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Mouth Sores? See Your Dentist

Candidiasis, Mouth Sores, Mouth Ulcers, Oral Cancer, Oral Herpes

“Every time I have a test, every time I prepare for a date, even when I was preparing for my driver’s test, I break out. Is there anything I can do to make it stop?” It is surprising how often this question comes up in dental offices. That’s OK. Your dentist is the right person to ask about mouth sores. Dentists know how to diagnose and treat the most common oral infections and conditions. When a condition is more unusual, dentists know the best specialists to care for their patients.

First, the dentist will need to figure out what is causing the sores. Common causes include viruses, medications, trauma, and in many cases, there is no known cause. It is important to know what triggers an out break – foods, medications, stress, temperature, and occasionally self induced. Please be patient with the dentist who takes this issue seriously. There may be a lot of questions such as, “How long ago did you notice this sore?”, “Did you feel this sore coming on before you could see it?”, “What did you eat and drink for the day or two before the sore appeared?”, and “Are you taking any new medications?”

The dentist will examine the head and neck looking for swollen lymph nodes which may indicate an infection. The appearance of the sores, and their location are particularly important. Often, the dentist will be able to make a diagnosis after the exam. Sometimes, a biopsy, removing a piece or all of the sore to examine it under a microscope is necessary to make or confirm the diagnosis.

So, what are the most common sores that people ask their dentists about? Pain is a good motivator. There is nothing more uncomfortable than a mouth ulcer. These sores are common. While these sores are very uncomfortable, they are not dangerous or even a sign of illness or infection. Dentists know them well and can readily identify them by a combination of their location in the mouth, their appearance, and the patient’s comments.

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Mouth ulcers, also known as canker sores, aphthous ulcers, or aphthae, range in size from very small to large. There may be single, few or many. The most common appearance is a small, round, red ulcer with a whitish rim. Patients may associate this kind of sore with certain foods, stress, and trauma (like biting the tongue). Sodium laurel sulphate (SLS) – a common ingredient in toothpaste – appears to cause eruptions of canker sores in some people. Aphthae may appear on the lining of the lips and cheeks, under the tongue, and on the sides of the tongue. Depending on the location, mouth ulcers heal in a week or two.

There are many treatments available to shorten the duration or relieve the pain of aphthae. Numbing gels such as Orajel or viscous lidocaine, relieve pain long enough to allow the patient to eat a meal or fall asleep. Barrier products like Orabase Sooth and Seal, and Canker Cover, protect the ulcer with a firm and/or sticky material. A dentist or physician may prescribe a steroid to apply to the ulcer; the steroid dulls the ache and speeds healing. Of course, many people prefer to take their usual pain killing medication such as ibuprofen and acetaminophen. One final recommendation is to use an SLS free toothpaste such as Biotene to both try to prevent future outbreaks, and because SLS free toothpaste is less uncomfortable on canker sores.

Oral herpes may appear similar to apthous ulcers. However, herpes usually appears in a slightly different locations. Commonly, herpes will break out on the lips outside the mouth and on the gum tissue adjacent to the teeth. Often, patients notice a tingling or uncomfortable feeling for a short time before herpes sores appear. Then, small blisters form. Aphthous ulcers do not have this blister phase. Herpetic lesions (sores) respond to the same treatments as aphthae. Additionally, dentists and physicians may prescribe effective antiviral medications which will shorten the duration of the herpes infection. It is very important to take antivirals during the prodromal or tingling phase for the maximum effect.

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Children often get infected by the herpes virus when they are very young. The effect is striking. Parents will first notice that the child is uncomfortable and unwell. Eating is difficult. A cursory view of the child’s mouth reveals fiery red gums and sores. These parents won’t know whether to see a dentist or a physician. Either doctor should know exactly what to recommend. This illness will pass in about a week. Acetaminophen or ibuprofen will reduce the fever and the discomfort. Stronger medication is not necessary. Offer mild drinks and soft foods.

Thrush is another oral condition that most often effects the very young, but also the elderly and people who have lower immunity. Also known as candidiasis and denture stomatitis, dentists are well prepared to diagnose and treat this malady. The overgrowth of yeast (Candida albicans) causes candidiasis. Many conditions allow yeast to grow – dry mouth (xerostomia), HIV infection, and the use of antibiotics are common causes.

The treatment of candidiasis begins by reducing the oral yeast population. There are a few classic anti-fungal medications available by prescription. They may include salves, gels, suspensions (liquid with a powder suspended in it that does not dissolve), and tablets. Denture wearers need to clean their prosthetics well with a denture brush, and soak them in a denture cleanser such as Efferdent. Candidiasis can be an intransigent infection that takes a long time and multiple medications for successful treatment. Patients whose candidiasis does not clear up after a month of treatment by their dentist should see their primary care physician to determine whether the oral candidiasis is due to an infection elsewhere in the body.

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Oral cancer takes about 8000 Americans per year. Dentists and physicians diagnose over 34,000 new cases of oral cancer each year. Ask your dentist to closely examine any sore, painful or not, that does not heal in two weeks. Expect a thorough oral cancer screening with every dental check-up.

People who are uncomfortable due to oral pain or the appearance of a mouth sore should see their dentist as soon as possible.