Page 5 - Journal of Laser Dentistry 1

sleep, sudden weight loss, food allergies, immune system reactions and deficiencies in vitamin B

12 , iron, and folic acid may contribute to their development. Nicorandil and certain types of chemotherapy are also linked to aphthous ulcers. One recent study showed a strong correlation with allergies to cow's milk. Aphthous ulcers are a major manifestation of Behçet disease, and are also common in people with Crohn's disease.

Trauma to the mouth is the most common trigger. Physical trauma, such as that caused by toothbrush abrasions, laceration with sharp or abrasive foods (such as toast, potato chips or other objects), accidental biting (particularly common with sharp canine teeth), after losing teeth, or dental braces can cause aphthous ulcers by breaking the mucous membrane. Other factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. Using a toothpaste without sodium lauryl sulfate (SLS) may reduce the frequency of aphthous ulcers but some studies have found no connection between SLS in toothpaste and aphthous ulcers. Celiac disease has been suggested as a cause of aphthous ulcers; small studies of patients (33% or 1 out of 3) with Celiac disease did demonstrate a conclusive link between the disease and aphthous ulcers vs control group (23%) but some patients benefited from eliminating gluten from their diet.

There is no indication that aphthous ulcers are related to menstruation, pregnancy and menopause. Smokers appear to be affected less often.

Prevention

Oral and dental measures

Regular use of non-alcoholic mouthwash may help prevent or reduce the frequency of sores. In fact, informal studies suggest that mouthwash may help to temporarily relieve pain.

In some cases, switching toothpastes can prevent aphthous ulcers from occurring with research looking at the role of sodium dodecyl

sulfate (sometimes called sodium lauryl sulfate, or with the acronymes SDS or SLS), a detergent found in most toothpastes. Using toothpaste free of this compound has been found in several studies to help reduce the amount, size and recurrence of ulcers.

Dental braces are a common physical trauma that can lead to aphthous ulcers and the dental bracket can be covered with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but since such trauma is usually accidental, this type of prevention is not usually practical.

Nutritional therapy

Zinc deficiency has been reported in people with recurrent aphthous ulcers. The few small studies looking into the role of zinc supplementation have mostly reported positive results particularly for those people with deficiency, although some research has found no therapeutic effect.

Treatment

A number of different treatments exist for apthous ulcers including: analgesics, anesthetics agents, antiseptics, anti-inflammatory agents, steroids, sucralfate, tetracycline suspension, and silver nitrate.

Amlexanox paste has been found to speed healing and improve pain.

Vitamin B

12 has been found to be effective in treating recurrent aphthous ulcers, regardless of whether there is a vitamin deficiency present.

Suggestions to reduce the pain caused by an ulcer include: avoiding spicy food, rinsing with salt water or over-the-counter mouthwashes, proper oral hygiene and non-prescription local anesthetics. Active ingredients in the latter generally include benzocaine, benzydamine or choline salicylate.

Anesthetic mouthwashes containing benzydamine hydrochloride have not been shown to reduce the number of new ulcers or