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an article by
Valentina Tkachenko
(visitor contribution)
Mouth Sores
Lichen Planus is a chronic condition which affects the skin and oral mucosa as lesions, papules, rashes, or sores. There is no known cause or responsible pathogen, but it is not contagious. Stress may be a likely culprit, as well as allergic reactions and complications of hepatitis C. Women suffer from the condition more commonly than men, and it occurs most often in middle aged adults. Oral lesions can manifest as white lacy streaks or as small papules on the mucosa. The streaks can also be found on the gums, tongue, palate, and lips. A bulbous form presents as liquid-filled vesicles which project from the skin. An erosive form is red and sore, and often occurs


in many localities of the mouth – this form is also most likely to be malignant and should be biopsied to rule out more serious problems. There is no cure, but inflammation can be controlled and even be forced into a dormant state, however subsequent flare-ups are not uncommon. Oral and topical steroids, retinoids, dapsone, and aloe vera can be used to contain the condition.

Herpes Simplex Virus (HSV) is organized into two types: HSV-1 and HSV-2. HSV-1 causes sores commonly referred to as cold sores or fever blisters whereas HSV-2 generally causes sores below the waist. HSV-1 can be spread through kissing or sharing objects such as tooth brushes or utensils. An outbreak can be brought about by general illness, fatigue, stress, or immunosuppression due to AIDS, chemotherapy, or steroids. There is no cure for herpes, but treatment is available to relieve the symptoms and prevent future outbreaks. The sores are often painful, especially after breaking.

Pemphigus Vulgaris is a potentially fatal autoimmune skin disorder, pemphigus vulgaris causes sores in the mouth which may spread to other regions of the head and body. The blisters are raw, draining, oozing, crusting, and often peeling or easily detached.  Pemphigus vulgaris patients are often given the same treatment as burn victims, aimed at reducing symptoms and preventing complications. The most severe cases are kept in the intensive care unit and are fed though an IV to minimize discomfort in the mouth. Antibiotics, antifungals, and topical anesthetics are used to fight infection and ease pain respectively. All unexplained sores or blisters should be examined by a doctor or dentist if they are in the mouth, especially when accompanied by fever, chills, muscle aches, or general ill feeling.

Aphthous Ulcerations is more commonly known as canker sores or simply mouth ulcers, aphthous ulcerations are small and shallow ulcerations which make eating and speaking uncomfortable. Canker sores usually occur in adolescents three or four times a year and can last up to a week. Stress or certain foods (most notably citrus and acidic foods) can trigger the sores or make them worse. Protrusions in the mouth such as sharp teeth or ill-fitting dentures or braces can also serve as triggers, as can nutritional problems or more serious medical conditions such as Celiac and Crohn’s disease. Aphthous ulcers are round, white or gray in color, with a red periphery. The sores usually heal on their own, although antimicrobial rinses may help speed the process.

Erythema Multiforme is without a known formal cause, erythema multiforme is a common skin condition which can present as a mild rash and range to a potentially fatal form called erythema multiforme major which involves mucous membranes. Thankfully the mild form is much more common and appears as itchy pink spots starting at the extremities and resolves within a week to ten days. HSV has been linked to the condition, as have allergies to certain medications and food preservatives. Erythema Multiforme is usually self-limiting and does not require treatment.

Geographic Tongue is a harmless, though often mildly irritating, condition which is characterized by missing papillae (taste buds) on patches of the tongue which come to resemble a cartographic pattern. The condition is usually asymptomatic and does not require any treatment to resolve itself, but often subsequently recurs in a different area of the tongue. There is no known cause for the condition and it does not pose any known health risks.

Oral Fibroma and Mucocele are benign tumors made of connective tissue which can grow on any organ. Oral fibromas can present anywhere in the mouth, but are most common on the gums, in particular at the joining of upper and lower teeth. Fibromas present as well defined bulbous masses of a uniform pink color which are generally unrestricted in movement and can be from 1mm to 2cm in diameter. Although they are generally harmless, oral fibromas are often removed for the comfort and convenience of the patient in a simple outpatient procedure. In cases of patients at high risk for oral cancer, such as heavy drinkers or regular smokers, the dentist will often biopsy the removed mass in order to test for cancer.

A mucocele is a painless sac of mucous liquid, often bluish or clear in color, which most often presents on the inside of the lower lip or near oral piercings, although it can form anywhere in the mouth. Mucocele often vanish on their own but can last several years – if they do not resolve themselves an oral surgeon or dentist can easily remove the sac if it causes the patient discomfort. The only proposed cause for these mucous cysts is sucking the lower lip or cheek between teeth, and this habit should be avoided to prevent mucocele from forming.

Sialolithiasis is the formation of salivary stones made of excess calcium, similar in nature to kidney stones, in the salivary glands. Most commonly they are found in the submandibular gland located under the floor of the mouth and are most common in people over 40. Sialolithiasis causes a salivary duct to become blocked, which in turn causes the salivary gland to swell and grow painful, in particular during meals when saliva is being produced but cannot exit into the mouth. The symptoms are usually quite clear, but confirmation can be obtained via an x-ray, CT scan, or sialendoscopy in which an endoscope is inserted into the salivary duct to see if a stone can be found and possibly retrieved with a special tool.

Treatments include gentle probing with a blunt instrument designed to manipulate the stone out, a therapeutic sialendoscopy described above, a small operation which makes an incision near the stone so that it can be extracted, or shock wave treatments aimed at breaking up the stone using ultrasound waves. The most common procedure is now the therapeutic sialendoscopy which generally ends the problem for the patient. If the issue recurs, an operation to remove the troublesome salivary gland is proposed to the patient. Overall saliva production usually does not decrease as the other five glands increase production to compensate for the loss. There is no known way to prevent salivary stones, but drinking plenty of fluids is recommended, in particular for those in hot or dry climates as well as those who engage in frequent physical exertion.

Squamous Cell Carcinoma is a type of skin cancer which affects epithelium tissues, which line the cavities and surfaces of the body, and comprise many glands. SCC in particular can manifest in various organs including the skin, lips, mouth, esophagus, urinary bladder, prostrate, lungs, vagina, and cervix. When the carcinoma (tumor) is confined to the original site it is dubbed in situ (also known as Bowen’s disease), as opposed to an invasive carcinoma which spreads to surrounding tissue. During its early stages SCC often presents as an ulcer or reddish plaque which slowly aggrandizes and sometimes bleeds, especially when on the lip or mouth. The lesion usually has hard, raised edges and is often opalescent. Risk factors for oral SCC include smoking and excessive consumption of alcohol as well as exposure to HPV (human papilloma virus).

Treatment is similar to that of most other cancers, comprising of surgery, radiation, and chemotherapy. Interestingly, the cancers caused by HPV seem more amenable to treatment than those in HPV-negative patients. Diagnosis is made based on a deep biopsy of the mass in order to assure that the center is tested and not merely the tissue which covers the carcinoma. Males are twice as likely to get SCC as women, and the peak age is 66. Caucasians are more likely to suffer from the disease, in particular those with especially pale skin. Areas normally exposed to the sun are at a particular risk, such as the lips, pinna (tip of the nose), and back of the neck. A patient who suspects SCC should make an appointment with his or her doctor as soon as possible to arrange a biopsy and prevent further damage if the result is positive.

Nicotinic Stomatitis, Denture Stomatitis develops as a direct result of tobacco use, in particular of smoking pipes or the practice of reverse smoking, consisting of placing the lit end of a cigarette in the mouth. The stomatitis is a lesion of the palatal mucosa which is usually asymptomatic or a minor annoyance to sufferers, many of whom are not aware of their condition. The lesion is a speckled white and red color which presents on the hard palate between the rugae and soft palate. NS usually begins as a reddened area around the minor salivary glands on the palate and gradually progresses to a white, thickened, fissured mass which resembles grayish-white cobblestones with a red dot in their center due to keratinization (the formation of horny tissue such as a callus via dehydration and damage) of the tissue surrounding salivary ducts.

Denture stomatitis is also known as thrush, and is caused by a fungus called Candida which causes an oral infection. Denture wearers are particularly at risk for the condition, as are those who do not exercise proper oral hygiene. Diabetics and steroid users (both via inhalation and in tablet form) are also at risk for thrush, along with patients using certain antibiotics. The affected area looks very red and sores are sometimes visible at the corners of the mouth. Smoking and wearing dentures for prolonged periods, especially overnight, are the most common direct causes of denture stomatitis. Doctors and dentists recommend improving oral hygiene, proper care for dentures including thorough cleaning and keeping them out of the mouth as much as possible until the infection goes away. Medication is also available, mostly in the form of tablets and lozenges which must be slowly dissolved in the mouth.

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