Abstract
Ulcer is a break in continuity of the epithelium brought about by molecular necrosis. Ulcers are most common in the oral region, for which the patient seeks help from their physician/dental surgeon. The presenting complaints are usually redness, burning sensation and/or pain. They can present in any part of the oral cavity but may be painful if it occurs in the movable area. Effective management of oral ulcer includes timely diagnosis , appropriate differentiation of the various etiologies , and appropriate treatment. This article deals with an overview of oral ulcer, including its etiological factors, types, clinical feature and diagnosis along with homoeopathic management.
Keywords:
Oral ulcer, Aphthous, Herpetiform ulcer, Behcet syndrome, Homoeopathy.
Introduction
A mouth ulcer is a painful, open sore that develops on the mucous membranes lining of the oral cavity. These ulcers occur due to damage or disruption of the mucous membrane. Oral ulcers are common, it may affect as many as 25% of the population worldwide. Some of the highest incidences are seen in the Indian subcontinent, southern France, and South American.
Most ulcers are benign and resolve spontaneously but a small proportion of them are malignant.
Mouth ulcers are typically round or oval, with a red border surrounding a greyish- white or yellow centre. They can vary significantly in size, from a few millimetres to over a centimetre across. Minor ulcers are more common and often heal within 7-10 days, while larger ulcers may take up to 6 weeks to recover fully.
Mouth ulcers typically begin with a tingling or burning sensation, followed by the development of the sore.
Proper oral hygiene is essential during an outbreak to prevent secondary infection and assist healing. Most ulcers will heal on their own without intervention, but more significant or persistent ulcers may require medication.
Types of Mouth Ulcers:
Minor Aphthous Ulcers: Also called canker sores, these are small, shallow ulcers 2-8mm across that heal within 10-14 days. They are the most common variety, caused by minor trauma.
Major Aphthous Ulcers: Large, deeper ulcers over 1 cm in diameter that take over 6 weeks to heal and often leave a scar. These are less common but more painful.
Herpetiform Ulcers: Clusters of dozens of small pinpoint ulcers that merge into irregular shapes. Foods, stress, hormones, or infection may trigger it.
Traumatic Ulcers: Direct injury from abrasive food, dental work, accidental biting, or oral devices leads to these painful irregular ulcers. They correspond to the specifics of the injury.
Chemical Ulcers: Burns caused by caustic chemicals, acids, hydrogen peroxide, aspirin, or other harsh substances. They are often deep and very Painful.
Allergic Ulcers: Certain foods, dyes, flavours, preservatives or other oral care products can prompt swelling and ulceration in those with allergies.
These often recur in the same areas.
Autoimmune Ulcers: Those with immune disorders like Crohn’s disease, lupus, rheumatoid arthritis, or celiac disease may suffer autoimmune destruction of oral tissue, leading to mouth ulcers.
Infectious Ulcers: Bacterial, fungal, and viral infections like herpes simplex can all lead to ulcer development, especially in immunocompromised patients. Appearance and location vary by infectious agent.
Aetiology of Oral Ulcer
Trauma:-
Traumatic ulcers could result from physical, thermal or chemical injuries [9].
It may be recurrent if the offending irritant is not removed. Local trauma is regarded as a causative agent for oral ulcer in susceptible individuals.
Trauma predisposes to oral ulcer by inducing edema, early cellular inflammation associated with an increased viscosity of the oral submucosal extracellular matrix.
Some changes in salivary composition, such as pH, that affect the local properties of saliva and a stress induced rise in salivary cortisol have been correlated with oral ulcer.
Viral infection:-
Recurrent intraoral viral infection is usually limited to secondary herpes simplex virus. The recurrences are most commonly due to human herpes virus-1 (HHV-1) (which usually causes orofacial infections). Recurrent oral HSV-2 lesions (which are usually associated with genital infections) are rare [10].
Clinically, the initial presentation is of fluid-filled vesicles which rapidly break down to form a cluster of small ulcers with ragged margins.
After primary infection, the virus is not eliminated from the body but migrates along nerve fibres to the trigeminal ganglion, where it lies dormant. In perhaps one-third of individuals the virus can be reactivated by non-specific stimuli e.g.
illnesses associated with fever, when it travels back to the periphery to cause secondary oral mucosal lesions. The lesions usually resolve in about 7 to 10 days in healthy individuals, but in immunocompromised patients secondary herpetic Lesions can be widespread, very slow to heal and refractory to treatment.
Behcet’s syndrome
vasculitis is the essential lesion in BS.
The abnormal inflammatory response in Behcet’s syndrome is caused by immune complexes induced by T lymphocytes and plasma cells. Recurrent aphthous stomatitis-like ulceration is a cardinal feature of Behcet’s syndrome.
HIV disease
Oral ulceration may occasionally arise in HIV disease. Oral ulcer occurs more frequently, lasts longer, and causes more painful symptoms than in healthy
individuals and is a common finding in HIV-positive children. RAS is usually a late finding in AIDS patients with CD4+ lymphocyte counts below 100 cells⁄ mm3, but it may occasionally be a presenting sign of HIV infection.
Inflammatory Bowel Disease
Aphthous-like ulceration can be a feature of inflammatory bowel diseases like Crohn’s disease and ulcerative colitis [5]. Approximately 10% of patients with Crohn’s disease have oral mucosal ulcers, and the oral manifestations occasionally precede intestinal symptoms.
Allergic Factors
Allergy has been suspected as a cause of ORAL ULCER and hypersensitivity to certain food substances, oral microbes such as Streptococcus sanguis, and Microbial heat shock proteins have been suggested as possible causative factors..
Foods such as chocolate, coffee, peanuts, cereals, almonds, strawberries, cheese, tomatoes.
Nutritional factors
The role of nutritional deficiency as a cause of oral ulcer with low serum levels of iron, folate, zinc or vitamins B1, B2, B6, and B12.
Deficiency of B and Folate results in Megaloblastic Anaemia (MA) with oral complications including glossitis, mucosal bleeding and oral ulcers [11].
Symptoms of Mouth Ulcers:-
Sensory disturbances in the oral cavity, like burning, tingling, itching or pain, indicate mouth ulceration. The pain can be sharp, aching, throbbing or stinging in nature.
Ulcer pain is severe enough to cause difficulties in eating, speaking and swallowing. The discomfort may also disrupt sleep.
Increased salivation or drooling due to the pain.
Noticeable foul breath odour and Metallic taste in the mouth persistently.
There is a feeling that a foreign body is lodged in the mouth.
Having difficulty maintaining proper oral hygiene due to discomfort.
Due to the pain and difficulty eating, there is a loss of appetite.
Signs on Examination
Small solitary or clustered lesions visible as white or yellow oval structures surrounded by erythematous halos.
Mucosal surface ulceration that appears as a superficial or deep open sore.
Ulcers can range from a few millimetres to over one centimetre in diameter with variable shapes and irregular wound margins.
Specific lesions may show bleeding, oozing of fluid or appear entirely ulcerated.
Other signs like petechiae, reddening, blisters, tissue loss and coating on the tongue supports mouth ulceration.6].
Homoeopathic Viewpoint:
According to Dr. Hahnemann’s categorization, which is outlined in his book “Organon of Medicine” in aphorisms 185-203, oral ulcer falls under the category of “One Sided Diseases.” Homoeopathy is a safer and more effective alternative to the aforementioned style of treatment since it takes a holistic approach, which treats the patient as a whole.
Miasm:
Homoeopathy treats the person as a whole. It means that Homoeopathic treatment focuses on the patient as a person, as well as his pathological conditions. The homoeopathic medicines are selected after a full individualizing examination and case taking, case analysis, which includes the medical history of the patient, physical and mental constitution of pt. In aph. 5. useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease. When we examine the patient of oral ulcer, psora and syphilis in the etiology is evident. [12]
Does Homeopathy For Mouth Ulcer Work?
Yes, homeopathy can be a practical approach for treating mouth ulcers. The fundamental principles of homeopathy that enable it to treat mouth ulcers successfully include the following:
Individualized Remedies: Rather than a one-size-fits-all approach, homeopathy aims to match the remedy profile to each person’s unique set of symptoms. This is more targeted to an individual’s distinct ulcer triggers.
Stimulation of Self-Healing: Homeopathic remedies are specially prepared to gently prompt the body’s natural ability to heal and achieve better balance.
This assists both the rapid healing of existing ulcers and prevents recurrence.
Addressing Root Causes: In homeopathy, understanding subtle and characteristic symptoms helps identify fundamental triggers that need resolution, not just superficial treatment. This allows the management of factors like nutritional deficiencies, hormones, genetics or stress that underlie mouth ulcer formation.
Gentle and Safe Remedies: The ultra-dilute nature of homeopathic medicines prepared from natural substances makes them non-toxic with essentially no side effects. This enables their safe use for all ages and alongside any other necessary medications the individual may be taking.
Multi-Targeted Treatment: Rather than focusing on just superficial ulcer treatment, the correct homeopathic constitutional remedy improves the person’s overall susceptibility. This means relief for current ulcers along with reduced recurrence rates due to enhanced resilience and wellbeing.
Homeopathic Treatment For Mouth Ulcers:
Borax: Borax is useful for ulcers that are sensitive to touch, accompanied by burning pain, and worsened by eating or drinking anything hot.
Mercurius Solubilis: This remedy is indicated for very painful ulcers with excessive saliva, bad breath, and a metallic taste in the mouth.
Nitric Acid: Nitric Acid is prescribed for deep and irregularly shaped ulcers that are extremely painful and may bleed easily.[13]
Kali Chloricum: Kali Chloricum is recommended for ulcers with a marked red border and a greyish-white or yellowish centre. A burning sensation may accompany these ulcers.
Natrum Muriaticum: Natrum Muriaticum is suitable for mouth ulcers that appear during times of emotional stress or grief. The ulcers may be painful and accompanied by a dry mouth.
Carbo Veg: Helpful for extremely painful ulcers with a burning sensation that gets worse from cold water but is relieved by gentle warmth. Excellent for debilitated patients.
Hepar Sulph: Suitable for highly sensitive ulcers that cannot tolerate the slightest touch. Splinter-like pain is felt while swallowing food. The patient is usually chilly and highly irritable.
Silicea: Silicea suits chronic cases with repeated mouth ulcers, especially in malnourished patients. Ulcers are stubborn and heal slowly with pus formation. Warmth relieves the condition.
Sulphur: Useful for sore, red ulcers predominantly on the tongue, gums or inside of lips. A burning sensation may extend towards the throat or esophagus. Slightest food triggers discomfort.[14]
In addition to homeopathic treatment for mouth ulcers, certain dietary and lifestyle changes can help manage and prevent them:
DIET CHANGES TO DEAL WITH MOUTH ULCER
Identify foods that trigger your mouth ulcers and avoid or limit their consumption. These may include spicy, acidic, or rough-textured foods.
Drink plenty of water
Include a variety of fruits, vegetables, whole grains, and lean proteins in your diet to ensure you’re getting essential nutrients for oral health.
Use a soft toothbrush and brush gently after every meal to avoid injuring oral tissues.
Opt for bland, soft foods like porridge, mashed potatoes or cooked vegetables, which won’t further hurt the existing ulcers.
Lifestyle Changes To Deal With Mouth Ulcer
Brush teeth gently with a soft-bristled toothbrush. Use a non-irritating toothpaste and rinse mouth with a mild antiseptic mouthwash.
Stop smoking and restrict alcohol intake as they can irritate the oral mucosa, delaying ulcer healing.
Consider taking vitamins B12, C, zinc and iron supplements if your diet lacks these nutrients vital for oral health.
Conclusion:
It is essential to consult with a homeopathic practitioner for an accurate diagnosis and personalized treatment plan. Alongside homeopathic treatment for mouth ulcers, making dietary and lifestyle changes can further enhance the effectiveness of the treatment and help manage mouth ulcers more effectively.
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About Author:
Dr Kanchan marskole,
MD Scholar Batch 2021-22,
Department of Practice of Medicine, Government Homoeopathic
Medical College and Hospital Bhopal, Madhya Pradesh.
