To diagnose aphthous ulcers your dentist will:
Ask you about the acute or chronic problems and symptoms you are experiencing: your “Chief Complaint."
Take a detailed history of the problem: For example, ask if aphthous ulcers run in the family, how often do the aphthous ulcers occur each month or year, what triggers or causes the ulcer, how long do the ulcers last, how painful are the ulcers, what helps relieve the pain, what has helped heal the ulcers, etc.Please tell your dentist if you have experienced a feeling of a “slimy film” in your mouth after using your toothpaste or mouthwash, or in the morning after waking up – this may this may indicate a reaction to Sodium Laurel Sulfate (SLS).
Please tell your dentist if you have any allergies, particularly food allergies, as some of these allergies may also be associated with triggering aphthous ulcers.
Use your clinical signs, symptoms and history to make a diagnosis, and to also rule out conditions that cause other types of oral lesions, such as a cold sore caused by the herpes virus.
Extraoral Exam: The dentist will inspect tissues of the head, face and neck for any abnormality. Intraoral Exam: The dentist will examine your mouth and teeth by:
Inspecting all the soft tissues of the mouth, noting any changes in the tissues that appear different than the normal or healthy condition. The size, type and location of any/all ulcers will be noted on your dental record/chart.
Your dentist may take photos of the ulcer(s).
Evaluating your gum (periodontal) health and inspecting the gum tissues around the teeth.
While inspecting the gum tissues around the teeth as well as the tissues lining the lips and cheeks, the dentist should look specifically for any signs of a thin white film, which may indicate a tissue reaction (sloughing) to Sodium Laurel Sulfate.
Examining and evaluating your occlusion (bite) to determine if your teeth are functioning properly or abnormally. People who have misaligned teeth can often have problems like cheek or lip biting, and the trauma from biting is often a cause of aphthous ulcers. Specialist Referral:
Your dentist may refer you to a dental, specialist such as a periodontist or specialist in oral medicine or oral pathology, for further diagnosis and treatment.
Physician Referral:
Your dentist may also refer you to a physician, such as an allergist, for further diagnosis and treatment.
Treatments Available for Aphthous Ulcers:
Minor aphthous ulcers generally respond well to treatment with prescription topical corticosteroid medicine. Topical corticosteroids have an anti-inflammatory effect that studies have shown help reduces the severity and duration of an aphthous ulcer, especially if the medicine is used as soon as possible after the ulcer appears.
Triamcinolone Dental Paste, 0.1%
The most common prescription topical corticosteroid used to treat aphthous ulcers is an adhesive dental paste containing triamcinolone (Kenalog) 0.1%. The dentist writes a prescription for this medicine for the patient to use at home, at work or while traveling.
The triamcinolone paste comes in a small tube and is used as follows:
Begin using this medication at the first sign of an ulcer, if possible, during the prodromal stage before the actual ulcer appears, when there just is burning or tingling. Otherwise, apply the medicine immediately to the area in the mouth that that has been traumatized, for example, from biting the lip or cheek.
Pull the lip or cheek out and pat the ulcer dry if possible with a q-tip or piece of tissue paper.
Apply a small dab of the paste onto a clean fingertip or Q-tip, and coat the ulcer with a layer of the paste that covers the ulcer completely.
If possible, run the tongue over the paste that is on the ulcer. The saliva will smooth out the paste and help the paste not stick to the teeth or other tissues.
Apply the triamcinolone paste at least four times per day, and up to 10 times per day as needed.
Continue to use the paste as directed until the ulcer heals.Corticicosteroid Mouthrinse
If the ulcer is not accessible enough to apply the triamcinolone paste, medicine can still be effectively delivered to the aphthous ulcer(s) with a corticosteroid mouthrinse such as dexamethazone. Five milliliters of the mouthrinse preparation is swished around in the mouth where the ulcer is located for two minutes, four times per day, until the ulcer heals. This mouthrinse is to be spit out after use, and not swallowed.
Chlorhexidine Mouthrinse
Some treatment regimens involve the use of both the triamcinolone paste and a prescription chlorhexidine mouthrinse (that does not contain alcohol). Some studies have shown that aphthous ulcers respond well to chlorhexidine rinsing.
More Potent Topical Corticosteroids
Some minor and major aphthous ulcer cases require stronger topical corticosteroid medicines, and a number of these medicines are available and can be prescribed if needed.
Systemic Corticosteroids
Some patients may require a short term (five day) dose of corticosteroid medication, which is taken by mouth, to effectively treat their aphthous ulcers.
Corticosteroid Injections
More severe aphthous ulcer cases may require an injection (“intralesional injection”) of a corticosteroid at the site of the ulcer in order to deliver enough medicine directly to the ulcerated area to help it heal.
Occlusal Adjustment
If cheek and/or lip biting is related to a problem with occlusion (the bite), the dentist can adjust your bite, adjust or make new dentures, or recommend orthodontic treatment to help the teeth function more properly. This may lessen the potential of cheek biting.
Dental Lasers
There are some reports that dental lasers can help reduce the pain of aphthous ulcers, but there are no large scale studies to confirm the benefits of this therapy.
Follow-up Care
Follow-up care is needed if more potent corticosteroid medication is used in order to monitor for any side effects such as yeast/candida infection.
Dental Specialist Referral
Your dentist may refer you to a dental specialist, such as a periodontist or specialist in oral medicine or oral pathology, for further diagnosis and treatment.
Physician Referral
Your dentist may also refer you to a physician for further diagnosis and treatment.
