Aphthous ulcer causes: Difference between revisions
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==Causes== | ==Causes== | ||
===Trauma=== | ===Trauma=== | ||
Trauma to the mouth is the most common trigger of aphthous ulcers.<ref name="pmid8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135 }} </ref><ref name="pmid7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393 }} </ref><ref name="pmidPMID 105102">{{cite journal| author=Wray D, Ferguson MM, Hutcheon WA, Dagg JH| title=Nutritional deficiencies in recurrent aphthae. | journal=J Oral Pathol | year= 1978 | volume= 7 | issue= 6 | pages= 418-23 | pmid=PMID 105102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=105102 }} </ref> | Trauma to the mouth is the most common trigger of aphthous ulcers.[[Physical trauma]], such as that caused by toothbrush abrasions, laceration with sharp foods or objects, accidental biting (particularly common with sharp canine teeth), or [[dental braces]] can cause mouth ulcers by breaking the mucous membrane.<ref name="pmid8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135 }} </ref><ref name="pmid7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393 }} </ref><ref name="pmidPMID 105102">{{cite journal| author=Wray D, Ferguson MM, Hutcheon WA, Dagg JH| title=Nutritional deficiencies in recurrent aphthae. | journal=J Oral Pathol | year= 1978 | volume= 7 | issue= 6 | pages= 418-23 | pmid=PMID 105102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=105102 }} </ref> | ||
===Drugs=== | ===Drugs=== | ||
Line 30: | Line 26: | ||
*HLA-DQ series | *HLA-DQ series | ||
==Nutritional | ===Nutritional Factors=== | ||
Aphthous ulcers are commonly seen in nutritional deficiencies. | |||
Low serum levels of following elements may result in recurrent aphthous ulcer:<ref name=Nutritional-Aphthous> Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991; 20: 389–91.</ref> | Low serum levels of following elements may result in recurrent aphthous ulcer:<ref name=Nutritional-Aphthous> Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991; 20: 389–91.</ref> | ||
*[[Iron]] | *[[Iron]] | ||
Line 36: | Line 33: | ||
*[[Zinc]] | *[[Zinc]] | ||
*[[Vitamins B1]], [[Vitamins B2|B2]], [[Vitamins B6|B6]], and [[Vitamins B12|B12]] | *[[Vitamins B1]], [[Vitamins B2|B2]], [[Vitamins B6|B6]], and [[Vitamins B12|B12]] | ||
===Allergic Factors=== | ===Allergic Factors=== | ||
It is thought that aphthous ulcer may be caused by [[hypersensitivity]] to certain | It is thought that aphthous ulcer may be caused by [[hypersensitivity]] to certain environmental allergens or food substances such as milk, chocolate, cheese, nuts, tomatoes, and wheat.<ref name=Allergens-aphthous>Wray D, Vlagopoulos TP, Siraganian RP. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982; 54(4):388–95.</ref><ref name=Allergens-Aphthous-2>Pacor ML, Di Lorenzo G, Martinelli N, et al. Results of double-blind placebo- controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis. Int Arch Allergy Immunol 2003;131(4):296–300.</ref> | ||
===SLS containing Toothpaste=== | |||
The large majority of toothpastes sold in the U.S. contain [[Sodium dodecyl sulfate|Sodium lauryl sulfate]] (SLS), which is known to cause Aphthous ulcers in certain individuals. Using a [[toothpaste]] without SLS will reduce the frequency of | The large majority of toothpastes sold in the U.S. contain [[Sodium dodecyl sulfate|Sodium lauryl sulfate]] (SLS), which is known to cause Aphthous ulcers in certain individuals. Using a [[toothpaste]] without SLS will reduce the frequency of Aphthous ulcers in persons who experience Aphthous ulcers caused by SLS.<ref name="pmidPMID 7825393">{{cite journal| author=Herlofson BB, Barkvoll P| title=Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. | journal=Acta Odontol Scand | year= 1994 | volume= 52 | issue= 5 | pages= 257-9 | pmid=PMID 7825393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7825393 }} </ref><ref name="pmidPMID 8811135">{{cite journal| author=Herlofson BB, Barkvoll P| title=The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. | journal=Acta Odontol Scand | year= 1996 | volume= 54 | issue= 3 | pages= 150-3 | pmid=PMID 8811135 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8811135 }} </ref> | ||
However, some studies find no connection between SLS in toothpaste and mouth ulcers.<ref name="pmidPMID 10218040">{{cite journal| author=Healy CM, Paterson M, Joyston-Bechal S, Williams DM, Thornhill MH| title=The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration. | journal=Oral Dis | year= 1999 | volume= 5 | issue= 1 | pages= 39-43 | pmid=PMID 10218040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10218040 }} </ref> | However, some studies find no connection between SLS in toothpaste and mouth ulcers.<ref name="pmidPMID 10218040">{{cite journal| author=Healy CM, Paterson M, Joyston-Bechal S, Williams DM, Thornhill MH| title=The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration. | journal=Oral Dis | year= 1999 | volume= 5 | issue= 1 | pages= 39-43 | pmid=PMID 10218040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10218040 }} </ref> | ||
===Microbial Factors=== | ===Microbial Factors=== | ||
It is thought that aphthous ulcers may be caused by microbial factors such as | It is thought that aphthous ulcers may be caused by microbial factors such as [[Streptococcus|Streptococcus sanguis]], [[Helicobacter pylori]], [[Varicella zoster]], and [[Cytomegalovirus]].<ref name=Microbial-aphthous> Lindemann RA, Riviere GR, Sapp JP. Serum antibody responses to indigenous oral mucosal antigens and selected laboratory-maintained bacteria in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1985;59:585.</ref><ref name=CMV-Aphthous> Leimola-Virtanen R, Happonen RP, Syrjanen S. Cytomegalovirus (CMV) and Hel- icobacter pylori (HP) found in oral mucosal ulcers. J Oral Pathol Med 1995;24: 14–7. </ref><ref name=Varicella-Aphthous> Pedersen A, Hornsleth A. Recurrent aphthous ulceration: a possible clinical mani- festation of reaction of varicella zoster of cytomegalovirus infection. J Oral Pathol Med 1993;22:64–8.</ref> | ||
===Immune System=== | ===Immune System=== | ||
Although the exact cause is not known, aphthous ulcers are thought to form when the body becomes aware of and attacks [[molecules]] which it does not recognize.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> The presence of the unrecognized [[molecule]]s garners a reaction by the [[T-cell]]s, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory [[T-cell]]s.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> | Although the exact cause is not known, aphthous ulcers are thought to form when the body becomes aware of and attacks [[molecules]] which it does not recognize.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> The presence of the unrecognized [[molecule]]s garners a reaction by the [[T-cell]]s, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory [[T-cell]]s.<ref name="Lewkowicz">{{cite journal |author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H.|title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. |journal=Immunol Lett. |volume=99 |issue=1 |pages=57-62 |year=2005 |pmid=15894112}}</ref> | ||
Repeat episodes of aphthous ulcers can be indicative of an [[immunodeficiency]], signalling low levels of [[immunoglobulin]] in the mucous membrane of the mouth. Certain types of [[chemotherapy]] cause mouth ulcers as a side effect.<ref name="pmidPMID 15894112">{{cite journal| author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H| title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. | journal=Immunol Lett | year= 2005 | volume= 99 | issue= 1 | pages= 57-62 | pmid=PMID 15894112 | doi=10.1016/j.imlet.2005.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15894112 }} </ref> | Repeat episodes of aphthous ulcers can be indicative of an [[immunodeficiency]], signalling low levels of [[immunoglobulin]] in the mucous membrane of the mouth. Certain types of [[chemotherapy]] cause mouth ulcers as a side effect.<ref name="pmidPMID 15894112">{{cite journal| author=Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H| title=Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. | journal=Immunol Lett | year= 2005 | volume= 99 | issue= 1 | pages= 57-62 | pmid=PMID 15894112 | doi=10.1016/j.imlet.2005.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15894112 }} </ref> | ||
=== | ===Systemic Disease=== | ||
Common systemic conditions that may be caused in aphthous ulcer are include:<ref name=Behcet’s-disease> Klein P, Weinberger A, Altmann VJ, et al. Prevalence of Behcet’s disease among adult patients consulting three major clinics in a Druze town in Israel. Clin Rheu- matol 2010;29(10):1163–6 | Common systemic conditions that may be caused in aphthous ulcer are include:<ref name=Behcet’s-disease> Klein P, Weinberger A, Altmann VJ, et al. Prevalence of Behcet’s disease among adult patients consulting three major clinics in a Druze town in Israel. Clin Rheu- matol 2010;29(10):1163–6.</ref> | ||
*[[Behcet’s syndrome]] | *[[Behcet’s syndrome]] | ||
*MAGIC syndrome | *MAGIC syndrome | ||
*[[Cyclic neutropenia]] | *[[Cyclic neutropenia]] | ||
*[[Crohn’s disease]] | *[[Crohn’s disease]] | ||
*[[Ulcerative colitis]] | |||
*[[HIV]] | *[[HIV]] | ||
*Cyclic neutropenia | |||
* | |||
Revision as of 20:49, 6 September 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
The exact cause of aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid.[1] Some drugs, such as nicorandil, also have been linked with mouth ulcers. In some cases they are thought to be caused by an overreaction by the body's own immune system.
Causes
Trauma
Trauma to the mouth is the most common trigger of aphthous ulcers.Physical trauma, such as that caused by toothbrush abrasions, laceration with sharp foods or objects, accidental biting (particularly common with sharp canine teeth), or dental braces can cause mouth ulcers by breaking the mucous membrane.[2][3][4]
Drugs
Genetic Factors
The role of genetic factors is the best-defined underlying cause of aphthous ulcer. Certain genetically specific HLAs which have been identified in aphthous ulcer patients include:[5]
- HLA-A2
- HLA-B5, B12, B44, B51, B52
- HLA-DR2 and HLA-DR7
- HLA-DQ series
Nutritional Factors
Aphthous ulcers are commonly seen in nutritional deficiencies. Low serum levels of following elements may result in recurrent aphthous ulcer:[6]
Allergic Factors
It is thought that aphthous ulcer may be caused by hypersensitivity to certain environmental allergens or food substances such as milk, chocolate, cheese, nuts, tomatoes, and wheat.[7][8]
SLS containing Toothpaste
The large majority of toothpastes sold in the U.S. contain Sodium lauryl sulfate (SLS), which is known to cause Aphthous ulcers in certain individuals. Using a toothpaste without SLS will reduce the frequency of Aphthous ulcers in persons who experience Aphthous ulcers caused by SLS.[9][10] However, some studies find no connection between SLS in toothpaste and mouth ulcers.[11]
Microbial Factors
It is thought that aphthous ulcers may be caused by microbial factors such as Streptococcus sanguis, Helicobacter pylori, Varicella zoster, and Cytomegalovirus.[12][13][14]
Immune System
Although the exact cause is not known, aphthous ulcers are thought to form when the body becomes aware of and attacks molecules which it does not recognize.[15] The presence of the unrecognized molecules garners a reaction by the T-cells, which trigger a reaction that causes the damage of a mouth ulcer. People who get these ulcers have lower numbers of regulatory T-cells.[15] Repeat episodes of aphthous ulcers can be indicative of an immunodeficiency, signalling low levels of immunoglobulin in the mucous membrane of the mouth. Certain types of chemotherapy cause mouth ulcers as a side effect.[16]
Systemic Disease
Common systemic conditions that may be caused in aphthous ulcer are include:[17]
- Behcet’s syndrome
- MAGIC syndrome
- Cyclic neutropenia
- Crohn’s disease
- Ulcerative colitis
- HIV
- Cyclic neutropenia
References
- ↑ Wray D, Ferguson M, Hutcheon W, Dagg J (1978). "Nutritional deficiencies in recurrent aphthae". J Oral Pathol. 7 (6): 418–23. PMID 105102.
- ↑ Herlofson BB, Barkvoll P (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontol Scand. 54 (3): 150–3. PMID 8811135.
- ↑ Herlofson BB, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study". Acta Odontol Scand. 52 (5): 257–9. PMID 7825393.
- ↑ Wray D, Ferguson MM, Hutcheon WA, Dagg JH (1978). "Nutritional deficiencies in recurrent aphthae". J Oral Pathol. 7 (6): 418–23. PMID 105102 PMID 105102 Check
|pmid=
value (help). - ↑ Albanidou‐Farmaki, E., et al. "HLA haplotypes in recurrent aphthous stomatitis: a mode of inheritance?." International journal of immunogenetics 35.6 (2008): 427-432.
- ↑ Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991; 20: 389–91.
- ↑ Wray D, Vlagopoulos TP, Siraganian RP. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982; 54(4):388–95.
- ↑ Pacor ML, Di Lorenzo G, Martinelli N, et al. Results of double-blind placebo- controlled challenge with nickel salts in patients affected by recurrent aphthous stomatitis. Int Arch Allergy Immunol 2003;131(4):296–300.
- ↑ Herlofson BB, Barkvoll P (1994). "Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study". Acta Odontol Scand. 52 (5): 257–9. PMID 7825393 PMID 7825393 Check
|pmid=
value (help). - ↑ Herlofson BB, Barkvoll P (1996). "The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers". Acta Odontol Scand. 54 (3): 150–3. PMID 8811135 PMID 8811135 Check
|pmid=
value (help). - ↑ Healy CM, Paterson M, Joyston-Bechal S, Williams DM, Thornhill MH (1999). "The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration". Oral Dis. 5 (1): 39–43. PMID 10218040 PMID 10218040 Check
|pmid=
value (help). - ↑ Lindemann RA, Riviere GR, Sapp JP. Serum antibody responses to indigenous oral mucosal antigens and selected laboratory-maintained bacteria in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1985;59:585.
- ↑ Leimola-Virtanen R, Happonen RP, Syrjanen S. Cytomegalovirus (CMV) and Hel- icobacter pylori (HP) found in oral mucosal ulcers. J Oral Pathol Med 1995;24: 14–7.
- ↑ Pedersen A, Hornsleth A. Recurrent aphthous ulceration: a possible clinical mani- festation of reaction of varicella zoster of cytomegalovirus infection. J Oral Pathol Med 1993;22:64–8.
- ↑ 15.0 15.1 Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchorzewski H. (2005). "Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations". Immunol Lett. 99 (1): 57–62. PMID 15894112.
- ↑ Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H (2005). "Predominance of Type 1 cytokines and decreased number of CD4(+)CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations". Immunol Lett. 99 (1): 57–62. doi:10.1016/j.imlet.2005.01.002. PMID 15894112 PMID 15894112 Check
|pmid=
value (help). - ↑ Klein P, Weinberger A, Altmann VJ, et al. Prevalence of Behcet’s disease among adult patients consulting three major clinics in a Druze town in Israel. Clin Rheu- matol 2010;29(10):1163–6.