Mouth ulcers are open lesions or sores in the mouth that can be caused by many different disorders or conditions, such as viral or fungal infections, immune deficiency, or cancer. Types of mouth ulcers include acrodermatitis enteropathica, canker sores, cold sores, oral leukoplakia, oral candidiasis (oral thrush), and oral mucositis.
Acrodermatitis enteropathica is a medical condition in which the body is unable to absorb zinc.
Canker sores are common but mostly harmless, and they appear inside the mouth as white or gray ulcers, which are eroded areas of the oral cavity that are marked by tissue disintegration, with a red border. A small percentage of patients may develop severe canker sores (complex aphthosis), which are persistent and painful sores. In infants, painful sores may interfere with eating and may require a visit to the pediatrician. In patients with a weakened immune system (for example, patients who are HIV positive or receiving chemotherapy), the fungus may spread throughout the body, causing infection in the esophagus (esophagitis), brain (meningitis), heart (endocarditis), joints (arthritis), or eyes (endophthalmitis).
Cold sores, or herpes labialis, is a condition that involves sores on the lips and inflammation of the gums and mouth. It is caused by the herpes simplex virus type 1 (HSV-1).
Oral leukoplakia is a condition in which thickened, white patches form on the gums, on the inside of the cheeks, and sometimes on the tongue. The cause of leukoplakia is unknown, but it is considered to result from chronic irritation. A subtype of leukoplakia is oral hairy leukoplakia (OHL). Hairy leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in people who are infected with the human immunodeficiency virus (HIV) or have acquired immunodeficiency syndrome (AIDS) or AIDS-related complex.
Oral thrush is a fungal or yeast infection in the mouth caused by an overgrowth of the fungus Candida albicans.
Oral mucositis is an inflammation of mucous membranes of the mouth, and it has been reported in many patients receiving radiation therapy.
Symptoms of mouth ulcers include pain and redness at the site of the lesion. Diagnosis is usually performed by examination of the appearance of the lesion or further tests, such as a blood test or biopsy. Treatment involves oral hygiene, topical preparations, and avoidance of irritating substances on or near the lesion.
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types of the disease
Acrodermatitis enteropathica: Acrodermatitis enteropathica is an inherited condition that occurs when the body is unable to absorb zinc. This trace element is necessary for the functioning of more than 300 different enzymes, which are proteins that either increase or decrease the rates of chemical reactions. Zinc plays a vital role in many other biological processes as well. Symptoms of this disease, including skin lesions or sores, hair loss, and diarrhea, often develop soon after birth in infants who are bottle fed or when an infant is weaned from breastfeeding. Lesions are any abnormal area on or in a tissue, such as an injury, wound, boil, sore, rash, moles, warts, or cysts.
Canker sores: Canker sores, also known as aphthous stomatitis or an inflammation of the mouth, are common but often harmless. They appear inside the mouth as ulcers that are white or gray with a red border. Ulcers are eroded areas of the oral cavity that are marked by tissue disintegration.
The reason canker sores appear is unknown but some experts believe that problems with the immune system (the body system that fights disease, bacteria, and viruses) may be involved.
Canker sores are usually seen in children and adolescents 10-19 years old. For about one-third of the children affected, lesions continue to reappear for years after the initial outbreak. These ulcers are not contagious and cannot be spread from one child to another. Canker sores also occur in women more often than men, often during menstrual periods. The sores are not considered to be precancerous.
Cold sores (herpes simplex virus): Herpes simplex type 1 (HSV-1) is also known as a cold sore or a fever blister. Herpes simplex type 1 infections are generally marked by painful, watery blisters on the skin or mucous membranes, such as the mouth or lips. Lesions heal with a crust-forming scab, which is the hallmark of herpes. The virus is particularly contagious during an outbreak, although individuals may be rid of the virus between outbreaks.
HSV-1 is a common virus. It is thought that 90% of adults have been exposed to the virus during their lifetimes, and most Americans have contracted the virus by the age of 20. Most people contract oral herpes when they are children by receiving a kiss from a friend or relative who is carrying the virus. Some patients may not have an initial outbreak until years later. After the first episode, the virus lies dormant in the nerves or the skin around the original area until something sets off the virus into another eruption. Colds, the flu, and stress may cause an outbreak of cold sores. It is not well understood why individuals have outbreaks at one time of life and not another.
Leukoplakia: Leukoplakia is the most common cause of all chronic mouth lesions. Although anyone can develop leukoplakia, it is most common in older men.
Oral leukoplakia is a condition in which thickened, white patches known as leukoplakic patches form on the gums, the inside of the cheeks, and sometimes the tongue. The cause of leukoplakia is considered to result from chronic irritation. Tobacco, either smoked or chewed, is the most common cause, but irritation may also come from other sources, such as long-term alcohol use.
Leukoplakia may also be caused by irritations such as an ill-fitting denture or the habit of chewing on the inside of the cheek.
In general, leukoplakia is not painful, but the patches may be sensitive when the individual touches them or eats spicy foods. Although the disorder usually is not dangerous, a small percentage of leukoplakic patches show early signs of cancer. Many cancers of the mouth occur next to areas of leukoplakia. For that reason, it is best to see a dentist if there are unusual changes in the mouth lasting longer than a week.
People with compromised immune systems sometimes develop an unusual form of the disorder called hairy leukoplakia. Hairy leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in people who are infected with the human immunodeficiency virus (HIV) or have acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Hairy leukoplakia consists of corrugated, fuzzy (hence the name "hairy"), white patches on the lateral borders of the tongue and less frequently elsewhere in the mouth. It may resemble thrush, an infection caused by the fungus Candida albicans.
Mucositis: Mucositis, or stomatitis, is inflammation of the mucous membranes lining the digestive tract from the mouth to the anus. Mucositis is a common side effect of chemotherapy and of radiotherapy that involves any part of the digestive tract, such as the mouth or the stomach. Chemotherapy is the treatment of cancer using specific chemical agents or drugs that are selectively destructive to malignant cells and tissues. Radiotherapy uses radiation or radioactive substances to treat disease.
Mucositis affects the rapidly dividing mucosal cells lining the mouth, throat, stomach, and intestines. These cells normally have a short life span. Chemotherapy or radiation therapy can destroy these cells quickly, and they may not immediately regenerate, leading to ulcers or sores. Mild mucositis is painful and may require pain medication for a week or two until the tissues recover. In severe cases of mucositis, a growth factor (a substance that affects the growth of a cell or an organism, such as palifermin or keratinocyte growth factor) and parenteral alimentation (providing nutrition through the veins) may be needed.
Damage to the mucosal cells also makes it difficult for the mouth to heal and fight off bacteria, leading to infection. Healthcare professionals recommend seeing a dentist regularly during chemotherapy or radiation treatment. Good mouth care, including the use of saltwater mouth rinses, and adequate hydration may prevent infection, bleeding, and difficulty eating and swallowing.
Oral candidiasis (also called moniliasis or oral thrush): Oral thrush is a fungal or yeast infection (candidiasis) in the mouth caused by an overgrowth of the fungus Candida albicans. Oral thrush appears in the mouth as red or white lesions, which are flat or slightly raised. The patches have varying sizes and shapes. When severe, this fungus can spread down the esophagus, making chewing and swallowing very painful. The esophagus, which is also known as the food pipe, is the body canal (tube) that carries food from the mouth to the stomach.
The patches are common among denture wearers and occur most often in those who are very young, the elderly, or those who have a suppressed (or weakened) immune system, such as cancer and HIV/AIDS patients. Individuals who have xerostomia (dry mouth syndrome) and those taking antibiotics may also get oral yeast infections.
The Candida albicans fungus is found almost everywhere in the environment, which is why most people have small amounts of Candida albicans in their mouths at any given time. However, individuals with healthy immune systems are usually able to prevent the fungus from multiplying and causing an infection. In rare cases, when candidiasis affects healthy individuals, symptoms are usually minor. In contrast, immunocompromised patients, such as patients infected with the human immunodeficiency virus (HIV) or patients receiving immunosuppressants (for example, Imuran®, cyclosporine, or methotrexate), often suffer from severe symptoms, including painful lesions in the mouth, that may make it difficult to eat.
Use of oral antibiotics, especially broad-spectrum antibiotics that have activity against a wide range of disease-causing bacteria, has been associated with an increased occurrence of yeast infection. Antibiotic use may eliminate normal, healthy bacteria, which may allow for the overgrowth of the fungus Candida albicans. Antibiotics have also been detected in animal products such as meat, poultry, and cow's milk. In human research, significantly higher Candida albicans counts were found in the stool of patients with antibiotic-associated diarrhea (AAD). Candidiasis infections are generally treated with antifungals for 10-14 days.