Aphthous ulcer
Encyclopedia
An aphthous ulcer also known as a canker sore, is a type of mouth ulcer
which presents as a painful open sore
inside the mouth
or upper throat
characterized by a break in the mucous membrane
. Its cause is unknown, but they are not contagious. The condition is also known as aphthous stomatitis (stomatitis
is inflammation of the mucous lining), and alternatively as Sutton's Disease, especially in the case of major, multiple, or recurring ulcers.
The term aphtha means ulcer; it has been used for many years to describe areas of ulceration on mucous membranes. Therefore, the term aphthous ulcer is a tautology
and the term aphthous stomatitis is preferred. Aphthous stomatitis is a condition characterized by recurrent discrete areas of ulceration that are almost always painful. Recurrent aphthous stomatitis (RAS) can be distinguished from other diseases with similar-appearing oral lesion
s, such as certain oral bacteria or herpes simplex
, by their tendency to recur, and their multiplicity and chronicity. Recurrent aphthous stomatitis is one of the most common oral conditions. At least 10% of the population has it, and women are more often affected than men. About 30–40% of patients with recurrent aphthae report a family history.
. These typically develop after puberty
with frequent recurrences. They occur on movable non-keratin
izing oral surfaces, but the ulcer borders may extend onto keratinized surfaces. They can occur on tongue, lips and cheeks.
Aphthous ulcers usually begin with a tingling or burning sensation at the site of the future aphthous ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer.
The aphthous ulcer appears as a white or yellow oval with an inflamed red border. Sometimes a white circle or halo around the lesion can be observed. The gray, white or yellow colored area within the red boundary is due to the formation of layers of fibrin
, a protein
involved in the clotting of blood. The ulcer, which itself is often extremely painful, especially when agitated, may be accompanied by a painful swelling of the lymph node
s below the jaw, which can be mistaken for toothache
; another symptom is fever
. A sore on the gums may be accompanied by discomfort or pain in the teeth. Canker sores are very sensitive to spicy foods and if secondary infection occurs in canker sores, then antibiotics may also be required to treat it.
fruits (e.g., oranges and lemons), physical trauma, stress, lack of sleep, sudden weight loss
, food allergies
, immune system
reactions, and deficiencies in vitamin B12
, iron
, and folic acid
may contribute to their development. Nicorandil
and certain types of chemotherapy
are also linked to aphthous ulcers. One recent study showed a strong correlation with allergies to cow's milk. Aphthous ulcers are a major manifestation of Behçet disease
, and are also common in people with Crohn's disease
.
Trauma to the mouth is the most common trigger. Physical trauma
, such as that caused by toothbrush abrasions
, laceration with sharp or abrasive foods (such as toast
or potato chips/crisps), accidental biting (particularly common with sharp canine
teeth), after losing teeth, or dental braces can cause aphthous ulcers by breaking the mucous membrane. Other factors, such as chemical irritants or thermal
injury, may also lead to the development of ulcers. Using a toothpaste
without sodium lauryl sulfate (SLS) may reduce the frequency of aphthous ulcers One smaller study found no connection between SLS in toothpaste and aphthous ulcers. Celiac disease has been suggested as a cause of aphthous ulcers and some patients benefited from eliminating gluten
from their diets.
There is no indication that aphthous ulcers are related to menstruation
, pregnancy, and menopause. Smokers appear to be affected less often.
, tetracycline suspension, and silver nitrate
. Amlexanox
paste has been found to speed healing and alleviate pain.
Suggestions to reduce the pain
caused by an ulcer include: avoiding spicy food
, rinsing with salt water
or over-the-counter mouthwash
es, proper oral hygiene
and non-prescription local anesthetic
s. Active ingredient
s in the latter generally include benzocaine
, benzydamine or choline
salicylate, and phenol
.Ice-creams have proved to reduce pain very effectively.
Anesthetic mouthwashes containing benzydamine hydrochloride have not been shown to reduce the number of new ulcers or significantly reduce pain, and evidence supporting the use of other topical anesthetics is very limited, though some individuals may find them effective. In general, their role is limited; their duration of effectiveness is, in general, short and does not provide pain control throughout the day. Such medications may also cause complications
in children.
Evidence is limited for the use of antimicrobial
mouthwashes but suggests that they may reduce the painfulness and duration of ulcers and increase the number of days between ulcerations, without reducing the number of new ulcers.
Corticosteroid
preparations containing hydrocortisone hemisuccinate or triamcinolone acetonide
to control symptoms are effective in treating aphthous ulcers.Commented in:
The application of silver nitrate
will cauterize the sore; a single treatment decreases pain but does not affect healing time though in children it can cause tooth
discoloration if the teeth are still developing
. The use of tetracycline is controversial, as is treatment with levamisole
, colchicine
, gamma-globulin
, dapsone
, estrogen
replacement and monoamine oxidase inhibitor
s.
While commonly used, Magic mouthwash
, a combination of a number of ingredients including viscous lidocaine
, benzocaine
, milk of magnesia, kaolin-pectate, chlorhexidine, or diphenhydramine
, has little evidence to support its use. One small-scale study has suggested that Vitamin B12
may be effective in treating recurrent aphthous ulcers, regardless of whether there is a vitamin deficiency present.
between 15% and 30%. The frequency of canker sores varies from fewer than 4 episodes per year (85% of all cases) to more than one episode per month (10% of all cases) including people suffering from continuous RAS.
Mouth ulcer
A mouth or oral ulcer is an open sore in the mouth, or rarely a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. The types of mouth ulcers are diverse, with a multitude of associated causes including: physical abrasion, acidic fruit, infection, other medical...
which presents as a painful open sore
Cutaneous conditions
There are many conditions of or affecting the human integumentary system—the organ system that comprises the entire surface of the body and includes skin, hair, nails, and related muscle and glands.- Diseases :...
inside the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
or upper throat
Throat
In vertebrate anatomy, the throat is the anterior part of the neck, in front of the vertebral column. It consists of the pharynx and larynx...
characterized by a break in the mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
. Its cause is unknown, but they are not contagious. The condition is also known as aphthous stomatitis (stomatitis
Stomatitis
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth...
is inflammation of the mucous lining), and alternatively as Sutton's Disease, especially in the case of major, multiple, or recurring ulcers.
The term aphtha means ulcer; it has been used for many years to describe areas of ulceration on mucous membranes. Therefore, the term aphthous ulcer is a tautology
Tautology (rhetoric)
Tautology is an unnecessary or unessential repetition of meaning, using different and dissimilar words that effectively say the same thing...
and the term aphthous stomatitis is preferred. Aphthous stomatitis is a condition characterized by recurrent discrete areas of ulceration that are almost always painful. Recurrent aphthous stomatitis (RAS) can be distinguished from other diseases with similar-appearing oral lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s, such as certain oral bacteria or herpes simplex
Herpes simplex
Herpes simplex is a viral disease caused by both Herpes simplex virus type 1 and type 2 . Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever...
, by their tendency to recur, and their multiplicity and chronicity. Recurrent aphthous stomatitis is one of the most common oral conditions. At least 10% of the population has it, and women are more often affected than men. About 30–40% of patients with recurrent aphthae report a family history.
Minor ulceration
Minor aphthous ulcers indicate that the lesion size is between 3–10 mm (0.118110236220472–0.393700787401575 in). They are most common aphthous ulcers. The appearance of the lesion is that of an erythematous halo with yellowish or grayish color. Pain that affects quality of life is the obvious characteristic of the lesion. When the ulcer is white or grayish, the ulcer will be extremely painful and the affected lip may swell. They may last about 2 weeks.Major ulcerations
Major aphthous ulcers have the same appearance as minor ulcerations, but are greater than 10 mm in diameter and are extremely painful. They usually take more than a month to heal, and frequently leave a scarScar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
. These typically develop after puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
with frequent recurrences. They occur on movable non-keratin
Keratin
Keratin refers to a family of fibrous structural proteins. Keratin is the key of structural material making up the outer layer of human skin. It is also the key structural component of hair and nails...
izing oral surfaces, but the ulcer borders may extend onto keratinized surfaces. They can occur on tongue, lips and cheeks.
Herpetiform ulcerations
This is the most severe form. It occurs more frequently in females, and onset is often in adulthood. It is characterized by small, numerous, 1–3 mm lesions that form clusters. They typically heal in less than a month without scarring. Supportive treatment is almost always necessary.Signs and symptoms
Aphthous ulcers can affect people of any age. Frequency of aphthous ulcers is reported to be more in females as compared to males. Most commonly aphthous ulcers are seen on the lining of cheeks, tongue, lips and roof of mouth.Aphthous ulcers usually begin with a tingling or burning sensation at the site of the future aphthous ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer.
The aphthous ulcer appears as a white or yellow oval with an inflamed red border. Sometimes a white circle or halo around the lesion can be observed. The gray, white or yellow colored area within the red boundary is due to the formation of layers of fibrin
Fibrin
Fibrin is a fibrous, non-globular protein involved in the clotting of blood. It is a fibrillar protein that is polymerised to form a "mesh" that forms a hemostatic plug or clot over a wound site....
, a protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
involved in the clotting of blood. The ulcer, which itself is often extremely painful, especially when agitated, may be accompanied by a painful swelling of the lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s below the jaw, which can be mistaken for toothache
Toothache
A toothache, also known as odontalgia or, less frequently, as odontalgy, is an aching pain in or around a tooth.-Causes:* Dental etiology, In most cases toothaches are caused by problems in the tooth or jaw, such as** Dental caries...
; another symptom is fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
. A sore on the gums may be accompanied by discomfort or pain in the teeth. Canker sores are very sensitive to spicy foods and if secondary infection occurs in canker sores, then antibiotics may also be required to treat it.
Causes
The exact cause of many aphthous ulcers is unknown but citrusCitrus
Citrus is a common term and genus of flowering plants in the rue family, Rutaceae. Citrus is believed to have originated in the part of Southeast Asia bordered by Northeastern India, Myanmar and the Yunnan province of China...
fruits (e.g., oranges and lemons), physical trauma, stress, lack of sleep, sudden weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
, food allergies
Food allergy
A food allergy is an adverse immune response to a food protein. They are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions....
, immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
reactions, and deficiencies in vitamin B12
Vitamin B12 deficiency
Vitamin B12 deficiency or hypocobalaminemia is a low blood level of vitamin B12, it can cause permanent damage to nervous tissue as a long term effect. Vitamin B12 was discovered from its relationship to the disease pernicious anemia, which is an autoimmune disease that destroys parietal cells in...
, iron
Iron
Iron is a chemical element with the symbol Fe and atomic number 26. It is a metal in the first transition series. It is the most common element forming the planet Earth as a whole, forming much of Earth's outer and inner core. It is the fourth most common element in the Earth's crust...
, and folic acid
Folic acid
Folic acid and folate , as well as pteroyl-L-glutamic acid, pteroyl-L-glutamate, and pteroylmonoglutamic acid are forms of the water-soluble vitamin B9...
may contribute to their development. Nicorandil
Nicorandil
Nicorandil is a vasodilatory drug used to treat angina. It is marketed under the trade names Ikorel , Dancor , Nikoran , Aprior , Nitorubin and Sigmart...
and certain types of chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
are also linked to aphthous ulcers. One recent study showed a strong correlation with allergies to cow's milk. Aphthous ulcers are a major manifestation of Behçet disease
Behçet's disease
Behçet's disease is a rare immune-mediated systemic vasculitis that often presents with mucous membrane ulceration and ocular involvements...
, and are also common in people with Crohn's disease
Crohn's disease
Crohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
.
Trauma to the mouth is the most common trigger. Physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, such as that caused by toothbrush abrasions
Abrasion (dental)
Abrasion is the loss of tooth structure by mechanical forces from a foreign element. If this force begins at the cementoenamel junction, then progression of tooth loss can be rapid since enamel is very thin in this region of the tooth...
, laceration with sharp or abrasive foods (such as toast
Toast
Toast is bread that has been browned by exposure to radiant heat. This browning reaction is known as the Maillard reaction. Toasting warms the bread and makes it firmer, so it holds toppings more securely...
or potato chips/crisps), accidental biting (particularly common with sharp canine
Canine tooth
In mammalian oral anatomy, the canine teeth, also called cuspids, dogteeth, fangs, or eye teeth, are relatively long, pointed teeth...
teeth), after losing teeth, or dental braces can cause aphthous ulcers by breaking the mucous membrane. Other factors, such as chemical irritants or thermal
Thermal
A thermal column is a column of rising air in the lower altitudes of the Earth's atmosphere. Thermals are created by the uneven heating of the Earth's surface from solar radiation, and are an example of convection. The sun warms the ground, which in turn warms the air directly above it...
injury, may also lead to the development of ulcers. Using a toothpaste
Toothpaste
Toothpaste is a paste or gel dentifrice used with a toothbrush as an accessory to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it serves as an abrasive that aids in removing the dental plaque and food from the teeth, assists in suppressing...
without sodium lauryl sulfate (SLS) may reduce the frequency of aphthous ulcers One smaller study found no connection between SLS in toothpaste and aphthous ulcers. Celiac disease has been suggested as a cause of aphthous ulcers and some patients benefited from eliminating gluten
Gluten
Gluten is a protein composite found in foods processed from wheat and related grain species, including barley and rye...
from their diets.
There is no indication that aphthous ulcers are related to menstruation
Menstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
, pregnancy, and menopause. Smokers appear to be affected less often.
Oral measures
- Regular use of non-alcoholic mouthwashMouthwashMouthwash or mouth rinse is a product used to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and anti-plaque mouth rinse kill the bacterial plaque causing cavities, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay...
may help prevent or reduce the frequency of sores. Informal studies suggest that mouthwash may help to temporarily relieve pain. - In some cases, switching toothpastes can prevent aphthous ulcers from occurring, with research looking at the role of sodium dodecyl sulfateSodium dodecyl sulfateSodium dodecyl sulfate , sodium laurilsulfate or sodium lauryl sulfate is an organic compound with the formula CH311OSO3Na). It is an anionic surfactant used in many cleaning and hygiene products...
(sometimes called sodium lauryl sulfate, or with the acronymes SDS or SLS), a detergent found in most toothpastes. Using toothpaste free of this compound has been found in several studies to help reduce the amount, size, and recurrence of ulcers. - Dental braceDental braceDental braces are devices used in the orthodontic industry that help align and straighten teeth and help to position them with regard to a person’s bite, while also working to improve dental health...
s are a common physical trauma that can lead to aphthous ulcers and the dental bracket can be covered with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but, since such trauma is usually accidental, this type of prevention is not usually practical.
Nutrition
- Zinc deficiencyZinc deficiencyZinc deficiency is insufficient zinc to meet the needs of biological organisms. It can occur in both plants and animals. Zinc deficient soil is soil in which there is insufficient zinc to allow plants to grow normally.-Description:...
has been reported in people with recurrent aphthous ulcers. The few small studies looking into the role of zinc supplementation have mostly reported positive results particularly for those people with deficiency, although some research has found no therapeutic effect.
Treatment
A number of different treatments exist for apthous ulcers including: analgesics, anesthetics agents, antiseptics, anti-inflammatory agents, steroids, sucralfateSucralfate
Sucralfate is a cytoprotective agent, an oral gastrointestinal medication primarily indicated for the treatment of active duodenal ulcers. Brand names include Sucramal in Italy; Carafate in U.S.A.; Pepsigard, Sucral, Sucrafil, Hapifate in India; Sutra or Musin in parts of South-East Asia; Sulcrate...
, tetracycline suspension, and silver nitrate
Silver nitrate
Silver nitrate is an inorganic compound with chemical formula . This compound is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides...
. Amlexanox
Amlexanox
Amlexanox is a medication with antiallergic and anti-inflammatory effects used in the treatment of aphthous ulcers...
paste has been found to speed healing and alleviate pain.
Suggestions to reduce the pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
caused by an ulcer include: avoiding spicy food
Scoville scale
The Scoville scale is a measurement of the spicy heat of a chili pepper. The number of Scoville heat units indicates the amount of capsaicin present. Capsaicin is a chemical compound that stimulates chemoreceptor nerve endings in the skin, especially the mucous membranes.The scale is named after...
, rinsing with salt water
Saline water
Saline water is a general term for water that contains a significant concentration of dissolved salts . The concentration is usually expressed in parts per million of salt....
or over-the-counter mouthwash
Mouthwash
Mouthwash or mouth rinse is a product used to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and anti-plaque mouth rinse kill the bacterial plaque causing cavities, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay...
es, proper oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
and non-prescription local anesthetic
Local anesthetic
A local anesthetic is a drug that causes reversible local anesthesia, generally for the aim of having local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well...
s. Active ingredient
Active ingredient
An active ingredient is the substance of a pharmaceutical drug or a pharmaceutical ingredient and bulk active in medicine; in pesticide formulations active substance may be used. Some medications and pesticide products may contain more than one active ingredient...
s in the latter generally include benzocaine
Benzocaine
Benzocaine is a local anesthetic commonly used as a topical pain reliever, or in cough drops. It is the active ingredient in many over-the-counter anesthetic ointments...
, benzydamine or choline
Choline
Choline is a water-soluble essential nutrient. It is usually grouped within the B-complex vitamins. Choline generally refers to the various quaternary ammonium salts containing the N,N,N-trimethylethanolammonium cation....
salicylate, and phenol
Phenol
Phenol, also known as carbolic acid, phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid. The molecule consists of a phenyl , bonded to a hydroxyl group. It is produced on a large scale as a precursor to many materials and useful compounds...
.Ice-creams have proved to reduce pain very effectively.
Anesthetic mouthwashes containing benzydamine hydrochloride have not been shown to reduce the number of new ulcers or significantly reduce pain, and evidence supporting the use of other topical anesthetics is very limited, though some individuals may find them effective. In general, their role is limited; their duration of effectiveness is, in general, short and does not provide pain control throughout the day. Such medications may also cause complications
Complication (medicine)
Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A...
in children.
Evidence is limited for the use of antimicrobial
Antimicrobial
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
mouthwashes but suggests that they may reduce the painfulness and duration of ulcers and increase the number of days between ulcerations, without reducing the number of new ulcers.
Corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
preparations containing hydrocortisone hemisuccinate or triamcinolone acetonide
Triamcinolone acetonide
Triamcinolone acetonide is a synthetic corticosteroid used to treat various skin conditions and to relieve the discomfort of mouth sores. It is a more potent type of triamcinolone, being about 8 times as effective as prednisone.-Medical use:...
to control symptoms are effective in treating aphthous ulcers.Commented in:
The application of silver nitrate
Silver nitrate
Silver nitrate is an inorganic compound with chemical formula . This compound is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides...
will cauterize the sore; a single treatment decreases pain but does not affect healing time though in children it can cause tooth
Tooth
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...
discoloration if the teeth are still developing
Tooth development
Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. Although many diverse species have teeth, non-human tooth development is largely the same as in humans...
. The use of tetracycline is controversial, as is treatment with levamisole
Levamisole
Levamisole is an anthelminthic and immunomodulator belonging to a class of synthetic imidazothiazole derivatives. It was discovered at Janssen Pharmaceutica in 1966...
, colchicine
Colchicine
Colchicine is a medication used for gout. It is a toxic natural product and secondary metabolite, originally extracted from plants of the genus Colchicum...
, gamma-globulin
Globulin
Globulin is one of the three types of serum proteins, the others being albumin and fibrinogen. Some globulins are produced in the liver, while others are made by the immune system. The term globulin encompasses a heterogeneous group of proteins with typical high molecular weight, and both...
, dapsone
Dapsone
Dapsone is a medication most commonly used in combination with rifampicin and clofazimine as multidrug therapy for the treatment of Mycobacterium leprae infections . It is also second-line treatment for prophylaxis against Pneumocystis pneumonia caused by Pneumocystis jiroveci Dapsone...
, estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
replacement and monoamine oxidase inhibitor
Monoamine oxidase inhibitor
Monoamine oxidase inhibitors are a class of antidepressant drugs prescribed for the treatment of depression. They are particularly effective in treating atypical depression....
s.
While commonly used, Magic mouthwash
Magic mouthwash
Magic mouthwash and magic swizzle are terms referring to a number of different mouthwash formulations. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis caused by radiation therapy or chemotherapy...
, a combination of a number of ingredients including viscous lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
, benzocaine
Benzocaine
Benzocaine is a local anesthetic commonly used as a topical pain reliever, or in cough drops. It is the active ingredient in many over-the-counter anesthetic ointments...
, milk of magnesia, kaolin-pectate, chlorhexidine, or diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
, has little evidence to support its use. One small-scale study has suggested that Vitamin B12
Vitamin B12
Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...
may be effective in treating recurrent aphthous ulcers, regardless of whether there is a vitamin deficiency present.
Epidemiology
Canker sores are a very common oral lesion. Epidemiological studies show an average prevalencePrevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
between 15% and 30%. The frequency of canker sores varies from fewer than 4 episodes per year (85% of all cases) to more than one episode per month (10% of all cases) including people suffering from continuous RAS.