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Afte della Bocca

What are

Mouth ulcers are lesions of the oral mucosa, characterized by roundish abrasions or ulcers with a diameter of 2-5 mm, although they can sometimes reach dimensions greater than one centimeter.

Slightly deep and surrounded by a reddish halo, oral sores can be single or present in groups. Normally they recover in 7-15 days, but tend to recur again after a long time.

When the mouth ulcers affect exclusively the oral mucosae and reappear at regular intervals, as happens in the vast majority of cases, we speak of recurrent aphthous stomatitis .

Incidence

Aphthosis is a very common affection, so much that it affects, during some period of life, from 20 to 60% of the population. Rare in infancy, canker sores can appear as early as adolescence and reach peak incidence between 20 and 50 years, with a similar prevalence in both sexes (slightly higher in women).

Causes

The causes of mouth ulcers are not yet completely known, although in this regard various hypotheses have been advanced, probably dependent on each other (psychosomatic, allergic, autoimmune, hormonal, infectious, genetic and dietetic).

In some cases, mouth ulcers can be the simple consequence of local traumas, such as bites during chewing or erosions caused by too strong use of the toothbrush.

According to the dietary hypothesis, on the other hand, the onset of mouth ulcers in predisposed subjects would be facilitated by a diet too rich in alcohol, spicy foods, animal fats, nuts, mustard, cheese and chocolate.

Also the lack of some minerals, such as zinc and especially iron, is significantly associated with the presence of oral mucous membranes (26.3% in the presence of iron deficiency anemia).

Similarly, the origin of mouth ulcers has been associated with vitamin deficiencies and, in particular, the lack of vitamin B12 (lacking in vegans) and folic acid or vitamin B9 (lacking when not enough fresh vegetables are consumed).

Finally, in some cases, mouth ulcers can be triggered by underlying diseases not yet identified and diagnosed.

Symptoms

The onset of a fever is often heralded by a burning sensation that occurs one or two days before in the area where the lesion will be formed, even if the appearance of the mucosa still appears normal.

After this first phase, in the affected area there is the appearance of a localized reddening which, later, will evolve into a roundish yellowish-white lesion.

The mouth sores thus formed have the characteristic of being painful both spontaneously and on contact.

Another peculiarity of this type of injury is the absence of bleeding.

Associated pathologies

As mentioned, sometimes mouth ulcers can be caused by other diseases not yet identified.

In fact, mouth ulcers tend to occur frequently in immunosuppressed individuals and in patients suffering from serious diseases, such as AIDS or some types of neoplastic diseases (tumors), but not only.

In fact, in addition to the mucous membranes of the oral cavity (lips, cheeks, tongue and sublingual region), mouth ulcers can also extend to the semi-mucous membranes and the genital mucous membranes (foreskin, glans, small and labia majora). This condition, associated with ocular alterations (iritis) and sometimes with lesions of other organs, is typical of large aphthosis or Behçet's syndrome, of which an autoimmune origin was also proposed.

Hence the importance of not underestimating this disorder, since it could represent the sign of a possible basic pathology, sometimes even very serious.

Treatment

To learn more, read: Medications for the treatment of aphthae in the mouth »

Since the causes that lead to the origin of mouth ulcers have not yet been completely clarified, there is no single treatment that can cure them.

Naturally, in the case in which the afte constitute the sign and / or the symptom of other basic pathologies, it is fundamental to identify them, in such a way as to be able to carry out an early diagnosis and in such a way as to intervene promptly with the most appropriate therapy.

In the case in which, instead, the etiology of canes is not known, it is possible to intervene with different approaches.

Precisely in this regard, it is first of all important to dispel the myth that the use of alcohol and acidic or spicy foods would be useful to disinfect mouth ulcers and accelerate healing.

In fact, these decidedly questionable practices have no scientific basis and the only effect it can produce is an exacerbation of pain, already in itself accentuated by food intake.

For example, propolis is a very useful natural remedy thanks to its antiseptic power, provided you avoid taking it in the form of hydroalcoholic dye. The alcohol contained in it, in fact, would do nothing but worsen the pain typically triggered by these injuries.

However, there is still no particularly effective treatment to combat mouth ulcers. However, the intake of foods, supplements and medicines able to increase physical and, above all, immune efficiency (vitamins, probiotics, minerals) may be useful.

Similarly, the use of psychophysical relaxation practices to reduce stress has also proved to be useful.

As for the possible pharmacological therapy, instead, the use of gels or mouthwashes based on anti-inflammatory drugs, or based on antiseptic substances such as, for example, chlorhexidine, may be useful.

The topical use of local anesthetics such as lidocaine, on the other hand, can be very useful in obtaining relief from the pain that characterizes mouth ulcers.

The topical use of corticosteroids, to be taken in the form of mouthwashes or massage pastes, has shown a certain usefulness in reducing the severity and duration of ulcerations, but has no effect on the frequency of aphosal episodes. However, it should be remembered that the use of this type of medication in the treatment of mouth ulcers must be carried out in moderation and only under the supervision of the doctor.

The use of topical antibiotics, on the other hand, is mainly reserved for the treatment of particularly large canes, but even in this case, such treatment should be carried out only if the doctor prescribes it.

Rinses with mouthwashes containing antibiotics, on the other hand, can be performed to prevent bacterial infections and complications secondary to ulcerative lesions.

In the presence of particularly painful mouth ulcers, the use of pain medication can give relief to the patient.

Finally, in more serious cases the approach with systemic therapies based on immunosuppressants and immunomodulators can be attempted. However, the use of these drugs in the treatment of mouth ulcers is very rarely and in any case only and exclusively under the strict supervision of the doctor.

Useful tips

To facilitate the healing of mouth ulcers and to get relief from the pain they cause, it may be useful to follow some simple tips.

First of all, to avoid further accentuating painful sensations, it may be useful to avoid the intake of spicy, acidic and / or very salty foods, animal fats and dried fruit.

Instead, it is advisable to take foods rich in vitamins (in particular, B12, C, D and folic acid) and foods rich in iron, zinc and probiotics.

In this regard, therefore, the importance of adopting a healthy and balanced diet is clear.

Furthermore, to facilitate spontaneous resolution of mouth ulcers it is useful:

  • Maintain a correct and accurate oral hygiene.
  • Use brushes with soft bristles for cleaning teeth.
  • Stop the smoking habit.
  • Eliminate the consumption of alcohol and spirits.