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There are many processes which can lead to ulceration of the oral tissues. In some cases they are caused by an overreaction by the body's own immune system. Factors that appear to provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies and deficiencies in vitamin B12, iron and folic acid. Some drugs, such as nicorandil, have also been linked with oral ulcers. Some recreational drugs cause mouth ulcers.
Trauma
Minor physical injuries
Trauma to the mouth is a common cause of oral ulcers. A sharp edge of a tooth, accidental biting (this can be particularly common with sharp canine teeth), sharp food, poorly fitting dentures, dental braces or trauma from a tooth brush may injure the mucosal lining of the mouth resulting in an ulcer. These ulcers usually heal rapidly if the source of the injury is removed (for example, if poorly fitting dentures are removed or replaced).
Chemical injuries
Chemicals such as Aspirin or alcohol that are held or that come in contact with the oral mucosa may cause tissues to become necrotic and slough off creating an ulcerated surface. Sodium Lauryl Sulfate (SLS), one of the main ingredients in most toothpastes, has been implicated in increased incidence of oral ulcers.
Infection
Viral, fungal and bacterial processes can lead to oral ulceration.
Viral
The most common is Herpes simplex virus which causes recurrent herpetiform ulcerations preceded by usually painful multiple vesicles which burst. Herpes Zoster (shingles), Varicella Zoster (chicken pox), Coxsackie A virus and its associated subtype presentations, are some of the other viral processes that can lead to oral ulceration. HIV creates immunodeficiencies which allow opportunistic infections or neoplasms to proliferate.
Bacterial
Bacterial processes leading to ulceration can be caused by 'Mycobacterium tuberculosis' (tuberculosis) and Treponema pallidum (syphilis).
Opportunistic activity by combinations of otherwise normal bacterial fauna, such as aerobic streptococci, Neisseria, Actinomyces, spirochetes, and Bacteroides species can prolong the ulcerative process.
Fungal
Coccidioides immitis (valley fever), Cryptococcus neoformans (cryptococcosis), Blastomyces dermatitidis ("North American Blastomycosis") are some of the fungal processes causing oral ulceration.
Immune system
Many researchers view the causes of aphthous ulcers as a common end product of many different disease processes, each of which is mediated by the immune system.
Aphthous ulcers are thought to form when the body becomes aware of and attacks chemicals which it does not recognize. The presence of the unrecognized molecules garners a reaction by the lymphocytes, which trigger a reaction that causes the damage of an oral ulcer.
Immunodeficiency
Repeat episodes of mouth ulcers can be indicative of an immunodeficiency, signaling low levels of immunoglobulin in the oral mucous membranes. Chemotherapy and HIV are both causes of immunodeficiency with which oral ulcers become a common manifestation.
Autoimmunity
Autoimmunity is also a cause of oral ulceration. Mucous membrane pemphigoid, an autoimmune reaction to the epithelial basement membrane, causes desquamation/ulceration of the oral mucosa.
Allergy
Contact with allergens can lead to ulcerations of the mucosa.
Dietary
Vitamin C deficiencies may lead to scurvy which impairs wound healing, which can contribute to ulcer formation. Similarly deficiencies in vitamin B12, iron, zinc and folic acid have been linked to oral ulceration. Too much ascorbic acid (Vitamin C) or citric acid may cause ulcers. In this case the sores disappear after intake decreases (for example, by substituting ascorbate salts for ascorbic acid).
A common cause of ulcers is Coeliac disease, in which case consumption of wheat, rye, or barley can result in chronic oral ulcers. If gluten intolerance is the cause, prevention means taking most breads, pastas, cakes, pies, cookies, scones, biscuits, beers etc. out of the diet and substituting gluten-free varieties where available. Artificial sugars, such as those found in diet cola and sugarless gum, have been reported as causes of oral ulcers as well.
Cancer
Oral cancers can lead to ulceration as the center of the lesion loses blood supply and necroses. Squamous cell carcinoma is just one of these.
Medical conditions associated with mouth ulcers
The following medical conditions are associated with mouth ulcers:
* Behc,et's disease
* bullous pemphigoid
* coeliac disease (gluten sensitivity)
* Crohn's disease
* gingivostomatitis
* leukoplakia
* oral lichen planus
* Lupus erythematosus
* oral thrush
* ulcerative colitis
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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