Oral Ulcers-Those Painful Days

Have u ever suffered from the oral ulcer? However, being a dentist I do. Oral ulcers are one of the commonest lesions occurring in the oral cavity. It is common for all the age group and gender. Predisposing factors are emotional stress, trauma, hormonal imbalance, infection nutritional deficiency, drugs and any systemic disorder.

Stress is considered to be the most common factor formation of oral ulcers. Stress in any form like exam, professional, and personal. Brushing tooth, impingement of tooth adjacent to mucosa and during any sharp object chewing can result in traumatic ulcers. Other factors like hormonal change during puberty, vitamin deficiencies, iron deficiencies and system factors like gastrointestinal disturbances may induce ulcers.

History taking always has a significant role in diagnosing ulcers. Most of the oral ulcers are preceded by prodromal symptoms.

Based on prodromal symptoms

•  Stress related = burning sensation at the site of ulcer
•  Traumatic = history of trauma
•  Viral = history of fever, chills, malaise
•  Iron/vitamin deficiency= features of anemia like angular cheilitis (bleeding at the corner of mouth), painful or burning tongue, inflamed tongue
•  Other system disorders= proper history could rule out

 Age as factor for diagnosis of oral ulcers

·         Children = Herpetic gingivostomatitis

·         Adults = stress related

·         Old age = systemic diseases/drugs

Based on duration for diagnosing ulcer

•  Acute = stress, trauma, infectious
•  Chronic = nutritional, systemic, trauma

Oral ulcers can occur in any part of the oral cavity such as tongue, palate, gingival, buccal mucosa and uvula. Usually the ulcers are surrounded by red border. Patients usually have altered speech if it is many in numbers. Stress related ulcers may vary from 1 or more than 1 in number at different sites. Size may be small in healthy patients to a very large size especially in immunocompromised patients. Few patients may have recurrent form of ulcers. Stress ulcers will be regular, round to ovoid in shape. Trauma associated ulcers may have the shape of the substance that induced trauma. If it is induced by a tooth, the mucosa may have the shape of cusp. Other factors causing ulcers could be single or multiple in number.

Ulcers induced by trauma can be diagnosed by clinical approach. These ulcers are single, and history will be suggestive of trauma. Certain ulcers will be recurrent, history of stress, burning sensation at the site before occurrence of ulcer, round, yellowish in color and particularly no fever and of short duration are diagnostic criteria. Diagnostic challenge appears if the ulcer has other etiologies like nutritional and systemic factors. Certain investigations like complete blood examination to assess levels of red blood cells, white blood cells, platelets, differential count, erythrocyte sedimentation rate and several other test according to the provisional diagnosis.

Several plethora of treatment is available for managing ulcers. First and foremost in the management of oral ulcer is relieving the symptoms followed by elimination of the causative agent. Several brand of anesthetics (benzocaine, lignocaine) available in the market to the subside pain due to ulcers. Antiseptics (chlorhexidine, metronidazole) to subside infection and secondary infection in the ulcer. Severe ulcers may need topical steroids (triamcinolone) or systemic steroids (prednisolone). These topical medicines can be applied two to three times a day or can be increased based on the severity. If any tooth impingement causing ulcer removal of tooth or trimming the sharp cusp of the tooth is considered. Improper tooth brushing induced ulcer needs proper counseling for technique and symptomatic treatment.

Other factors like nutritional deficiency need nutritional support (iron, vitamin) and topical anesthetic. Infectious and system disorder related ulcer needs proper diagnosis and eliminate the potential cause may benefit the patient. Drug induced ulcer needs symptomatic treatment and physician consultation for withdrawal of drug or change of drug.