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Canker Sores (Aphthous Mouth Ulcers)

Millions of people suffer from recurrent painful canker sores or mouth ulcers called aphthous stomatitis. Although many causes are known, there are few effective treatments.

A blister forms in the mouth and the top is quickly sloughed off, leaving a punched out whitish circular area that hurts to touch, particularly when food is in the mouth. Among the causes are infections including herpes, cytomegalovirus, yeast, and other viruses that have not even been characterized. They can also be caused by an autoimmune reaction in which a person's own immunity causes the blisters to form, and they have been reported to be caused by an allergy to chemicals in toothpastes and mouth washes. No studies have isolated bacteria or viruses often enough to blame them. However, some studies show a rise in a person's immunity against herpes and cytomegalovirus when the person suffers from these aphthous ulcers. When you have an outbreak, your doctor may order blood tests that are usually normal, antibody titre to herpes which are repeated two weeks later, and test for chronic infections like hepatitis C and HIV. On rare occasions mouth ulcers can be a sign of Crohn's Disease (intestinal ulcers), certain cancers such as leukemia or lymphomas, or other immune defects.

The Food and Drug Administration approved an oral paste called amlexanox (Aphthasol) to reduce swelling. The most effective treatment is for a doctor to inject a small amount of a type of cortisone called triamcinolone, into each ulcer. It will get rid of the ulcers rather quickly, but it will not prevent them from recurring (1). Various journal articles have reported successful treatment with prednisone to supress immunity (2): pentoxifylline, a drug to increase blood flow to the mouth (3): thalidomide to reduce blood flow to the area (4,5); acyclovir to kill herpes; or colchicine, a gout medication (6).

1) Triamcinolone acetonide 40mg/cc in 5 cc vial; dilute to 10 mg/cc and inject into ulcer.

2) MLB Deasis, LJ Bernstein, J Schliozberg. Treatment of resistant oral aphthous ulcers in children with acquired immunodeficiency syndrome. (with prednisone) Journal of Pediatrics 127: 4 (OCT 1995): 663-665.

3) Jeffrey M. Jacobson of Mt. Sinai School of Medicine in New York (pentoxifylline).

4) SC Ball, KA 1) Sepkowitz, JL Jacobs. Thalidomide for treatment of oral aphthous ulcers in patients with human immunodeficiency virus: Case report and review. American Journal of Gastroenterology 92: 1 (JAN 1997): 169-170.

5) JM Bonnetblanc, C Royer, C Bedane. Thalidomide and recurrent aphthous stomatitis: A follow-up study. Dermatology 193: 4 (1996): 321-323.

6) J Katz, P Langevitz, J Shemer, S Barak, A Livneh. Prevention of recurrent aphthous stomatitis with colchicine: An open trial. Journal of the American Academy of Dermatology. 1994 (Sept); 31(3 Part1): 459-461.

7) A Livneh, N Zaks, J Katz, P Langevitz, J Shemer, M Pras. Increased prevalence of joint manifestations in patients with recurrent aphthous stomatitis (RAS). Clinical and Experimental Rheumatology 14:4 (JUL-AUG 1996): 407-412.

June 3rd, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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