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 == | ||
===Common Causes=== | ===Common Causes=== | ||
====Trauma==== | ====Trauma==== | ||
Trauma to the mouth is the most common trigger of | Trauma to the mouth is the most common trigger of Aphthous ulcers.[http://www.patient.co.uk/showdoc/40024908/][http://www.health-disease.org/skin-disorders/aphthous-ulcer.htm][http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mouth_ulcers?OpenDocument] [[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. | ||
====SLS containing Toothpaste==== | ====SLS containing Toothpaste==== | ||
Factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. The large majority of toothpastes sold in the U.S. contain [[Sodium dodecyl sulfate|Sodium lauryl sulfate]] (SLS), which is known to cause | Factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. 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>{{cite journal | author = Herlofson B, Barkvoll P | title = Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal = Acta Odontol Scand | volume = 52 | issue = 5 | pages = 257–9 | year = 1994 | pmid=7825393 | url=http://www.wealthpartners.net/pdf/0535.pdf | format=PDF}}</ref><!-- | --><ref>{{cite journal | author = Herlofson B, Barkvoll P | title = Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal = Acta Odontol Scand | volume = 52 | issue = 5 | pages = 257–9 | year = 1994 | pmid=7825393 | url=http://www.wealthpartners.net/pdf/0535.pdf | format=PDF}}</ref><!-- | ||
--><ref>{{cite journal | author = Herlofson B, Barkvoll P | title = The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal = Acta Odontol Scand | volume = 54 | issue = 3 | pages = 150–3 | year = 1996 | pmid=8811135}}</ref><!-- | --><ref>{{cite journal | author = Herlofson B, Barkvoll P | title = The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal = Acta Odontol Scand | volume = 54 | issue = 3 | pages = 150–3 | year = 1996 | pmid=8811135}}</ref><!-- | ||
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====Artificial Sugars==== | ====Artificial Sugars==== | ||
Artificial sugars, such as those found in diet cola and sugarless gum, have been reported as causes of | Artificial sugars, such as those found in diet cola and sugarless gum, have been reported as causes of Aphthous ulcers as well. They can also be linked to an increased intake of acids such as [[ascorbic acid]] (one form of [[Vitamin C]]) or [[citric acid]]. In this case the sores disappear after intake decreases (for example, by substituting [[ascorbate]] [[salt]]s for ascorbic acid). | ||
====Penicillin==== | ====Penicillin==== | ||
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====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"/> | ||
====Immune System==== | ====Immune System==== | ||
Although the exact cause is not known, | 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> | ||
Repeat episodes of | 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.<!-- | ||
--><ref name="nonhodgkinsAdvice">{{cite web | title=Non Hodgkin's Lymphoma Cyberfamily — Side effects | url=http://www.nhlcyberfamily.org/effects.htm | publisher=NHL Cyberfamily | accessdate=2006-08-10}}</ref> | --><ref name="nonhodgkinsAdvice">{{cite web | title=Non Hodgkin's Lymphoma Cyberfamily — Side effects | url=http://www.nhlcyberfamily.org/effects.htm | publisher=NHL Cyberfamily | accessdate=2006-08-10}}</ref> | ||
Mouth ulcers may also be symptoms or complications of several diseases listed in the following section. The treatment depends on the believed cause. | Mouth ulcers may also be symptoms or complications of several diseases listed in the following section. The treatment depends on the believed cause. | ||
Revision as of 17:23, 12 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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
Common Causes
Trauma
Trauma to the mouth is the most common trigger of Aphthous ulcers.[2][3][4] 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.
SLS containing Toothpaste
Factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. 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.[2][3][4] However, some studies find no connection between SLS in toothpaste and mouth ulcers.[5]
Artificial Sugars
Artificial sugars, such as those found in diet cola and sugarless gum, have been reported as causes of Aphthous ulcers as well. They can also be linked to an increased intake of acids such as ascorbic acid (one form of Vitamin C) or citric acid. In this case the sores disappear after intake decreases (for example, by substituting ascorbate salts for ascorbic acid).
Penicillin
According to small-scale experiments by one patent applicant Hau, (6,248,718), topical preparations of high doses of penicillin resulted in accelerated healing of mouth ulcers.
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.[6][7] 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.[6]
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.[8] 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.[8]
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.[9] Mouth ulcers may also be symptoms or complications of several diseases listed in the following section. The treatment depends on the believed cause.
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 B, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study" (PDF). Acta Odontol Scand. 52 (5): 257–9. PMID 7825393.
- ↑ Herlofson B, 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.
- ↑ Chahine L, Sempson N, Wagoner C (1997). "The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study". Compend Contin Educ Dent. 18 (12): 1238–40. PMID 9656847.
- ↑ Healy C, Paterson M, Joyston-Bechal S, Williams D, Thornhill M (1999). "The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration". Oral Dis. 5 (1): 39–43. PMID 10218040.
- ↑ 6.0 6.1 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.
- ↑ 8.0 8.1 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.
- ↑ "Non Hodgkin's Lymphoma Cyberfamily — Side effects". NHL Cyberfamily. Retrieved 2006-08-10.
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