Aphthous ulcer causes: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 8: | Line 8: | ||
==Causes== | ==Causes== | ||
===Trauma=== | ===Trauma=== | ||
Trauma to the mouth is the most common trigger of aphthous ulcers | 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> | ||
*Toothbrush abrasions | |||
*Lceration with sharp foods or objects | |||
*Accidental biting (particularly common with sharp canine teeth) | |||
*[[Dental braces]] | |||
===Drugs=== | ===Drugs=== | ||
| Line 27: | Line 31: | ||
===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 [[allergens]] such as:<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> | ||
*Environmental allergens | |||
*Food substances | |||
**Milk | |||
**Chocolate | |||
**Cheese | |||
**Nuts | |||
**Tomatoes | |||
**Wheat | |||
====SLS containing Toothpaste==== | ====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:<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> | ||
*[[Streptococcus|Streptococcus sanguis]] | |||
*[[Helicobacter pylori]] | |||
*[[Varicella zoster]] | |||
*[[Cytomegalovirus]] | |||
===Immune System=== | ===Immune System=== | ||
| Line 46: | Line 62: | ||
**Increased levels of several cytokines such as [[interleukin-2]], [[interferon-g]], and [[tumor necrosis factor-a|tumor necrosis factor-a (TNF-a)]] | **Increased levels of several cytokines such as [[interleukin-2]], [[interferon-g]], and [[tumor necrosis factor-a|tumor necrosis factor-a (TNF-a)]] | ||
=== | ===systemic conditions=== | ||
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> | 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><ref name=Crohn’s-Aphthous> Schnitt SJ, Antonioli DA, Jaffe B, Peppercorn MA. Granulomatous inflammation of minor salivary gland ducts: a new oral manifestation of Crohn’s disease. Hum Pathol 1987; 18: 405–7.</ref><ref name=HIV-Aphthous-2>Ramos-Gomez FJ, Flaitz C, Catapano P, Murray P, Milnes AR, Dorenbaum A. Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection. J Clin Pediatr Dent 1999; 23: 85–96.</ref> | ||
*[[Behcet’s syndrome]] | *[[Behcet’s syndrome]] | ||
*MAGIC syndrome | *MAGIC syndrome | ||
| Line 54: | Line 70: | ||
*[[HIV]] | *[[HIV]] | ||
Revision as of 20:34, 6 September 2016
|
Aphthous ulcer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Aphthous ulcer causes On the Web |
|
American Roentgen Ray Society Images of Aphthous ulcer causes |
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.[2][3][4]
- Toothbrush abrasions
- Lceration with sharp foods or objects
- Accidental biting (particularly common with sharp canine teeth)
- Dental braces
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
Allergic Factors
It is thought that aphthous ulcer may be caused by hypersensitivity to certain allergens such as:[6][7]
- Environmental allergens
- Food substances
- Milk
- Chocolate
- Cheese
- Nuts
- Tomatoes
- Wheat
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.[8][9] However, some studies find no connection between SLS in toothpaste and mouth ulcers.[10]
Microbial Factors
It is thought that aphthous ulcers may be caused by microbial factors such as:[11][12][13]
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.[14] 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.[14] 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.[15]
- The exact pathogenesis of recurrent aphthous ulcer in immunocompromised patients is not fully understood. It is thought that aphthous ulcer in immunocompromised patients may occur by following mechanisms:[16][17]
Abnormality in immunologic response may result in aphthous ulcer by following mechanisms:
- Deposition of immune complexes within the oral epithelium
- Elevated level of salivary immunoglobulin A
- Alteration of the CD41/CD81 ratio
- Increased levels of several cytokines such as interleukin-2, interferon-g, and tumor necrosis factor-a (TNF-a)
systemic conditions
Common systemic conditions that may be caused in aphthous ulcer are include:[18][19][20]
- Behcet’s syndrome
- MAGIC syndrome
- Cyclic neutropenia
- Crohn’s disease
- HIV
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.
- ↑ 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.
- ↑ 14.0 14.1 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). - ↑ Pekiner FN, Aytugar E, Demirel GY, et al. Interleukin-2, interleukin-6 and T reg- ulatory cells in peripheral blood of patients with Behcet’s disease and recurrent aphthous ulcerations. J Oral Pathol Med 2012;41(1):73–9.
- ↑ Hasan A, Shinnick T, Mizushima Y, et al. Defining a T-cell epitope within HSP 65 in recurrent aphthous stomatitis. Clin Exp Immunol 2002;128(2):318–25.
- ↑ 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.
- ↑ Schnitt SJ, Antonioli DA, Jaffe B, Peppercorn MA. Granulomatous inflammation of minor salivary gland ducts: a new oral manifestation of Crohn’s disease. Hum Pathol 1987; 18: 405–7.
- ↑ Ramos-Gomez FJ, Flaitz C, Catapano P, Murray P, Milnes AR, Dorenbaum A. Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection. J Clin Pediatr Dent 1999; 23: 85–96.