaction by the body's own immune system.
Causes
Trauma
Trauma to the mouth is the most common trigger of aphthous ulcers.Physical trauma, such as that caused by toothbrush abrasions, laceration with sharp foods or objects, accidental biting (particularly common with sharp canine teeth), or dental braces can cause mouth ulcers by breaking the mucous membrane.[2][3][4]
Drugs
Genetic Factors
The role of genetic factors is the best-defined underlying cause of aphthous ulcer. Certain genetically specific HLAs which have been identified in aphthous ulcer patients include:[5]
- HLA-A2
- HLA-B5, B12, B44, B51, B52
- HLA-DR2 and HLA-DR7
- HLA-DQ series
Allergic Factors
It is thought that aphthous ulcer may be caused by hypersensitivity to certain environmental allergens, food substances such as milk, chocolate, cheese, nuts, tomatoes, and wheat.[6][7]
Gluten
There is a commonly held belief that another cause of aphthous ulcers is gluten intolerance (Celiac disease), whereby consumption of wheat, rye, barley and sometimes oats can result in chronic mouth ulcers. However, two small studies of patients with Celiac disease have demonstrated no link between the disease and Aphthous ulcers.[8][9] If patients with Aphthous ulcers do happen to have gluten intolerance, they may experience benefit in eliminating breads, pastas, cakes, pies, scones, biscuits, beers and so on from their diet and substituting gluten-free varieties where available.[8]
SLS containing Toothpaste
The large majority of toothpastes sold in the U.S. contain Sodium lauryl sulfate (SLS), which is known to cause Aphthous ulcers in certain individuals. Using a toothpaste without SLS will reduce the frequency of Aphthous ulcers in persons who experience Aphthous ulcers caused by SLS.[10][11] However, some studies find no connection between SLS in toothpaste and mouth ulcers.[12]
Microbial Factors
It is thought that aphthous ulcers may be caused by microbial factors such as Streptococcus sanguis, Helicobacter pylori, Varicella zoster, and Cytomegalovirus. The exact pathogenesis of aphthous ulcer caused by microbial factors is not fully understood. It is thought that oral mucosal damage in aphthous ulcer is caused by the cross reactivity between mitrocondrial heat shock protein and microbial antigens, and as a result T-cell mediated response to the antigens lead to oral mucosal damage.
Immune System
Although the exact cause is not known, Aphthous ulcers are thought to form when the body becomes aware of and attacks molecules which it does not recognize.[13] The presence of the unrecognized molecules garners a reaction by the T-cells, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory T-cells.[13] common systemic conditions that may be caused in aphthous ulcer are include:
- Behcet’s syndrome
- MAGIC syndrome
- Cyclic neutropenia
- Crohn’s disease
- HIV disease
The exact pathogenesis of aphthous ulcer caused by different systemic conditions is not fully understood. It is though that recurrent aphthous ulcer Repeat episodes of Aphthous ulcers can be indicative of an immunodeficiency, signalling low levels of immunoglobulin in the mucous membrane of the mouth. Certain types of chemotherapy cause mouth ulcers as a side effect. Mouth ulcers may also be symptoms or complications of several diseases listed in the following section. The treatment depends on the believed cause.[14]
References
- ↑ Wray D, Ferguson M, Hutcheon W, Dagg J (1978). "Nutritional deficiencies in recurrent aphthae". J Oral Pathol. 7 (6): 418–23. PMID 105102.
- ↑ Herlofson BB, Barkvoll P (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontol Scand. 54 (3): 150–3. PMID 8811135.
- ↑ Herlofson BB, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study". Acta Odontol Scand. 52 (5): 257–9. PMID 7825393.
- ↑ Wray D, Ferguson MM, Hutcheon WA, Dagg JH (1978). "Nutritional deficiencies in recurrent aphthae". J Oral Pathol. 7 (6): 418–23. PMID 105102 PMID 105102 Check
|pmid=value (help). - ↑ Albanidou‐Farmaki, E., et al. "HLA haplotypes in recurrent aphthous stomatitis: a mode of inheritance?." International journal of immunogenetics 35.6 (2008): 427-432.
- ↑ Wray D, Vlagopoulos TP, Siraganian RP. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982; 54(4):388–95.
- ↑ Pacor ML, Di Lorenzo G, Martinelli N, et al. Results of double-blind placebo- controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis. Int Arch Allergy Immunol 2003;131(4):296–300.
- ↑ 8.0 8.1 Bucci P, Carile F, Sangianantoni A, D'Angio F, Santarelli A, Lo Muzio L. (2006). "Oral aphthous ulcers and dental enamel defects in children with celiac disease". Acta Paediatrica. 95 (2): 203–7. PMID 16449028.
- ↑ Sedghizadeh PP, Shuler CF, Allen CM, Beck FM, Kalmar JR. (2002). "Celiac disease and recurrent aphthous stomatitis: a report and review of the literature". Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 94 (4): 474–8. PMID 12374923.
- ↑ Herlofson BB, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study". Acta Odontol Scand. 52 (5): 257–9. PMID 7825393 PMID 7825393 Check
|pmid=value (help). - ↑ Herlofson BB, Barkvoll P (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontol Scand. 54 (3): 150–3. PMID 8811135 PMID 8811135 Check
|pmid=value (help). - ↑ Healy CM, Paterson M, Joyston-Bechal S, Williams DM, Thornhill MH (1999). "The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration". Oral Dis. 5 (1): 39–43. PMID 10218040 PMID 10218040 Check
|pmid=value (help). - ↑ 13.0 13.1 Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H. (2005). "Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations". Immunol Lett. 99 (1): 57–62. PMID 15894112.
- ↑ Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H (2005). "Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations". Immunol Lett. 99 (1): 57–62. doi:10.1016/j.imlet.2005.01.002. PMID 15894112 PMID 15894112 Check
|pmid=value (help).