Canker sores, or aphthous ulcers, are the lesions caused by AS. They may seem like a fairly benign, limited condition, but in the presence of so many other problems that occur with IBD they can be upsetting and painful. Fortunately they are usually harmless and treatment is aimed at reducing discomfort. AS is not believed to be contagious and cannot be spread to other people.
Symptoms
Aphthous ulcers are shallow ulcers in the mucosa (lining) of the mouth. They may appear anywhere in the mouth, but are frequently found on the inside of the lower lip or cheeks, or on the sides or base of the tongue. They may last from 1 to 2 weeks to months. The ulcers may appear whitish or yellow with a red base, with a grayish layer that develops when they begin to heal.Causes
It is not known why AS may appear in some people with IBD. Some theories include stress, bacterial infection, or trauma. Clearly, there is a link between severe AS and a weakened immune system.Theories on the cause of AS also include deficiencies of various vitamins and minerals.
Diagnosis
AS that is not very troublesome or painful does not necessarily require a specific visit to a physician. However, it should be discussed at the next visit to the gastroenterologist who is treating the IBD. If the ulcers become large, very painful, or do not heal, a dentist or physician should be consulted. A gastroenterologist can determine if the ulcers are in fact AS, in most cases simply by their appearance, and if further testing or any treatment is needed. Mouth ulcers can be caused by other conditions (such as contact dermatitis, herpes infection, hand-foot-and-mouth disease, and lupus) that may need treatment so they should always be seen by a physician for a diagnosis.If the ulcers do appear troublesome, the physician may order tests such as a complete blood cell count; erythrocyte sedimentation rate; and iron, folate, and B-12 levels. A culture or biopsy of the lesions may also be taken.
Treatment
Mild cases of AS may not require any treatment as the ulcers will heal on their own. Topical anesthetics such as lidocaine are frequently prescribed for local pain relief. Troublesome ulcers may be treated with a topical corticosteroid in a paste, cream, spray, or rinse. A specific treatment for AS, amlexanox, is occasionally prescribed for topical use as well, with published studies showing good effectiveness. Mouth rinses that reduce the amount of bacteria in the mouth may also be used. Cases of AS that are related to a serious underlying condition such as HIV infection may be treated with oral medication.If the ulcers are irritated by certain foods, there may need to be a change in diet. Soft, bland, non-acidic foods (without spices or salt) may lessen irritation. Sucking on ice chips may relieve some pain. Other treatments, such as applying milk of magnesia to the sores or rinsing with salt water, diluted hydrogen peroxide, or Benadryl (diphenhydramine) may be helpful in some cases. Pain killers are also sometimes used, but remember that NSAIDs may cause a flare-up of IBD in some people.
Because AS may also be worsened by trauma, it is important to take care to not bite or injure the inside of the mouth. Any dental problems (jagged teeth, ill-fitting appliances) that may be causing or contributing to the ulcers should be addressed by a dentist.
In cases of AS that are due to a flare-up of IBD, the ulcers typically resolve when the flare-up is under control.
