Mouth
sores can be painful, annoying and unsightly. Some appear inside the
mouth-on the gums, tongue, lips, cheeks or palate (roof of the mouth).
Others, like cold sores, can appear outside the mouth, such as on and around
the lips, under the nose and on the chin.
Mouth sores can be caused by oral cancer or bacterial, viral or fungal
infections.
Some other causes include:
1. Irritations, such as dentures that no longer fit properly and rub against
tissues.
2. Loose orthodontic wires or the sharp edge of a broken tooth or
filling.
3. Extreme sensitivity to ingredients found in some toothpastes or mouth
rinses.
4. Medication, cancer treatment side effects or reaction to therapy.
5. Certain specific skin, oral or systemic diseases.
Although there are many types of mouth sores, the most common are canker
sores, cold sores, leukoplakia (a thick white or gray patch) and candidiasis or
thrush (a fungal infection).
Some people may experience occasional discolored, painless spots in their
mouth. Most are harmless and will disappear or remain unchanged. However, some
sores or spots can be serious and need the attention of your dentist or
physician. For example, oral cancer may not be painful at first, but it can be
deadly. That’s why regular dental checkups are important. Have your dentist
examine any mouth sore or spot that fails to heal within two weeks.
Canker Sores
Canker sores appear inside the mouth. They usually are small ulcers (minor
aphthous ulcers) with a white, yellow or gray center and a flat red border.
Rarely, canker sores can be very large (major aphthous ulcers) with a raised
border. There may be one or several ulcers and they often recur at varying
periods of time.
A canker sore usually begins as a red spot or bump. It may produce a tingling
or burning sensation before other symptoms appear. Canker sores are painful.
Fortunately, most canker sores heal spontaneously in 7 to 10 days.
The exact cause of canker sores is not known. Genetics play a role. White
cells (lymphocytes) in our immune system may affect the lining of the mouth
causing these irritating, but harmless sores. Even biting the inside of the
cheek or tongue or chewing a sharp piece of food may trigger a canker sore.
Canker sores are not contagious or precancerous. There is no permanent cure
for canker sores; therefore, treatment is for discomfort or pain.
Over-the-counter topical medications (such as numbing agents or protective
ointments) and antimicrobial (germ-fighting) mouth rinses may offer temporary
relief. Avoid hot, spicy, or acidic food and beverages that can irritate the
sore. Treatment for an attack involves corticosteroids, Prednisone-like
medications that control troublesome lymphocytes. The medication may be in a
topical form (applied to the skin), or systemic (taken as a tablet or
capsule).
Cold sores
Cold sores are groups of painful, fluid-filled blisters (often called fever
blisters). These unsightly sores usually erupt on the lips, and sometimes on
skin around the lips. Clusters of small blisters may also occur on the gum
tissue near the teeth and/or on the bony roof of the mouth.
Cold sores-caused by herpes virus Type 1 or Type 2-are contagious. The
initial infection (primary herpes), which often occurs before adulthood, may be
confused with a cold or the flu. The infection can cause painful lesions to
erupt throughout the mouth, and some patients can quite ill for a week. Most
people who get infected with herpes do not get sick, however. Once a person is
infected with herpes, the virus stays in the body, where it may remain inactive.
Unfortunately, in some people, the virus becomes activated periodically, causing
the cold sore to appear on the lips or other sites. A variety of irritants
(wind, sun, fever, stress) can cause a flare.
Cold sores usually heal in about a week. Once the blister breaks, an
unsightly scab forms. Over-the-counter topical anesthetics and protectants,
anti-inflammatory agents or topical antiviral agents may provide temporary
relief for the discomfort but do little to speed healing. As with the common
cold, there is no cure for these viral infections. Topical or systemic antiviral
drugs can be prescribed by your dentist, but they are ineffective after 3 or 4
days of blister formation and usually are not recommended in otherwise healthy
patients.
Leukoplakia
Leukoplakia (loo-koh-PLAY-kee-ah) is a white or gray patch
that develops anywhere on the inside of the mouth. It is caused by excess cell
growth of the lining of the mouth. It is often a response to chronic irritation,
such as smoking or smokeless tobacco (snuff, chewing tobacco), certain foods,
cheek biting, irregular dental restorations or broken teeth. In some instances,
a cause cannot be determined. Leukoplakia patches develop slowly over a period
of time. The patch may eventually become rough. It typically is not sensitive or
painful.
Leukoplakia generally is harmless, but there is a risk that it can become
cancerous. To be certain that a spot or sore is not a threat, your dentist may
do a biopsy to determine if any potentially dangerous cells are present. If the
leukoplakia is sensitive, cancer must be ruled out by biopsy.
Erythroplakia
Erythroplakia (e-ryth-ro-PLAY-ki-a) is a red patch that may
be found in any part of the mouth but is most common in the floor of the mouth
or on the gum tissue behind the back teeth. The cause is unknown but is most
likely associated with smoking or other tobacco use and alcoholic beverages.
Chronic irritation and poor nutrition may also be contributing factors. Although
erythroplakia is less common than leukoplakia, most of these lesions are found
to be precancerous or cancerous when biopsied. Red lesions that do not heal in a
week or two should be evaluated by your dentist. This applies even if you do not
smoke or drink alcohol.
Lichen Planus
Lichen planus (li-ken PLAY-nus) is a disorder that involves
a chronic, itchy, inflammatory rash or lesion on the skin or in the mouth. The
lesions may consist of white spots or “lacelike” white changes. Lesions on the
sides of the tongue, insides of the cheek and on the gums, may be tender or
painful. Its cause is genetic and related to chronic immune reaction.
Lichen planus generally occurs during or after middle age. Lichen planus is
not contagious and does not pose a high risk for becoming cancer. There is no
cure, so treatment is for discomfort or pain. Rinses, ointments, or pills can be
prescribed by your dentist, if needed. The diagnosis can be confirmed by biopsy
and clinical characteristics.
Candidiasis
Candidiasis (can-di-DI-a-sis), also known as oral thrush or moniliasis, is a
fungal infection. It produces creamy white and red patches that form on surfaces
of the mouth. It can be painful and may cause bad breath and difficulty tasting
or swallowing.
It occurs when the yeast Candida albicans reproduce in abnormally large
numbers. For example, Candida may flourish after antibiotic treatment, when
normal bacteria in the mouth have decreased, when the immune system is
suppressed or when the mouth is dry (xerostomia). Dry mouth is a common side
effect of many prescription or over-the-counter medications.
Candidiasis most often occurs in the very young, the elderly, and those
debilitated by disease, such as diabetes and AIDS. It also frequently occurs
among people who wear dentures.
Treatment consists of controlling conditions that cause the outbreak.
Cleaning dentures to remove Candida is important in preventing denture-induced
problems.
Saliva substitutes or prescription medications are also available to treat
dry mouth. Antifungal medications may be used when the underlying cause cannot
be treated or eliminated. Good oral hygiene is essential.
Oral Cancer
Oral of mouth cancer may appear on the lips, tongue, cheek lining, gums,
palate (roof of the mouth) or floor of the mouth. Cigarettes and other tobacco
products, including smokeless tobacco, are associated with 70 percent of oral
cancer cases. Drinking alcoholic beverages can also increase your chances of
having oral cancer.
Oral cancer may appear as a white or red lesion, lump or ulcer. It is usually
small and painless at first, but can grow and spread quickly. Many oral cancers
are discovered during routine dental examinations. Control of leukoplakia and
erythroplakia may prevent some oral cancers from developing. Some oral cancers
can resemble benign (non-dangerous) changes, so may delay early diagnosis. Early
diagnosis and treatment greatly increase the chances of survival and a good
quality of life.
