Published in "Panorama"
Aphthae, a palliative rather than curative condition
Aphthae, Canker sores or aphthous stomatitis, is one of the most common infections of the mouth, causing discomfort and annoyance to both patients and physicians, says Dr.Balachandran, Dermatologist, Al Rafa Poly Clinic, Dubai. Recurrent canker sores are one of the most common inflammatory conditions of the mouth, afflicting about 20 percent of the general population anywhere.
What is aphthae? Dr.Balachandran explains, “The condition manifests as small sores in the mouth, singly or in groups, of varying size. It occurs on the tongue, inside linings of the cheeks and lips and in some instances, on the gums also. Aphthae begin as small oval or round reddish swellings which usually rupture within a day, and are covered by a thin white or yellow membrane. Depending on their type, they may heal from one week to one month or more.”
“Clinically”, explains Dr. Antony Chalissery, ENT specialist, Al Rafa Poly Clinic “we can classify aphthous ulcers into three general categories, Minor, Major and Herpetiform aphthae.” Dr.Balachandran describes minor aphthae as “small ulcers which are between 1-2mm in size which can be extremely painful, with a tendency to occur in groups sometimes. In fact majority of young adults have this form of aphthae wherein the sores which are shallow, are covered by pseudomembrane, surrounded by a pinkish halo. They normally heal within two weeks. The major aphthae, is again seen in young adults though it can occur in anyone and its size varies from 0.5 – 1 cm. While most of its characteristics are similar to the minor aphthae, it is usually seen in singles, not in groups. Major aphthous ulcers are often seen in HIV and AIDS patients and the lesions in these cases are more severe, more painful and deeper seated. The major aphthae take longer to heal, even 4-6 weeks and they could leave scars in the affected areas.”
“Herpetiform aphthae are small, clustered lesions, which may occur on the mucous membrane of the oral cavity and resemble some viral lesions,” says Dr.Chalissery. “They occur as multiple recurrent crops of 10 or more small ulcers of different size, shallow in nature like aphthous minor. These ulcers may linger on for as long as a month but heal without leaving any scars. This form of aphthae normally appear for the first time in adults around the ages of 20 to thirty.” While oftentimes, the symptoms of the one and the other may overlap, the various forms of aphthae can occur at the same time in patients, say the doctors.
What Causes Canker Sores? According to the doctors, the exact cause of aphthae is yet not clearly known. However, a multitude of factors are believed to be involved in the condition, of which stress is deemed to be the predominant culprit. Factors precipitating aphthae include stress, nutritional deficiencies and type of diet maintained, trauma, hormonal changes, and immunologic disorders. Other contributory factors include allergies, heredity and psychological factors.
“Even some drugs, like the ones used in the treatment of epilepsy or neuralgic pain, can cause aphthae – this would be the drug-induced condition,” says Dr.Balachandran.
Dental factors, again are precipitative, says Dr.Marina N.Goveas, Dentist and Prosthodontist, Al Rafa Poly Clinic. “Mouth ulcers are a common result of trauma from ill fitting dentures, fractured teeth, or fillings and faulty brushing habits. In addition, deficiency of oral and dental hygiene can bring on the problem. However, ulcers which are a result of such trauma, heal fast if the causative factors are removed and also with the use of certain mouthwashes. Also Aphthae are seen in people with haematinic deficiency, that is when there is a deficiency of iron, folate, or vitamin B-12.”
Is it possible that people suffering from other disorders or systemic diseases, have aphthae as a symptom of their disease? Yes, very much so, opine Drs.Balachandran and Chalissery. Diseases cause by microbial organisms, skin and blood diseases, rheumatoid diseases, cancers and radiotherapy, can all bring on aphthae. Aphthous ulcers are seen in patients suffering from Behçet's disease, Crohn's disease, cyclic neutropenia, HIV/AIDS, ulcerative colitis, malabsorption syndromes and gluten-sensitive enteropathy.”
How does one then know if he’s suffering from simple aphthae or that there is an underlying problem behind the aphthae? Dr.Balachandran is reassuring, “Most of the times, each of these above conditions will have other identifying symptoms besides the aphthae. For instance, in Behçet's disease, the person will have genital ulcers or eye lesions as well.”
Who are the people susceptible to aphthae? “While the first bout of aphthae may begin when a child is 10 or 12 years old, there is no hard and fast rule as regards the age of a person being affected by the problem,” says Dr.Balachandram. “Kids as young as four or five years can get it since stress is very much a part and parcel of a kid’s life in modern times! By the same reasoning, professionals are more likely to have the disorder. In some cases, the problem may also be inherited. ”
Gender-wise, women are more susceptible to having recurrent aphthae than men, says Dr.Chalissery. “This is probably due to the female hormones. In fact, some women may have bouts of aphthae during certain times of their menstrual cycles. Also, some of them, with pregnancy, may see an improvement of the problem in terms of reduced frequency and severity or even experience a remission of the problem.”
How is diagnosis of aphthae made? Most often, as with other ailments, diagnosis begins with complete history taking and patient profile. Since there are not any specific test for aphthae, certain blood tests may be undertaken if indicated. The patient may be investigated for iron and vitamin B-12 deficiency. Further, allergy tests may be indicated to determine if the aphthae is on account of nutritional deficiency or other allergens. The doctors, however caution that patients with an ulcer of over three weeks' duration should be investigated further and if necessary, a biopsy may be in order to rule out malignancy or other serious conditions such as chronic infections.
If the aphthae is completely unrelated to any other systemic or other disorders, treatment involves stepping up nutritional standards involving intake of sufficient foods containing essential vitamins, minerals, et al. Where spicy, oily or other foods are found to precipitate the condition, these are best avoided. Anti-inflammatory analgesics, antibiotics and steroids remain the mainstay of treatment, according to the doctors. Antibiotic mouthwashes, in addition to preventing complications from bacterial infections in the sores, may reduce the unpleasant symptoms of aphthae and also quicken the healing process. The doctors caution that where patients with severe recurrent aphthae may be prescribed steroids or other immuno-suppressant drugs orally, they must be strictly supervised by the attending physician since these drugs can have potentially undesirable side effects. The specialists emphasize that the treatment of aphthous ulcers is palliative rather than curative in nature.
E N D
No comments:
Post a Comment