Mouth sore (singaw) can affect individuals of any age group, from children to the elderly. It is a condition characterized by superficial or deep painful sores on the lips, inner cheeks, and tongue that can extend to the upper portions of the throat in some cases. Mouth sores can prevent one from properly chewing his food, can cause loss of appetite as having a lot of mouth sores can alter the taste of food and, if recurrent (paulit-ulit), can lead to malnutrition, especially in children. How a mouth sore develops is poorly understood, but one thing is sure: Mouth sores can be locally or systemically induced.
Local inducers include cheek biting, chronic mouth breathing (due to blockage of nasal passages), ill-fitting dentures, overuse of tobacco or alcohol, sensitivity to toothpastes, mouthwashes, food dyes or preservatives and spices, extremely hot food, sharp or allergenic foods, foods that are highly acidic, poor oral hygiene, and other infections such as the following:
Herpes virus
• Epstein Barr virus (that cause hand, foot, and mouth disease).
• Bacterial as in gingivitis (gums only) periodontosis (loss of tissue surrounding the teeth), syphilis and gonorrhea (both sexually transmitted disease).
• Fungal as in oral thrush (a fungal infection due to the fungus candida that occurs in 80% of individuals with HIV and AIDS.
Systemic inducers include drugs or toxic (deadly) agents (antibiotics, anti-convulsants, chemotherapy, radiation, lead, etc.), poor nutrition (as in iron deficiency, vitamin C deficiency, deficiency of B vitamins) and diseases as follows:
• Gastrointestinal problems that inhibit digestion and absorption of nutrients (inflammatory bowel disease).
• Weak immune system as in those with flu or colds, and those with cancer.
• Hormonal changes, stress, injury, and sunlight can induce herpetic sores.
• Autoimmune diseases (one’s own body produces substances that attack and harm the body’s own tissues) such as: blistering diseases (blisters all over the body with mouth sores), Behcet’s Syndrome (a disease that results from damage of blood vessels throughout the body, particularly the veins). Most symptoms of the disease are caused by inflammation (a reaction of the body to injury or disease) of these veins.
• Lupus erythematosus, a disease in which the human immune system becomes hyperactive and attacks normal healthy tissues. Symptoms of this disease can affect many different body organs, including the joints, skin, kidneys, blood cells, heart, and lungs.
• Hematologic as in cyclic neutropenia (abnormally low number of neutrophils, cells that normally make up 50 to 70% of circulating white blood cells that serve as a primary defense against infections by destroying bacteria in the blood). Here, neutropenia tends to occur every three weeks, lasting three to six days at a time due to changing rates of cell production by the bone marrow. Patients with neutropenia are more susceptible to bacterial infections and without prompt medical attention, the condition becomes life threatening and deadly.
• Squamous cell carcinoma of the mouth.
Different treatments
Treatment for mouth sores can be divided into five categories: antibiotics, anti-inflammatories, drugs that modulate (modify) the immune system, symptomatic and alternative treatments.
1. Tetracycline capsule 250 mg. — one capsule dissolved in 180 ml. of water, rinse with this suspension four times daily for 4 to 5 days.
2.Tetracycline syrup, 250 mg. per 5 ml. – 5 ml. “swish and spit” four times daily for 4 to 5 days.
3. Minocycline tablet, 100 mg. — one tablet dissolved in 180 ml. of water, rinse with the suspension twice daily for 4 to 5 days.
4. Triamcinolone 0.1% in orabase — apply direct to ulcer 2 to 4 times daily until healed.
5. Dexamethasone elixir 0.5 mg. per 5 ml. — swish and spit with 5 ml. every 12 hours.
6. Thalidomide — 200 mg. one to two times daily for 3 to 6 weeks (not for pregnant women).
7. Amlexanox 5% paste — apply direct to ulcer two to four times daily.
8. Viscous lidocaine, 2% apply to ulcer as needed.
9. Zinc lozenges — suck one lozenge four to six times daily.
10. Vitamin C, 500 mg. one tablet 4x daily.
11. Vitamin B Complex, one tablet, four times daily.
12. I-Lysine, 500 mg. — one tablet one to three times daily.
13. Magnesium hydroxide antacid and diphenhydramine hydrochloride (5 mg. per ml.) to be mixed half and half — swish and swallow 4 to 6 times daily.
14. Oral NSAID (non steroidal anti-inflammatory agents) or acetaminophen may provide some analgesia when ulcers are very painful.
15. Sage and chamomile mouthwash, created by infusing equal amounts of the two herbs in water, four to six times daily maybe helpful.
16. Carrot, celery, and cantaloupe juices are helpful complementary agents.
17. Echinacea is reported to speed healing probably through its immune-modulating properties.
Treatments discussed here need clearance from your doctor as these are not for everyone. Each specific treatment is indicated for a certain problem and may be contraindicated for others. Age is also an important factor in the above treatments.
Mouth sores are a poorly understood clinical problem that causes significant pain in an otherwise healthy individual. Meticulous oral hygiene, mild mouthwashes for comfort, treatment of the underlying cause (that is, stopping drugs, avoiding toxins, refitting of dentures, eliminating allergens), a bland, soft pureed or liquid diet can be done and, of course, avoiding alcohol and smoking is a great help.
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For questions or inquiries, call 09174976261, 09998834802 or 263-4094; email gc_beltran@yahoo.com.