conditions canker-sore

RECND552

Canker Sore

Condition:Aphthous Ulcer
Other:Canker Sore
ICD-10 Codes:K12

Summary

Top 3 natural treatments for canker sores.

1. Elimination diet
2. Chamomile tea (Matricaria recutita) rinse
3. Myrrh (Commiphora myrrh) rinse

Naturopathic Treatments

Diet
• elimination diet
• avoid preservatives, additives
• change toothpaste

Botanicals
chamomile tea (Matricaria recutita)
licorice (Glycyrrhiza glabra)
myrrh (Commiphora myrrh)
• alow gel (Aloe vera)

Supplements
vitamin B12
zinc
• deglycyrrhizinated licorice (DGL)
vitamin C
folic acid

Conventional Treatments

• mouth rinse containing dexamethasone
• antibiotics
• xylocaine
• diphenhydramine
• liquid antacids
• 3% hydrogen perozide/water solution gargle
• topical paste containing benzocaine, amlexanox, fluocinonide
• tetracycline syrup
• cimetidine
• colchicine
• debacterol
• corticosteroid creams

Signs & Symptoms

Minor:
• painful, shallow, small (<1 cm)
• lesions are preceded by burning or tingling
• present on labial or buccal mucosa, soft palate, tongue, floor of mouth
• lesions heal in 1-2 weeks, but tend to recur
• may scar

Major:
• lesions are deep, large (>1 cm)
• lesions heal in a month or longer

Herpetiform:
• cluster of small (1-5 mm) lesions
• painful, round/oval which later coalesce into larger ulcers with irregular borders

DDx

• oral cancer
• oral candidiasis
• acute necrotizing ulcerative gingivitis
• hand-foot-mouth disease
• Behcet s syndrome
• Reiter s syndrome
herpes simplex virus
• syphilis
• Vincent s stomatitis
• dental trauma
• chickenpox
• oropharyngeal anthrax
• pemphigus
• angular cheilitis

Pathogenesis

• chronic oral mucosa inflammation
• idiopathic; may result from hypersensitivity to antigens in oral mucosa;
• tends to recur for years and become secondarily infected by flora

Diagnostics

• physical exam
• subjective hx
• seek medical care if ulcers are recurrent or abnormally large, present with high fever, sores extend to the lips, pain is not alleviated by OTC medication, eating or drinking is very challenging;

Must Rule-out:
• celiac disease
• vitamin deficiency (C, folate, B12)
• Behcet's disease
• drug-induced (e.g. nicorandil)
• sodium lauryl sulfate in toothpaste
• infection

Diagnostic Tests
• visual exam
vitamin B12, folate, iron levels
• CBC
• Tzanck smear
• biopsy
• test for HIV

References

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