Aphtous ulcers-oral herpes

Canker Sores(aphtous ulcers)

What is a canker sore

A canker sore is a shallow sore shaped like a crater (ulcer) on your tongue or on the inside of your lip or cheek. Canker sores have a red border and a white or yellow center. They may be painful and can make it hard to talk and eat. You may have one or more than one canker sore at a time. Unlike cold sores, you cannot spread canker sores to other people.

Anyone can get a canker sore but women, teenagers, and young adults have them more often. People usually get their first canker sore between the ages of 10 and 40. Most people have canker sores at some time in their lives, and some people have them regularly.There are two types of canker sores:

Simple canker sores.

These may appear three or four times a year and last up to a week. They typically occur in people between 10 and 20 years of age.
Complex canker sores.

These are less common and occur more often in people who have previously had them.

What causes a canker sore?

The exact cause of most canker sores is unknown. Stress or tissue injury is thought to be the cause of simple canker sores. Certain foods – including citrus or acidic fruits and vegetables (such as lemons, oranges, pineapples, apples, figs, tomatoes, and strawberries) – can trigger a canker sore or make the problem worse. Sometimes a sharp tooth surface or dental appliance, such as braces or ill-fitting dentures, might also trigger canker sores.

Some cases of complex canker sores are caused by an underlying health condition, such as an impaired immune system; nutritional problems, such as vitamin B-12, zinc, folic acid, or iron deficiency; and gastrointestinal tract disease, such as Celiac disease and Crohn’s disease.. Canker sores may also develop when you:

Are stressed or tired.
Have your menstrual cycle, if you are a woman.
Hurt your mouth, such as biting your lip.
Have braces on your teeth.
Have food allergies. Eating foods that you are allergic to may cause you to get a canker sore.
Eat or drink food or juice that has a lot of acid, such as orange juice.
Do not get enough vitamins or minerals in your diet, such as iron.

What Are the Symptoms of Canker Sores?

You may have a canker sore if you have:

A painful sore or sores inside your mouth – on the tongue, soft palate (the back portion of the roof of your mouth), or inside your cheeks
A tingling or burning sensation prior to the appearance of the sores
Sores in your mouth that are round, white, or gray in color, with a red edge or border

In severe canker sore attacks, you may also experience:

Fever
Physical sluggishness
Swollen lymph nodes

How Are Canker Sores Treated?

Pain from a canker sore generally lessens in a few days and the sores usually heal without treatment in about a week or two.

If sores are large, painful, or persistent, your dentist may prescribe an antimicrobial mouth rinse, a corticosteroid ointment, or a prescription or nonprescription solution to reduce the pain and irritation.

Can Canker Sores Be Prevented?

Although there is no cure for canker sores and they often reoccur, you may be able to reduce their frequency by:

Avoiding foods that irritate your mouth – including acidic or spicy foods
Avoiding irritation from gum chewing
Brushing with a soft-bristled brush after meals and flossing daily, which will keep your mouth free of foods that might trigger a sore.

You should call your dentist about canker sores if you have:

Unusually large sores
Sores that are spreading
Sores that last 3 weeks or longer
Intolerable pain despite avoiding trigger foods and taking over-the-counter pain medication
Difficulty drinking enough fluids
A high fever with the appearance of the canker sore(s)

Canker sores may hurt for 7 to 10 days. Minor canker sores heal completely in 1 to 3 weeks, but major canker sores can take up to 6 weeks to heal. Some people get another canker sore after the first sore has healed. Most canker sores heal without a scar.

How is a canker sore diagnosed?

If you see your doctor or dentist about the pain caused by your canker sores, he or she will do a
physical exam by looking in your mouth to diagnose the canker sore.

How is it treated?

You do not need to see a doctor for most
canker sores. They will get better on their own. There are many things you can try at home to relieve the pain caused by your canker sores:

Eat soft, bland foods that are easy to swallow, such as yogurt or cream soup. Cut your food into small pieces or mash or puree it. Avoid coffee, chocolate, spicy or salty foods, citrus fruits or juices, nuts, seeds, and tomatoes.
Drink cold fluids, such as water or iced tea, or eat Popsicles. Sometimes fluid touching the canker sore can cause a stinging pain. Use a straw so the fluid doesn’t touch the canker sore. Hold ice on the canker sore until it is numb.
Rinse your mouth with salt water. To make a salt water rinse, dissolve 1 tsp (5 g) of salt in 1 cup (250 mL) of warm water.
Buy an over-the-counter medicine such as Orabase, Anbesol, or milk of magnesia to put on your canker sores. Use a cotton swab to apply the medicine. Put it on your sores 3 to 4 times a day.
Take a pain reliever, such as
nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve). Do not give aspirin to anyone younger than 20 because of the risk of
Reye syndrome.
If your canker sores do not feel better after trying these steps at home for 2 weeks, you may need to see your doctor or dentist. He or she may recommend medicines that will help the pain caused by your canker sores. Usually these medicines are swished or gargled in your mouth, or they are painted on the sore. Your doctor may prescribe
steroid cream (triamcinolone or fluocinonide) or paste (amlexanox) to rub on your canker sore and/or a prescription mouthwash to use.
Talk to your doctor if you have a fever, have trouble swallowing, or if your canker sores keep coming back. You may have another problem that is causing your symptoms.

How can canker sores be prevented?

Most of the time the cause of canker sores is unknown. Unless you know what causes your canker sores, you cannot prevent them from happening. If you do know what causes your canker sores, you can help prevent them by avoiding what you know causes them. For example, if you have gotten canker sores in the past from hurting the inside of your mouth, you might help prevent them by chewing your food slowly and carefully, trying not to talk and chew at the same time, and using a soft-bristled toothbrush when you brush your teeth.

If you have gotten canker sores in the past by eating foods that have a lot of acid (such as citrus fruits or tomatoes) and sharp or harsh foods (such as bread crusts, corn chips, or potato chips), it might help to avoid these. Other ways that might help to prevent canker sores include limiting your use of alcohol and tobacco and controlling the stress in your life.

In general, it is important to get enough vitamins and minerals in your diet, like folic acid, vitamin B12, zinc, and iron.

If your canker sores do not feel better after trying these steps at home for 2 weeks, you may need to see your doctor or dentist. He or she may recommend medicines that will help the pain caused by your canker sores. Usually these medicines are swished or gargled in your mouth, or they are painted on the sore. Your doctor may prescribe
steroid cream (triamcinolone or fluocinonide) or paste (amlexanox) to rub on your canker sore and/or a prescription mouthwash to use.

Talk to your doctor if you have a fever, have trouble swallowing, or if your canker sores keep coming back. You may have another problem that is causing your symptoms.

What are the differences between a cold sore(oral herpes) and a canker sore (aphtous ulcers)

CANKER SORES

Canker sores appear inside the mouth. They usually are small ulcers (minor aphthous ulcers) with a white, yellow or gray center and a flat red border. Rarely, canker sores can be very large (major aphthous ulcers) with a raised border. There may be one or several ulcers, and they often recur at varying periods.
A canker sore usually begins as a red spot or bump. It may produce a tingling or burning sensation before other symptoms appear. Canker sores are painful. Fortunately, most canker sores heal spontaneously in seven to 10 days. If the sore is present longer than two weeks, see your dentist.
The exact cause of canker sores is not known. Genetics plays a role. White blood cells (lymphocytes) in our immune system may affect the lining of the mouth, causing these irritating, but harmless, sores. Fatigue, emotional stress and certain foods can increase the possibility of a canker sore for some people. Even biting the inside of the cheek or tongue or chewing a sharp piece of food may trigger a canker sore.
Canker sores are not contagious or precancerous. There is no permanent cure for canker sores; therefore, treatment is for discomfort or pain.Over-the-counter topical medications (such as numbing agents or protective ointments) and antimicrobial (germ-fighting) mouth rinses may offer temporary relief. Avoid hot, spicy or acidic foods and beverages that can irritate the sore. Specific treatment for an attack involves corticosteroids (prednisone-like medications), in either topical or systemic (tablet or capsule) form, that control the troublesome lymphocytes.

COLD SORES

Cold sores are groups of painful, fluid-filled blisters (often called “fever blisters”). These unsightly sores usually erupt on the lips, and sometimes on skin around the lips. Clusters of small blisters also may occur on the gum tissue near the teeth and/or on the bony roof of the mouth.
Cold sores are caused by herpes virus Type 1 or Type 2 and are contagious. The initial infection (primary herpes), which often occurs before adulthood, may be confused with a cold or the flu. The infection can cause painful lesions to erupt throughout the mouth, and some patients can be quite ill for a week. Most people who become infected with herpes do not get sick.
Once a person is infected with herpes, the virus stays in the body, where it may remain inactive. Unfortunately, in some people, the virus becomes activated periodically, causing the cold sore to appear on the lips or other sites. A variety of irritants— wind, sun, fever, stress—can cause a flare.
Cold sores usually heal in about a week. Once the blister breaks, an unsightly scab forms. Over-the-counter topical anesthetics and protectants or anti-inflammatory agents or topical antiviral agents may provide temporary relief for the discomfort, but they do little to speed healing. As with the common cold, there is no cure for these viral infections. Topical or systemic antiviral drugs can be prescribed by your dentist, but they are ineffective after three to four days of blister formation and usually are not recommended in otherwise healthy patients.

Cold Sore (oral herpes)

Oral herpes is an infection caused by the
herpes simplex virus. The virus causes painful sores on your lips, gums, tongue, roof of your mouth, and inside your cheeks. It also can cause symptoms such as fever and muscle aches.

The herpes simplex virus affects only humans. Mouth sores most commonly occur in children aged 1-2 years, but they can affect people at any age and any time of the year.
People contract
herpes by touching infected saliva, mucous membranes, or skin. Because the virus is highly contagious, most people have been infected by at least 1 herpes subtype before adulthood.
After the herpes virus infects you, it has a rather unique ability to proceed to 3 stages.
- Primary infection: The virus enters your skin or mucous membrane and reproduces. During this stage, oral sores and other symptoms, such as fever, may develop.
  - The virus may not cause any sores and symptoms. You may not know that you have it. This is called asymptomatic infection.
  - Asymptomatic infection occurs twice as often as the disease with symptoms.
- Latency: From the infected site, the virus moves to a mass of nervous tissue in your spine called the dorsal root ganglion. There the virus reproduces again and becomes inactive.
- Recurrence: When you encounter certain stresses, emotional or physical, the virus may reactivate and cause new sores and symptoms.

Oral Herpes Causes

Herpes simplex is a DNA virus that causes sores in and around your mouth. Two herpes subtypes may cause these sores.

Herpes simplex virus, type 1 or herpes-1, which causes 80% of cases of oral herpes infections

Herpes simplex virus, type 2 or herpes-2, which causes the rest

Oral Herpes Symptoms

Incubation period: For oral herpes, the amount of time between contact with the virus and the appearance of symptoms, the incubation period, is 2-12 days. Most people average about 4 days.

Duration of illness: Signs and symptoms will last 2-3 weeks. Fever, tiredness, muscle aches, and irritability may occur.
- Pain, burning, tingling, or itching occurs at the infection site before the sores appear. Then clusters of
  blisters erupt. These blisters break down rapidly and, when seen, appear as tiny, shallow, gray ulcers on a red base. A few days later, they become crusted or scabbed and appear drier and more yellow
- Oral sores: The most intense pain caused by these sores occurs at the onset and make eating and drinking difficult.
  - The sores may occur on the lips, the gums, the front of the tongue, the inside of the cheeks, the throat, and the roof of the mouth.
  - They may also extend down the chin and neck.
  - The gums may become mildly swollen and red and may bleed.
  - Neck lymph nodes often swell and become painful.
  - In people in their teens and 20s, herpes may cause a painful throat with shallow ulcers and a grayish coating on the tonsils.

When to Seek Medical Care

When to call the doctor

Because the sores are painful, you may have difficulty eating or drinking. To prevent dehydration, call your doctor as soon as you cannot eat or drink.
Call your doctor immediately if any of these symptoms, which suggest dehydration, occur:
- A decrease in urination (fewer wet diapers in infants)
- Drowsiness
- Irritability
- Dry mouth
Call your doctor if you or your children are not sure what the sores are.
If your child is younger than 6 weeks, notify your doctor when sores appear. Severe infection or disease complications occur more commonly in infants. For instance, besides affecting the mouth, the herpes simplex virus may go to the brain and produce damage.
People whose immune systems are weakened should also call their doctor when sores appear. Your immune system protects you from infection or fights infection. If your system is weakened, you are more likely to have severe infection or disease complication.

When to go to the hospital

Signs and symptoms of dehydration may warrant going to a hospital’s emergency department.

Exams and Tests

A doctor will base a diagnosis on information you provide and on physical examination. The characteristic appearance of the herpes sores leaves little doubt. Further testing is usually not necessary.

If you require a definitive diagnosis, for instance, if your infection involves other organ systems, the doctor may conduct laboratory tests.

A sample from the sores to identify the virus

A culture analysis

A staining test called the Tzanck smear

Antigen and antibody studies

Blood sampling for antibody studies

Oral Herpes Treatment Self-Care at Home

Use acetaminophen (Feverall, Panadol, Tylenol) or ibuprofen (Excedrin, Ibuprin, Advil, Motrin) for fever and muscle aches.

Drink plenty of fluids to prevent dehydration.

Medical Treatment

Treatment includes medication for fever and taking plenty of fluids.

A topical anesthetic such as viscous lidocaine (Dilocaine, Nervocaine, Xylocaine, Zilactin-L) may be prescribed to relieve pain.
Oral or IV medication does exist for herpes but is not recommended for people with a normal immune system. It is used only for people with weakened immune systems, infants younger than 6 weeks, or people with severe disease.
Some people may require hospital admission.
- Those with severe local infection
- People whose infection has spread to other organ systems
- People with weakened immune systems
- Dehydrated individuals who need IV hydration
- Infants younger than 6 weeks

Next Steps Follow-up

Drink plenty of fluids.

Use pain medications as instructed by the doctor.

Use medications to control fever.

Watch for signs and symptoms of dehydration.

Prevention

Avoid touching saliva, skin, or mucous membranes that have sores.

Outlook

The sores and symptoms of oral herpes completely clear up in 2-3 weeks. But the sores may reappear under certain stressful situations.