"Why do we get mouth sores? I get them on
my tongue and under as well as on the inside of my
mouth."
"I am 40, normal menstrual history. Meds I'm
on are Orthocept® for birth control, Celexa®,
an antidepressant, and Zyrtec® for allergies."
Carol
Mouth sores are sometimes called apthous ulcers or
apthous stomatitis when the cause is not known but
thought to be allergic or immune in origin. About
15-20% of the population complains of recurrent mouth
sores at various times (1).
I am glad you included your medications because many
times these sores are caused by prescribed or over-the-counter
medications. Of the medicines you list, none are known
for a high incidence of mouth ulcers except anti-depressants
which can have a drying effect on the mouth. All of
your mediciations have had a very small incidence
of this problem reported. The Zyrtec® can produce
a pharyngitis and both Zyrtec® and Celexa®
have about a 20% incidence of dry mouth. It is possible
that a lack of saliva makes you more susceptible to
the mouth sores from some other ingested food or drink.
The list of causes of mouth sores is quite long (2).
In general, however, you should look for direct contact
irritants or allergens, immune skin conditions and
infectious agents.
Contact irritants/allergens can include:
tooth paste
mouthwash
acidic foods like colas, juices, coffee
spicy foods, eg., cinnamon
tobacco
Therefore look at foods or beverages that you are
using on a daily basis and go through a trial period
of eliminating them either all at once and add them
back one at a time about every two weeks, or eliminate
one at a time for two weeks. If you have any suspected
food allergies such as wheat, eggs etc, be sure to
include them in the elimination process.
Immune skin conditions can manifest in the mouth
without being a problem elsewhere on the skin. A dermatologist
can sometimes help with this and even do a biopsy
to get a precise diagnosis (3). Some of those skin
conditions include:
lichen planus
pemphigus vulgaris
benign mucous membrane pemphigoid
discoid lupus erythematosus
erythema multiforme
The treatment may include systemic or topical steroids
but you need a firm diagnosis by a dermatologist.
If you tend to have skin problems otherwise, check
with a dermatologist about the oral sores. They can
also perform cultures for some infectious agents.
Infectious causes can include:
oral herpes simplex
cytomegalovirus
yeast
Behcets disease (often causes vulvar ulcers also)
periadenitis mucosa necrotica recurrens
Your dentist may be helpful with these (4). Be sure
to have your teeth cleaned as dental plaque can make
the recurrences more often. If you find that any toothpastes
or mouthwashes seem to make the recurrences worse,
discuss that with the dentist to get alternative brand
suggestions.
Finally, recurrent mouth sores can be a manifestation
of a systemic disease such as hepatitis, HIV, lupus
or other conditions that affect the immune system.
Ask your doctor to screen for any of these that might
be appropriate.
Burning Mouth Syndrome
Burning mouth syndrome is different from having mouth
ulcers that are sore. With burning mouth syndrome
there is a generalized burning pain that may include
the tongue, the roof of the mouth, the gums, the inside
of the cheeks and/or the back of the mouth or throat.
There are usually no visible ulcers or sores that
can be seen although ocassionally the tissues look
slightly reddened. Dry mouth and a bitter metallic
tase sometimes go along with this condition. The pain
is often not present in the morning but intensifies
throughout the day and into the evening.
It is more common in women after menopause and after
60 but it can occur at younger ages and in males also.
Often the cause is related to ingested substances
that are irritants or toxic to the nerves of the mouth
just as they may be for causing mouth ulcers. Sometimes
there are other causes but many times no one can find
a cause for it. Other terms used to describe this
condition syndrome include glossodynia (tongue pain)
and stomatodynia (mouth pain).
Other causes can be similar to those that cause ulcers
and may include:
dry mouth due to Sjogren's syndrome, anti-hypertensive
medications (especially ACE inhibitors) and anti-depressants
nutritional deficiencies such as iron, zinc, folate
and vitamins B-1, B-2, B-6, B-9 and B-12
irritating dentures, tooth pastes, chewing gums, mouth
washes, tongue brushing
food allergies
gastric reflux
medical conditions such as thrush infections, diabetes,
hypothyroidism
Since there are so many different causes for both
recurrent mouth ulcers and burning mouth syndrome,
it is important to individualize diagnosis and treatment
for each individual. Start with the simple and sequentially
eliminate various possibilities.
Look up the side effects of any medications you are
taking and if any are reported to cause mouth burning,
ask your doctor to consider a substitute medication.
Eliminate for 2 weeks regular tooth pastes, mouth
wash, chewing gums, tobacco and very acid liquids
(certain fruit juices, colas and coffee). Baking soda
toothpaste may be ok to use during this time.
If these above steps do not resolve the problem, see
your doctor or dentist to make sure you do not have
diabetes, Sjogren's syndrome, thrush (yeast infection
of the mouth), nighttime teeth grinding, denture irritation
or other conditions they can detect.
You may also want to consider testing for low thyroid
(TSH), mineral deficiencies (MineralCheck) and food
allergies (foodScan IgE).
Treatment is to eliminate the cause. If that cannot
be done, switching to basic baking soda based toothpaste
and mouth wash. You might also consider an anesthetic
mouth rinse (UlcerEase).
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