Mouth Ulcers

This section on mouth ulcers covers Herpes, Cold Sores, Canker Sores or Apthous Ulcers, and Thrush (Candidiasis).

 
Viral infections can affect the mouth?

• Herpes Simplex
  • This causes Oral Herpes, which affects from 50-60% of HIV patients.
  • It is a chronic infection, with widespread painful ulcers.
  • The ulcers are white with red borders.
  • Medications may allow it to disappear for a time, but it will re-appear.
  • It is spread by intimate physical contact.
  • Infants can acquire it from their mothers during pregnancy or birth.
  • In people with immune deficiencies it is particularly severe, and prolonged treatment may be needed.

Herpes

Herpes

• Cold Sores, found on the lip, are also caused by a herpes virus.

Cold sore

• Measles may appear in the mouth as little white spots with a red border.
• Chicken Pox blisters are also found in the mouth.
• Ulcers occurring during glandular fever (Infectious Mononucleosus) may resemble herpes ulcers.

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How are viral infections treated?

• There is no cure for a viral infection, and so the symptoms need to be treated.
  • This is done by using mouth-rinses, and applying topical anaesthetics and protective ointments to the ulcers.
  • In most cases the viral infection lasts for 10-14 days.

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Fungal infections can affect the mouth?

• Thrush, also called candidiasis, is the most common fungal mouth infection.
  It appears as a white patch, which can easily be stripped off to leave a red, bloody area.

Thrush

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How is thrush (candidiasis) treated

• It is treated with an antibiotic and a mild antiseptic mouthrinse will usually be prescribed.
• Tooth brushes should be discarded after each use to prevent re-infection.

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Canker Sore or Aphthous Ulcer

• This is a painful ulcer that can vary in size and appears singly or in groups.
  • The exact cause is unknown, but stress and viruses probably play a role.
  • These rounded, painful, shallow ulcers recur at intervals of a few days to a few months
  • The ulcers are less than 5 mm. in diameter.
  • They have a grey/white centre, with a red, inflamed border.
  • The lips, cheeks and the floor of the mouth are affected.
  • The healing period is about 10-14 days.

Canker sore

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How are Cankers treated

• In most instances these conditions get better spontaneously in 10-14 days.
  • Protective ointments and pain relievers are applied directly to the ulcers. They are usually the only pain relief that is needed.
  • Occasionally the doctor may prescribe steroids.
  • Chlorohexidine mouthwashes can have a beneficial effect.

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B. Blister lesions of the mouth

1. What are blister-type lesions?
2. What is the difference between a vesicle and a bulla?
3. What kinds of blisters are most commonly found in the mouth?

 
Blister-type lesions

• These are blisters or vesicles of varying size, found on the inner surfaces of the cheeks.
  They sometimes rupture (pop) leaving raw, open wounds

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1. What is the difference between a vesicle and bulla?

• Vesicles are small, only a few millimeters in size.
  Bullae can be considerably larger.
  Both are blisters.

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2. What kinds of blisters are most commonly found in the mouth?

• Pemphigus is a chronic skin disease, which also appears in the mouth.
  • It is related to immune system problems, and appears in middle age.
  • It requires specialist treatment using steroid medication.
• Pemphigoid is not associated with skin problems.
  • It can also affect the eyes
  • This is a common inflammatory lesion. The erosive or ulcerated form can be pre-cancerous.
  • It needs treatment with steroids, by a specialist.

Pemphigus

Pemphigus

Pemphigoid

• Lichen Planus
  • This condition affects adult women more commonly than men.
  • It is mostly seen on the inner surface of the cheek in a lacy pattern of white raised areas.
  • The erosive or ulcerated form of this condition is rare, but can be pre-cancerous.<!–Occasionally the lesions become eroded or ulcerated.–>
  • It is usually a benign condition and is not the same as leukoplakia.

Lichen planus

• Erythema Multiforme
  • This appears on the skin as well as in the mouth.
  • It is related to certain drugs and immune system problems, and is most commonly found in young men.
  • The symptoms need to be treated by a specialist, but the cause is often difficult to find.

Erythema multiforme

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