Hello Motzart,
I must first advise you that we are unable to diagnose your problem
online. The possibilities posted in my answer are just that ?
possibilities, and not a diagnosis. This answer is not intended to
diagnose or treat your health problems, and is meant for informational
purposes only. I?d suggest seeing another doctor and discussing your
entire medical history, including medicines, supplements, vitamins and
any other medical problems you may have. The doctor should look at the
?Big Picture? when diagnosing you.
With that said, have you had blood tests for herpes, syphilis, CMV,
HIV, Celiac disease, Lupus and other auto-immune diseases? Do you take
steroids or cortisone of any kind? If so, they, as can other
medications, aggravate your oral mucosa. Do you have poor-fitting
dentures, or jagged spots on your teeth? Do you smoke?
?We first must distinguish between a mouth ulcer (canker sore) and a
fever blister (cold sore).Ulcers are typically found inside the mouth
and are not contagious, while Fever blisters are found outside,
typically on the lips, and are very contagious.
Fever blisters are caused by the herpes virus, and are most
effectively treated by acyclovir, denovir or penciclovir.?
http://www.21stcenturydental.com/smith/education/ulcers.htm
Mouth sores can interfere with smiling, eating, and look unsightly.
They can be caused by:
Ill fitting dentures
Braces
Sharp edge of a broken tooth
Bacteria
Fungal or viral infection
Disease
Symptom of a disease and/or disorder
This page also discusses Lichen planus.
http://www.dentalgentlecare.com/mouth_sores.htm#caused
?People with SJS will show extensive ulcers in the eyes, mouth,
nose, genitalia, and skin, usually two to four weeks after the herpes
outbreak. The skin lesions are called "targets" because of the annular
(ring) configuration. When these lesions coalesce, or merge, such
extensive erosion occurs that affected individuals often must be
admitted to a hospital burn unit.
Because of the potential exposure to the aforementioned drugs and
their possible higher incidence of recurrent mucosal herpes, people
with LE certainly would be more susceptible to SJS than the normal
population.
Treatments: There is no effective treatment of SJS. The use of high
doses of systemic corticosteroids in SJS could be associated with
higher mortality due to infections. In some cases, individuals with
SJS develop permanent and often debilitating scarring of the eyes.?
http://www.lupus.org/education/topics/oral.html#stevens
?Erythema multiforme is an unusual allergic reaction which results
in red rashes, blisters and ulcers of the mouth membranes and the
skin, either together or separately. Some cases are very severe and
may be fatal, but most persons have a much more mild, self-limiting
form of the disease. Recurring examples do occur, especially when
recurring herpes virus infection (fever blisters on the lip) is the
triggering event. Erythema multiforme has an abrupt onset and
typically resolves without scarring in 2-6 weeks. Systemic or topical
corticosteroids are usually effective.?
?Usually a dermal problem, erythema multiforme also often affects the
mucous membranes of the mouth, eyes, nasal/paranasal sinuses, and
genitalia. Major forms of the disease have an average annual incidence
rate of 0.5/100,000 persons. Toxic epidermal necrolysis is much more
rare, occurring only once in every 1,000,000 persons each year.?
?Erythema multiforme is usually self-limiting and runs its course in
2-6 weeks, but one in five patients will experience recurrent
episodes, usually in the spring and autumn. Management includes the
use of systemic corticosteroids, topical corticosteroids for less
severe and more localized lesions. These two therapies may be more
effective when used in combination. Topical anesthetic agents may be
needed to reduce the pain, especially during mealtimes, and
intravenous rehydration may be necessary because of the pain of eating
and drinking fluids.
Usually there is healing without scar formation and without
recurrence. Recurrent cases, when they occur, typically have a
recurrence every 1-6 months, or may only manifest on additional
contact with the initiating factor, such as recurrent herpes labialis
or new drug contact. For those with recurring disease the continuous
use of oral acyclovir or another antiviral medication may help to
control the Herpes simplex outbreaks, thereby preventing the onset of
additional episodes of erythema multiforme.
Patients with toxic epidermal necrolysis have a one in three chance of
dying of their disease, while the Stevens-Johnson syndrome carries a
2-10% mortality rate. Normally, however, erythema multiforme is not a
life-threatening disease.?
http://www.maxillofacialcenter.com/BondBook/mucosa/em.html
Aphthous Ulcers/Canker sores
============================
?I say this because when I was involved in my oral
medicine-training program at the University of Pennsylvania in the
early 70's, we were heavily involved in both epidemiologic and basic
science investigations of aphthous ulcers. I firmly believe that the
disease is an auto-immune phenomenon; that the predisposition to the
condition is genetically conferred; that all sorts of factors can
elicit their occurrence including trauma, chemicals, hormonal cycles,
stress, smoking, etc.; that many treatments have been proposed for
aphthous ulcers and many work, from vegetable milkshakes, to rinses
with chlortetracycline, to topically applied steroids. Why some work
in some individuals, and others don't goes unanswered. I'm sure it is
related to the etiology. What I have found is that you must be
prepared to try a multitude of treatment modalities in some aphthous
sufferers. Even then, sometimes, nothing works."
Keep in mind that the final common pathway of mucosal damage is the
ulceration, which is often nonspecific in nature, giving us little
clue to its exact etiology. Someday the specific treatment may be
found.?
?The treatment of aphthous ulcers is palliative in nature. Oral rinses
containing local anesthetic agents, e.g., diphenhydramine (Benadryl),
promethazine (Phenergan), dyclonine (Dyclone) or lidocaine (Xylocaine)
combined with coating agents, e.g., Kaopectate, Milk of Magnesia,
Maalox or sucralfate (Carafate) are useful for mild, widespread or
inaccessible lesions. Chlorhexidine-containing rinses (Peridex) are
also reported to be efficacious, as is tetracycline suspension.
Topical corticosteroids are the primary therapeutic agents used to
treat aphthous ulcers. Fluocinonide (Lidex) or other intermediate
strength topical corticosteroids can be applied to individual lesions
and covered with an occlusive dressing (Zilactin-B).
Super-potent topical corticosteroids, e.g., clobetasol (Temovate) and
halobetasol (Ultravate), are useful to treat major aphthae, although
systemic corticosteroids are often required, e.g., prednisone, in
combination with intralesional steroid injections, to achieve healing.
Colchicine, dapsone, and pentoxifylline (Trental) have all been
reported as effective; however, confirmatory double-blind studies are
currently lacking. Severe episodes of aphthae also respond to
azathioprine (Imuran), thalidomide, and cyclosporine (Sandimmune).The
prognosis of aphthous ulcers is good to excellent; however, there is
no permanent cure. Once an individuals have had one episode of
aphthous ulcers, they are more likely to have a second episode?
There is a great deal of information on this page, but copyright
restrictions prohibit me from posting more here. Please read the page
for further information.
http://www.21stcenturydental.com/smith/education/ulcers.htm
?The precise mechanism by which canker sores form has not been
definitively determined but it is likely that their development is
related to a reaction of an individual's own immune system.
Canker sores are thought to form when, for unexplained reasons, a
person's immune system identifies the presence of chemical molecules
that it does not recognize. The presence of these molecules activates
an attack by the immune system's lymphocytes (a type of white blood
cell), somewhat similar as when a person's immune system attacks a
transplanted organ. The carnage created by the lymphocytes' attack on
these unrecognized molecules results in the formation of mouth ulcers.
We term these ulcers canker sores.?
http://www.animated-teeth.com/canker_sores/t1_canker_sores.htm
Triggers for canker sores:
--------------------------
Toothpastes and mouthwashes that contain sodium lauryl sulfate.
Mechanical trauma.
Emotional stress / Psychic stress.
Nutritional deficiencies.
Allergies and sensitivities.
Hormonal changes.
Genetics
Infectious agents (both bacterial and viral).
Medical conditions.
Medications.
http://www.animated-teeth.com/canker_sores/t1_canker_sores.htm
?Aphthous ulcers can be classified into three different types: minor,
major and herpetiform.1,2 Minor aphthae are generally located on
labial or buccal mucosa, the soft palate and the floor of the mouth.
They can be singular or multiple, and tend to be small (less than 1 cm
in diameter) and shallow3 (Figure 1). Major aphthae are larger and
involve deeper ulceration. Major aphthae may also be more likely to
scar with healing2 (Figure 2). Herpetiform aphthae frequently are more
numerous and vesicular in morphology. Patients with benign aphthous
ulcers should have no other findings such as fever, adenopathy,
gastrointestinal symptoms or other skin or mucous-membrane symptoms.?
http://www.aafp.org/afp/20000701/149.html
?In the medical literature, oral apthae often are referred to as
recurrent apthous stomatitis. These sores, or lesions, affect up to 15
percent of the normal population.
Conditions associated with a higher frequency of oral apthae are:
?systemic lupus erythematosus (SLE)
?inflammatory bowel disease (IBD)
?acquired immune deficiency syndrome (AIDS) and other causes of
immunodeficiency states
?Behcet's Disease. Behcet's is a rare disease characterized by oral,
genital, and skin ulcers as well as eye inflammation and systemic
vasculitis.?
http://www.lupus.org/education/topics/oral.html#stevens
Intraoral herpes simplex lesions
==================================
?Recurrent herpes simplex infections seldom occur intraorally. When
they do, they usually involve mucosa attached to bone, such as gingiva
or hard palate (Figures 11 and 12). Rarely do they involve mobile
mucosa. In recurrent intraoral herpes simplex infections, the vesicles
persist for just a short time, rupture, leaving a painful, superficial
ulcer. Many times these ulcers will coalesce. The major differential
diagnosis for recurrent intraoral herpes is aphthous stomatitis.
Though both conditions may have similar durations and triggering
factors, they occur at different sites. As indicated previously
recurrent intraoral herpes occurs on mucosa attached to bone while
aphthous ulcers (Figure 13) occur on unattached or mobile mucosa. The
diagnosis is usually made on clinical history and findings. Rarely are
viral cultures, cytologic smears or biopsies utilized.?
http://dentistry.ouhsc.edu/intranet-Web/ContEd/OPCE/RHSI.html
HERPETIC GINGIVOSTOMATITIS (PHG ) ?Around 90% of the U.S. population
is affected with this disease. Ninety-nine percent of affected
individuals undergo a sub clinical infection which generally does not
have any clinical manifestations. The sub clinical infection in
children may be confused with eruption gingivitis. One percent of
affected individuals develop the full-blown disease. PHG occurs mostly
in children from age six months to puberty.?
http://www.dent.ucla.edu/ftp/pic/visitors/herpes/page1.html
?Another location for secondary herpes simplex lesions is intra oral.
Intraorally these lesions are seen to occur on mucosa that is attached
to underlying periosteum (this mucosa is keratinized) Example: palatal
mucosa and attached gingiva.
Lesions begin as painful vesicles, which break down and become ulcers.
Ulcers coalesce to form a single ulcer with irregular border.Both, the
intra oral herpes lesions and the herpes lesion on the lips heal in 1
to 2 weeks. Herpes labials lesion heals by formation of a brown crust,
but there is no residual scar.?
http://www.monroecc.edu/wusers/sviswanathan/case.htm
?Intraoral Herpes (Figure 1-9). Intraoral herpes forms on extremely
firm oral tissue surfaces, such as the palate (roof of the mouth) and
attached gingiva. Vesicles are not usually identified because they
break down almost immediately into ulcers and coalesce to form
multiple jagged ulcerations.?
?Complications. The lesions may persist and be very serious in
patients with a compromised immune system. While the virus may
regress, it does not disappear. The lesions caused by the virus do
disappear, however. Also, it is important for dental specialists to
recognize that this may be a very serious infection when it occurs in
immuno-compromised patients (AIDS, renal transplant, cancer
chemotherapy, and so forth).?
http://www.free-ed.net/sweethaven/MedTech/Dental/OralPath/lessonmain.asp?iNum=fra0145
Oral candidiasis
================
?Candidiasis often know as oral thrush is a fungal infection that
occurs when they yeast Candida albicans reproduce in large numbers. It
can also be called angularchelitis. It results in red and cream or
while colored, slightly raised patches on the mucous membrane of the
tongue, mouth and throat that form on the mouth's moist surfaces. The
mucous membrane beneath the patches is usually raw and bleeding. The
overgrowth of this fungus results when the balance in the normal oral
microbe population is disturbed by antibiotic therapy or disease.
Tissues under the patch can be painful It can cause difficult in
swallowing and diminish the sense of taste. It occurs most frequently
in infants, in adults suffering from chronic illnesses, in the
debilitated, in the immunosuppressed.?
http://www.dentalgentlecare.com/mouth_sores.htm#Candidiasis
?Oral thrush is an infection of yeast fungus, Candida albicans, in the
mucous membranes of the mouth. Strictly speaking, thrush is only a
temporary candida infection in the oral cavity of babies. However, we
have for this purpose expanded the term to include candida infections
occurring in the mouth and throat of adults, also known as candidosis
or moniliasis.?
?These changes can occur as a side effect of taking antibiotics or
drug treatment such as chemotherapy. These changes can also be caused
by certain conditions such as diabetes, drug abuse, malnutrition, and
as a consequence of immune deficiencies relating to old age or
infection, such as AIDS.
Furthermore, people whose dentures don't fit well can sustain breaks
in the mucous membranes in their mouth, which can act as a gateway for
candida. People who suffer from this problem often have moist, pale
pink spots on their lips, known as angular cheilitis, which is an
indication of a candida infection.?
http://www.netdoctor.co.uk/diseases/facts/oralthrush.htm
Human papillomavirus
====================
?Human papillomavirus ? Oral warts can occur anywhere in the mouth,
including the tongue. The causative agent is the human papillomavirus
(HPV). These growths generally are not painful and can be ignored
unless they interfere with appearance or function. It is estimated
that 40 million Americans are infected with one or more of the 80
strains of HPV. HPV has been implicated in some oral cancers and is
contagious. ?
http://www.dentalgentlecare.com/mouth_sores.htm#Candidiasis
?Oral warts are caused by a virus -- papillomavirus, to be exact.
Viruses are little more than protein-coated, renegade bits of DNA
capable of commandeering a cell, forcing it to create more viruses.
Viruses are biological chain letters. The envelope is the protein coat
that protects the letter. The letter (viral DNA) contains instructions
that tell the cell how to produce more envelopes with letters
(viruses).?
?You also need to know that the papillomavirus can be transmitted by
close contact, and (like the herpes virus) the papillomavirus can
cause a sexually transmitted disease. Oral warts can cause genital
warts and vice versa, through oral-genital contact. Oral warts can
also be transmitted by oral-oral contact (kissing, for example). You
should give serious consideration to having the warts removed to
protect people with whom you are in close contact.?
http://health.ivillage.com/dental/dmouthsores/0,,5p24,00.html
Behcet's Syndrome (Oral ulcers)
-------------------------------
?Behcet's syndrome http://www.melungeonhealth.org/behcet.html .
Although rare, it presents with oral ulcers - a summary follows:
Sores in the Mouth are painful canker sores that can overlap and take
days or weeks to heal. Look for white or yellow centers, with a red
edge. They are especially painful on the tongue, but can be found
anywhere inside the mouth. Gum lesions are not very common, but do
occur. If they predominate, then consider another diagnosis. These
sort of ulcers are quite common amongst perfectly healthy people and
they have to be linked with some other symptoms to be part of Behcet's
Syndrome. Thalidamide may be given for this condition. IDF 10/05?
http://www.dentalgentlecare.com/mouth_sores.htm#Candidiasis
?In the United States, it affects more women than men. Behçet's
disease tends to develop in people in their 20's or 30's, but people
of all ages can develop this disease. Behçet's disease is an
autoimmune disease that results from damage to blood vessels
throughout the body, particularly veins. In an autoimmune disease, the
immune system attacks and harms the bodies' own tissues.?
Mouth
?Painful sores in the mouth called ?aphthous ulcers? (known as oral
aphthosis [af-THO-sis] and aphthous stomatitis) affect almost all
patients with Behçet's disease. Individual sores or ulcers are usually
identical to canker sores, which are common in many people. These
sores are usually a result of minor trauma. They are often the first
symptom that a person notices and may occur long before any other
symptoms appear. However, the lesions are more numerous, more
frequent, and often larger and more painful. Aphthous ulcers can be
found on the lips, tongue, and inside of the cheek. Aphthous ulcers
may occur singly or in clusters, but occur in virtually all patients
with Behcet?s. The sores usually have a red border and several may
appear at the same time. They may be painful and can make eating
difficult. Mouth sores go away in 10 to 14 days but often come back.
Small sores usually heal without scarring, but larger sores may scar.?
http://www.behcets.com/site/pp.asp?c=bhJIJSOCJrH&b=262321
Bullous SLE
============
?This is a serious (fortunately, rare) disease in which individuals
have antibodies against their own mouth and skin. These autoantibodies
react against type VII collagen, a molecule found in the basement
membrane zone. The basement membrane zone is an area where the outer
layer of the skin (epidermis) and mouth (epithelium) are separated
from the inner layer of skin (dermis) and mouth (submucosae).?
?Half of these individuals have extensive superficial erosions
affecting the mouth, esophagus, larynx, trachea, genitalia, and eyes?
Do you have sores elsewhere on your body?
http://www.lupus.org/education/topics/oral.html#stevens
ANUG (Formerly called Trenchmouth)
===================================
This literature review article examines the increase in incidence of
Acute Necrotizing Ulcerative Gingitivitis (ANUG) as a result of the
increasing incidence of severe immunodeficiency states such as
Acquired Immunodeficiency Syndrome (AIDS) in the presence of poor
nutrition. This review provides an understanding of the etiology,
pathophysiology, and management of ANUG with malnutrition.The
Epidemiology, Etiology, and Pathophysiology of Acute Necrotizing?
http://www.dentalgentlecare.com/mouth_sores.htm#Candidiasis
?Trench mouth is a painful form of gingivitis (gum inflammation). The
term "trench mouth" comes from World War I, when the disorder was
common among soldiers.
The mouth normally contains a balance of different microorganisms.
Trench mouth occurs when there is an overabundance of normal mouth
bacteria resulting in infection of the gums, which develop painful
ulcers. Viruses may be involved in allowing the bacteria to overgrow.
Risks include the following:
? Poor oral hygiene
? Poor nutrition
? Throat, tooth or mouth infections
? Smoking
? Emotional stress
This disorder is rare. When it does occur, trench mouth most often
affects adults younger than 35.
http://health.allrefer.com/health/trench-mouth-info.html
?? Signs and symptoms
A. Mnemonic: "3 B's"
1. Bad breath (Fetor Oris from tissue necrosis)
2. Bad taste
3. Gingival Bleeding
B. Painful Gingivitis
1. Redness
2. Swelling
3. Oral Ulcers
C. Punched out lesions on interdental papillae
D. Mucus membranes covered with grayish necrotic membrane
http://www.fpnotebook.com/DEN9.htm
Consider asking your doctor about prescribing Duke?s Magic
Mouthwash. This was developed when I worked at Duke Medical Center,
and I have seen it cure (Or at least relieve) a variety of mouth
ailments!
?In the June 1, 2000, entry of "Diary," we shared a letter mentioning
Duke's Magic Mouthwash. Several readers have since requested the
recipe. It was developed at Duke University and is used for aphthous
ulcers. The recipe mixes nystatin suspension, 100,000 U per mL, 30 mL
or nystatin powder 3 million units, 60 mg hydrocortisone and
diphenhydramine HCL syrup to a sufficient quantity 240 mL. Ten mL is
swished and swallowed four times a day for five to 10 days. JTL has
prescribed Duke's Magic Mouthwash with generally favorable results.
While many of these remedies use viscous lidocaine or diphenhydramine
as their base, JTL has been intrigued by the variety of "additives,"
which seem to confer medicinal properties. JTL has found this
concoction to be easy for pharmacists to prepare and agreeable to
patients: 120 mL viscous lidocaine; 40 mL erythromycin (400 mg per 5
mL); 40 mL methylprednisolone elixir (15 mg per 5 mL). He instructs
patients to gargle and swallow or spit out (depending on location of
the lesions) 5 to 10 mL at least five times daily until lesions
resolve. While this concoction works nicely for sores located in the
oropharynx, lesions located around the lips and gums may benefit from
a combination of topical corticosteroid gel (e.g., fluocinonide) and
an oral antiviral remedy such as acyclovir, as noted in a published
report (J Inf Dis June 2000;181:1906-10).?
http://www.aafp.org/afp/20001201/diary.html
I hope this has helped you out. I urge you to visit a different doctor
? ask around to find a highly recommended doctor. If you live near a
university medical center, call and locate a good ENT. Quite possibly
a visit to a good dentist or oral surgeon may be helpful as well. I
wish you the best.
If any part of this answer is unclear, please request an Answer
Clarification, and allow me to respond, before you rate. I will be
happy to assist you further, before you rate.
Sincerely, Crabcakes
Search Terms
=============
Stevens-Johnson syndrome + recurring mouth sores
intraoral ulcers
Aphthous Ulcers
Behcet's Syndrome + oral sores
Oral candidiasis
Duke?s Magic Mouthwash |
