Common Mouth Sores

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Select Your Current Condition:

• • Canker Sores (Small Ulcers -White or Gray Base & Red Border)
  • Fever Blisters- Cold Sores (Herpes Simplex)
  • Intra-Oral White & Red Patches (Fungal Sores)
  • Intra Oral Thick Whitish-Color Patch
  • Oral Cancer

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Intro

Mouth sores can be painful, unsightly and can interfere with smiling and the pleasure of eating. Mouth sores or disorders have numerous causes.

Any mouth sore that persists for more then a week should be examined at our office. If all else is ruled out, Dr. Landers may offer a brush biopsy (tissue sample obtained with a miniature brush). This test is simple and painless. A brush biopsy can usually determine the cause or rule out cancer. Although there are numerous types of mouth sores and disorders, the most common are from oral trauma, irritations and oral flora. This emergency section will cover mouth sores from common Oral flora: Canker Sores, Cold Sores, Leukoplakia and Candidiasis. There is also a section which covers Oral Cancer.

It is important to note that mouth sores can have many origins. You may also elect to review any of the above links to other topics.

 

 
 
#1 Canker Sores (Small Ulcers w/ White or Gray Base & Red Border)

Canker sores (Aphthous Ulcers) are small ulcers with a white or gray base and red border. There can be one or a number of sores in the mouth. Canker sores are very common and often recur. Although the exact cause is uncertain, some experts believe that immune system problems or bacteria or viruses may be involved. They are not contagious.

Canker Sores (Aphthous Ulcers) Vs. Cold Sores (Herpes Simplex Virus)

Canker sores are often confused with cold sores (Herpes Simplex). An easy way to distinguish between the two is to remember that canker sores occur inside the mouth, and cold sores (Herpes Simplex) *usually occur outside the mouth.

Canker sores are usually larger verses the multiple tiny fluid-filled blisters which are common in Cold Sores (herpes simplex).

For Further clarification, Canker sores occur exclusively on unattached soft (cheek, floor of mouth, etc.) mucosa. If Cold Sores (Herpes Simplex) *occur inside the mouth they are usually found on attached gum tissues.

The Term Attached Vs Unattached Is Better Understood Through Self Evaluation.

Where is “Attached Gum Tissue?”

Touch your finger to your front tooth. Slide your finger up until you touch your gums. This gum tissue is named “Attached Tissue”. When gum tissues are healthy they are pink in color and firm to the touch (cover and attach to bone).

Where is “Unattached Oral Tissue?”

Now touch the inside of your upper lip. This slippery soft & movable tissue is called unattached tissue. It is not rigid because it is not covering bone. Hence it is given the name “Unattached tissue”.

Factors That Can Increase the Likelihood of a Canker Sore:

• Fatigue
• Stress
• Allergies
• People with intestinal problems, such as ulcerative colitis and Crohn’s disease (more susceptible)

Avoid

• Trigger foods: nuts, chocolate, acidic fruits
• Oral trauma: toothbrush trauma, cheek or tongue bite, etc.
• Reactions from hot foods or drinks
• Sodium Lauryl Sulfate: (A soap found in most toothpaste and mouth washes) Consider Biotene toothpaste.

Treatment – Management of Canker Sores?
Canker sores usually heal after a week or two, but recurrent outbreaks are common.

Rinsing With Antimicrobial Mouthrinse May Help Reduce The Irritation.

• Listerine
• (Rx) Mouth Rinses that contain: Chlorhexidine
• Sometimes, antibiotics and some oral bandages can reduce secondary infection

Keep the Irritation from Getting Worse

• Avoid Hot, Spicy Or Acidic Foods

Temporary Relief From “Over-the-Counter” Products Which Coat The Lesion Or Numb It Or Both

• Orabase B
• Zilactin B

If you are a patient of record Dr Landers may also prescribe something stronger.

 
 
#2 Fever Blisters/Cold Sores (Herpes Simplex)?

Cold sores, which are also called fever blisters or, are composed of groups of painful, fluid-filled blisters that often erupt around the lips and sometimes under the nose or around the chin. Cold sores are usually caused by herpes virus type I and are very contagious. The first infection (primary herpes), which often occurs before adulthood, may occur without symptoms or may be confused with a cold or flu. Painful lesions may be present throughout the mouth.

Once a person has a primary herpes infection, the virus stays in the body, occasionally causing recurrent attacks. For some people, however, the virus remains inactive. The recurrent herpes lesions are characterized by multiple tiny fluid-filled blisters (cold sores) that most commonly occur on the edge of the lips. Recurrent attacks may follow a fever, sunburn, skin abrasions or emotional upsets.

Canker Sores (Aphthous Ulcers) Vs. Cold Sores (Herpes Simplex Virus)

Canker sores are often confused with cold sores (Herpes Simplex). An easy way to distinguish between the two is to remember that canker sores occur inside the mouth, and cold sores (Herpes Simplex) *usually occur outside the mouth.

Canker sores are usually larger verses the multiple tiny fluid-filled blisters which are common in Cold Sores (herpes simplex).

For Further clarification, Canker sores occur exclusively on unattached soft (cheek, floor of mouth, etc.) mucosa. If Cold Sores (Herpes Simplex) *occur inside the mouth they are usually found
on attached gum tissues.

The Term Attached Vs Unattached Is Better Understood Through Self Evaluation.

Where is “Attached Gum Tissue?”
Touch your finger to your front tooth. Slide your finger up until you touch your gums. This gum tissue is named “Attached Tissue”. When gum tissues are healthy they are pink in color and firm to the touch (cover and attach to bone).

Where is “Unattached Oral Tissue?”
Now touch the inside of your upper lip. This slippery, soft & movable tissue is called unattached tissue. It is not rigid because it is not covering bone. Hence it is given the name “Unattached tissue”.

Cold Sore (Herpes Simplex) Management:
Oral herpes simplex is a viral disease. The blisters usually heal in about a 1-2 weeks. Over-the­-counter topical anesthetics can provide temporary relief. There are also prescription antiviral drugs available that may reduce these kinds of viral infections.

When the Sores are Inside the Mouth Treatment Steps include:

• Prescription from our office.
• Increase your Fluids and nutrition (liquid food supplements, if needed)

Note you may request and receive a prophylactic Rx to prevent breakout from common causes like; sun exposure, dental visit. Please call our office if you need a prescription (you must be a patient of record).

For severe cases/chronic cases long term treatment is available:
Acyclovir, 2 tablets 2 times a day for up to 3 years.
Re-evaluate need yearly by discontinuing drug and observing the patient for recurrence.

 
 
#3 Intra-Oral White & Red Patches (Fungal Sores)

Candidiasis (moniliasis, oral thrush) is a fungal infection that occurs when the yeast Candida albicans reproduce in abnormally large numbers. It is common among people who wear dentures and most often occurs in people who are very young, elderly, debilitated by disease, or who have an immune system that is not functioning properly. Diet may also play a role. People who have a dry mouth are very susceptible to Candidiasis. Candida may also flourish after antibiotic treatment when the normal bacteria in the mouth have decreased.

Candidiasis Is Characterized By:

• Creamy And Red Patches That Form On Moist Surfaces Of The Mouth
• Tissues Under The Patch Can Be Painful
• Swallowing Difficulties Possible
• Diminished Sense Of Taste Possible

How is Candidiasis treated?

Treatment consists of controlling the conditions that caused the outbreak.

• If antibiotics are the cause, reducing the dose or discontinued use.
• Saliva substitutes or prescription medications are available to add moisture to the mouth.
• In all situations good oral hygiene is essential.
• Consider Chlorhexidine Oral Rinse (Peridex or PerioGard) or Listerine as an adjunct for long term control in immunosuppressed patients.
• Antifungal medications may be used when the underlying cause is unavoidable or incurable.

Rx Fungal Sores

• The first drugs of choice for local topical treatment of oral fungal infection is: Mycelex Troche or Mycostatin Pastilles
• The drug of choice for topical treatment of fungal infections at the corner of your mouth (Angular Chelitis) is: Mycolog Cream
• The ingestable drugs of choice for systemic treatment of oral fungal infections are: Nizoral or Diflucan

Denture Related Candida

• Cleaning dentures to remove Candida
• Removing dentures at night allows the denture bearing tissues to have a chance to regenerate.
• For endentulous patients: prescribe myocostatin powder (15gm) to be sprinkled into cleaned denture.

 
 
#4 Intra Oral Thick, Whitish-Color Patch

Leukoplakia is an Intra Oral Thick, Whitish-Color Patch that forms on the cheeks, gums or tongue and is caused by excess cell growth. It is common among tobacco users and can also result from irritations such as ill-fitting dentures or a habit of chewing on one’s cheek. The danger of leukoplakia is that it can progress to cancer. Your dentist may want to take a biopsy if the leukoplakia appears to be threatening. Mouth sores that persist for a week or more should be examined by your dentist.

How is Leukoplakia Treated?
By examining the lesion and checking the results of the biopsy, Dr. Landers will determine how to manage your care. Treatment begins with removing the factors that contribute to the lesion. For some patients that means quitting tobacco use. For others, it means removing ill­ fitting dentures or bridges and replacing them with properly fitting ones. Your dentist will regularly examine the lesion at three to six month intervals depending upon its type, location and size.

If all else is ruled out, and the white patch remains for two or more weeks Dr. Landers will likely suggest a biopsy. In most situations at our office you will be offered a brush biopsy (tissue sample obtained with a miniature brush). This test is simple and painless. A brush biopsy can usually determine the cause, rule out cancer, and determine if a more invasive surgical biopsy is necessary.

 
 
#5 Oral Cancer

INCIDENCE AND SURVIVAL
Oral or pharyngeal cancer will be diagnosed in an es­timated 30,000 Americans this year, and will cause ap­proximately 8,000 deaths. On average, only half of those with the disease will survive more than five years.

THE IMPORTANCE OF EARLY DETECTION
(Early Detection Saves Lives)

During a dental examination at our office, Dr. Landers or a Periodontal therapist will routinely screen for precancerous changes in the oral tissues. It’s important, to detect cancer at an early stage, when it can be more successfully treated. When cancer is not found early, tumors may grow deep into local tissues and can spread to other parts of the body. This spreading reduces the chances for successful treatment.

With early detection and timely treatment, deaths from oral cancer could be dramatically reduced.

The five-year survival rate for those with localized disease at diagnosis is 76 percent compared with only 19 percent for those in which cancer has spread to other parts of the body.

Early detection of oral cancer is often possible. Tis­sue changes in the mouth that might signal the begin­nings of cancer often can be seen and felt easily.

Possible Signs/Symptoms Of Oral Cancer

White Or Red Lesions That Might Signal Oral Cancer
Two lesions that could be precursors to cancer are leukoplakia (white lesions) and erythroplakia (red le­sions). Although less common than leukoplakia (white), erythroplakia (red) and lesions with erythroplakic (red) compo­nents have a much greater potential for becoming can­cerous. Any white or red lesion that does not resolve it­self in two weeks should be reevaluated and considered for biopsy to obtain a definitive diagnosis.

List of Possible Signs/Symptoms Of Oral Cancer

• Color changes such as the development of red and/or white lesions
• A persistent sore or irritation that bleeds easily and does not heal
• A lump, thickening, rough spot, crust, or small eroded area
• Pain, tenderness or numbness anywhere in the mouth or lip
• Soreness Or A Feeling That Something Is Caught In The Throat
• Hoarseness
• Difficulty Chewing, Swallowing or Speaking
• Ear Pain
• Difficulty Moving The Jaw Or Tongue
• Swelling Of The Jaw That Causes Dentures To Fit Poorly Or Become Uncomfortable
• A change in the way your teeth fit together when you close your mouth completely

If all else is ruled out, and the white patch remains for two or more weeks, Dr. Landers will likely suggest a biopsy. In most situations, at our office you will be offered a brush biopsy (tissue sample obtained with a miniature brush). This test is simple and painless. A brush biopsy can usually determine the cause, rule out cancer, and determine if a more invasive surgical biopsy is necessary.

RISK FACTORS

• Tobacco/Alcohol Use – Tobacco or excessive alcohol use increase the risk of oral cancer. Using both tobacco and alcohol poses a much greater risk than using either substance alone.
• Sunlight – Exposure to sunlight is a risk factor for lip cancer
• Age – Oral cancer is typically a disease of older people usu­ally because of their longer exposure to risk factors. In­cidence of oral cancer rises steadily with age, reaching a peak in persons aged 65-74. For African Americans, inci­dence peaks about 10 years earlier.
• Gender – Oral cancer strikes men twice as often as it does women.
• Race – Oral cancer occurs more frequently in African Americans than in Caucasians.

Prevention
You may be able to protect yourself from oral cancer by modifying your diet. Studies suggest that a diet high in fruits and vegetables may prevent the development of precancerous lesions.

Reducing your risk of oral cancer becomes more important with age because oral cancer is more likely to strike older adults. In fact, about 95 percent of all oral cancers occur in people older than 40.

Become active in maintaining your own oral health:

• As part of your oral hygiene routine, watch for changes in your soft oral tissues
• Eliminate cancer-causing habits­ especially tobacco and excessive alcohol use
• Visit your dentist regularly