Ill fitting dentures
	Braces
	Sharp edge of a broken tooth
	Bacteria
	Fungal or viral infection
	Disease
	Symptom of a disease and/or disorder

1.  Canker sores are small white or gray based ulcer with a red border IN the mouth.  They are very common but not contagious. Fatigue, stress or allergies can increase the likelihood of getting canker sores.

Canker Sore Self Test  

 Canker Sores Expanded                                         

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2.  Cold sores are called fever blister or herpes simplex because they are usually caused by herpes virus type 1 which is very contagious and occur OUTSIDE the mouth. 

  

	Cold Sores	Canker Sores
Cause	Herpes simplex virus I/	Varied
Location	Most often found around the mouth but sometimes occur on the gums or roof of the mouth	Inside the mouth (soft tissue)
Duration	7-14 days	7-14 days
Treatment	Topical creams   Oral anti-viral medications Valtrex for herpes outside the mouth	Over-the-counter anesthetics   In severe cases, topical-based steroids
Is it contagious?	Yes	No
Triggers	Stress   Trauma   Ultraviolet light   Weakened immune system	Stress   Ultraviolet light   Certain foods   Trauma

Cold Sores Expanded

Dec 12/03 Academy of General Dentistry                                                             

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3.  Leukoplakia It is defined as a whitish plaque that cannot be characterized  as any other disease and is not associated with any physical or chemical causative agent except the use of tobacco ***  A thick, whitish  or gray color patch that forms on the inside of cheeks, gums or tongue and is caused by excess cell growth.  It is the mouth's reaction to chronic irritation of the mucous membranes of the mouth.  It is found among tobacco users, or those wearing ill fitting dentures or have a habit of chewing on their check.  It is more common in men than in women, however women with leukoplakia have a higher risk of developing squamous cell cancer.***

+

The growth can occur at any time in life but it most common in the elderly.
 

"Hairy" leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in people who are infected with HIV, have AIDS, or AIDS-related complex. It 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 which, in adults, usually occurs if your immune system is not working properly, and may be one of the first signs of infection with the HIV virus.  Unlike thrush, it is not easily scrapped off. It is painless, but patients occasionally complain of its appearance and texture.   Causes : Irritation from rough teeth, fillings, crowns, or ill-fitting dentures that rub against your cheek or gum Chronic smoking, pipe smoking, or other tobacco use body's reaction to the Epstein-Barr virus (responsible for mononucleosis) Sun exposure to the lips Oral cancer, although rare HIV or AIDS  Symptoms: White or gray colored patches on your tongue, gums, roof of your mouth, or the inside of the cheeks of your mouth. This patch may have developed slowly over weeks to months and be thick, slightly raised, and may eventually take on a hardened and rough texture. Painless but may be sensitive to touch, heat, spicy foods, or other irritation. Diagnosis Biopsy will likely be taken to rule out other causes. Treatment Treatment may involve: removing the source of irritation i.e. rough tooth or an irregular surface on a denture or filling the tooth will be smoothed and dental appliances repaired caused by smoking, you will be asked stop smoking or using other tobacco products. hairy leukoplakia requires treatment with an antiviral medication Leukoplakia is usually harmless, and lesions usually clear in a few weeks or months after the source of irritation is removed. If eliminating the source of irritation is ineffective in reducing leukoplakia, the lesion may need to be surgically removed. The lesion can be removed either by your general dentist or by an oral surgeon in their office under local anesthesia.ADA 7/04

         New Discovery-Sanguinarine, a natural anti-bacterial agent, was once a key ingredient in the Viadent line of toothpastes and mouth rinses.Researchers suspect that sanguinarine causes the formation of white lesions, called oral leukoplakia. The current study suggests that users of the former Viadent formulation were eight to 11 times more likely to develop leukoplakia than were those who had never used the product. Patients who used the old formulation of Viadent develop lesions two, three, four, even five years after they stopped using the product".  Patients with leukoplakia should be alert for oral cancer.* 

Oral lycopene - An efficacious treatment for oral leukoplakia?

A total of 58 patients received either 8 mg oral lycopene in two doses daily (n=20), 4 mg oral lycopene in two doses daily or placebo capsules  for a 3-month period. Progress of patients was followed for a further 2 months.

There was no significant difference in the clinical response of people who took 8 mg lycopene compared with those taking 4 mg lycopene. The clinical responses measured in both these groups were significantly greater, however, than those in the control group. The response, assessed histologically, after the 8-mg
lycopene treatment was significantly better than that from 4 mg lycopene and than the response seen in the control group, Patients taking 4 mg lycopene also responded significantly better than those in the control group .

Oral lycopene appears, from this small RCT conducted over 5 months, to be effective in the treatment and management of oral leukoplakia.

Oral lycopene — an efficacious treatment for oral leukoplakia? Joanna M Zakrzewska1
Singh M, Krishanappa R, Bagewadi A, Keluskar V. Efficacy of oral lycopene in the treatment of oral leukoplakia. Oral Oncol 2004; 40:591−596.

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4.  Oral lichen planus:

	is a mouth rash of unknown cause.
	is not contagious and not inherited.
	may be painless or cause pain.
	may be more severe at times of  stress.
	may eventually disappear.
	skin, nails and scalp may be affected .
	may be caused or aggravated by medicines, tooth filling materials, or toothpastes.
	biopsy is usually necessary to confirm the diagnosis.+
	Oral lesions-classifications and appearances
	white area wipes off and leaves a bleeding submucosa.

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Lichen Planus of the Mouth

Lichen planus of the mouth and tongue most commonly affects 1-2% of the population, most of whom are middle aged women. The condition is less common in the very young and the very old.  It appears on the inside of the cheeks, gums and tongue. Oral lichen planus is more difficult to treat and typically lasts longer than skin lichen planus. Fortunately, many cases of lichen planus of the mouth cause minimal problems. About one in five people who have oral lichen planus also have skin lichen planus.

Oral lichen planus typically appears as patches of fine white lines and dots. These changes usually do not cause problems. Dentists during routine checkups often find them. More severe forms of oral lichen planus can cause painful sores and ulcers in the mouth. Often a biopsy of affected tissue is needed to confirm a diagnosis of lichen planus. Your doctor may have to make sure that the sores are not caused by a yeast or an infection and are not canker sores.  Sometimes, several biopsies are needed at various times, along with blood tests.

No one knows what causes lichen planus, although some experts suspect that it is an abnormal immune reaction following a viral infection, probably aggravated by stress. Occasionally, lichen planus in the mouth appears to be an allergic reaction to medications, filling material, dental hygiene products, chewing gum, or candy. The cases of lichen planus-type allergic reactions to dental materials are very rare. When an allergy by dental material has been proven, removing dental material is recommended.

Lichen planus in the mouth occurs in six different forms with a variety of symptoms:

	lacy-white streaks
	white plaques, or eroded ulcers
	gums are affected, so that the surface of the gum peels off, leaving the gums red and raw.

                      
There is no known cure for oral lichen planus although there are many treatments that eliminate the pain of sores. When the disease causes no pain or burning, treatment may not be needed. More severe forms of lichen planus - those with pain, burning, redness, blisters, sores and ulcers - can be treated with a variety of medications, both applied to the sores (topical) and taken by mouth (oral). As with any disease of the lining of the mouth, lichen planus can lead to poor dental hygiene and gum disease.     

See:  www.aad.org/pamphlets/lichen.html 

 

Table 2. Compounds with potential to cause contact stomatitis include1,2
Antibiotics	Iodine
Antiseptic lozenges	Mouthwashes
Chewing gum	Toothpastes (especially those containing cinnamonaldehyde, formalin and herbal components)
Cosmetics	Topical anesthetics
Dental materials (amalgam, steel wires, beryllium, palladium, platinium, acrylic components)	Topical steroids
Food additives

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Table 4. Drugs that have potential to cause glossitis
Atrovastatin	Etidronate	Penicillamine
Benzodiazepines	Fluoxetine	Penicillins
Bleomycin	Fluvoxamine	Rivastigmine
Captopril	Gabapentin	Serteraline
Carbamazepine	Gold compounds	Sildenafil
Cephalosporines	Imipenem/cilastatin	Sulfonamides
Chloramphenicol	Lansoprazole	Tacrine
Chlorhexidine	Mefenamic acid	Tetracyclines
Clarithromycin	Mercaptopurine	Triamterene
Clomipramine	Methotrexate	Tricyclic antidepressants
Cyclosporine	Metronidazole	Trihexyphenidyl
Doxepin	NSAIDs	Venlafaxine
Enalapril	Olanzapine

The danger is that it can progress to cancer.  

This condition often needs a biospy.     

         

      Treatment involves identifying the factors that may cause the lesions. An examination and a biopsy are done in order to determine how to individually manage your care.  The cause of this condition must be removed .  The lesion must be examined at three to six month intervals depending on its type, location and size. Fluocinonide (Lidex) - 60g
apply to affected areas four times a day. Also try using milder toothpastes instead of tartar control products also seems to lessen the number of ulcers and makes them less sensitive.

                                                                             

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  5.    Candidiasis often know as oral thrush is a fungal infection that occurs when they yeast Candida albicans reproduce in large numbers. It can also be called angularchelitis.  It results in red and cream  or while colored, slightly raised patches on the mucous membrane of the tongue, mouth and throat that form on the mouth's moist surfaces. The mucous membrane beneath the patches is usually raw and bleeding. The overgrowth of  this fungus results when the balance in the normal oral microbe population is disturbed by antibiotic therapy or disease.  Tissues under the patch can be painful  It can cause difficult in swallowing and diminish the sense of taste. It occurs most frequently in infants, in adults suffering from chronic illnesses, in the debilitated, in the immunosuppressed.

 

     This is a common condition in very young, elderly or debilitated by disease or with improperly functioning immune system, denture wears who are over closed , babies, or  after antibiotic treatment and in individuals on long-term antibiotic, corticosteroid, or antineoplastic therapy.  It is often an early symptom of HIV infection.  People with dry mouths also have a higher occurrence of Candidiasis.  

     Treatment consists of controlling the conditions that caused the outbreak. Because candidiasis is common among denture-wearers, a thorough daily cleaning of dentures is important.  Removing dentures at night also allows the denture-bearing tissues to regenerate.  Saliva substitutes or prescription medication can help.  Good oral hygiene is essential. It can also be treated with antifungal/anti-inflammatory ointment. Also try hard not to lick your lips especially when the corners are cracked. Fluconazole is very helpful along with rigorous daily oral care   

Antifungals Nystain 200 mg oral Ketoconazole 200 tabs Itraconazole 100 mg Fluconazole 100 mg tabs Chlorhexidine glucoate 0.12% Amphotericin B 100 mg/ml suspension Clotrimazole 10 mg troches