Aphthous Stomatitis
'Aphthous stomatitis' , or simply ‘aphthae’ (mouth ulcers), announce themselves with itching and redness in the area a day or two before they appear, and then become a slightly hollowed sore 2–3 mm in diameter with a white centre surrounded by a red halo. They look like a small crater and are very painful. They last about 1 week to 15 days and then heal. Aphthae always form inside the mouth and are neither contagious nor viral. These features distinguish them from cold sores.
Factors involved in the formation of mouth ulcers
Stress: Stress, now accepted as one of the causes of many conditions such as migraine, high blood pressure and gastritis, is one of the most important causes of mouth ulcers. In women, premenstrual tension (the period before menstruation) is also a factor that accelerates their formation.
Foods: Foods that can irritate the oral mucosa, such as citrus fruits, vinegar, pickles, crisps and salty and spicy snacks, are considered important factors that accelerate ulcer formation. In addition, foods that can be allergenic for some people, such as buckwheat, rye, barley, chocolate, hazelnuts, shellfish, soya, tomatoes, aubergine, apples, figs and cheese, also accelerate ulcer formation.
Trauma: Biting the cheek, tongue or lips, irritation from hard foods, harsh tooth brushing, sore spots caused by poorly fitting dentures and badly made fillings help create suitable ground for ulcers.
Toothpaste: "Sodium lauryl sulphate" (SLS), added to toothpastes as a foaming agent to improve their cleaning properties, is an irritant chemical that increases the breakdown of mucosal cells. With this property, SLS is a substance with a direct effect on ulcer formation.
Systemic Diseases: Behçet’s disease: a disease that presents with recurrent ulcers inside the mouth together with many systemic signs such as genital ulcers, conjunctivitis, retinitis and leucocytosis.
Recurrent mouth ulcers can also be seen together with many malignant and autoimmune diseases.
Other causes: Vitamin B12 and iron deficiency and habits such as smoking and chewing tobacco are known to be important factors contributing to ulcer formation.
Treatment
Mouth ulcers, which cannot be cured as such, usually heal on their own after 7–15 days even without any treatment. Measures taken are aimed only at reducing pain and soreness. Recently, technological advances in dentistry have also created alternatives for ulcer treatment. Laser applied in 2 sessions while the ulcer is emerging can reduce its pain and allow it to heal in a very short time.
People troubled by mouth ulcers may have an easier time if they apply one or more of the measures listed below.
To reduce pain and shorten the healing period
· Hot, acidic and irritating foods should be avoided.
· The ulcer area can be cleaned with cotton wool or gauze soaked in hydrogen peroxide.
· A thin paste made from water and bicarbonate of soda can be applied to the ulcer.
· A solution made by adding half a spoonful of salt to half a glass of water can be used as a gargle three times a day,
· Anaesthetic creams made for the mouth can be applied to the ulcer before meals.
Although various types of sores appear in the mouth as a sign of many diseases, mouth ulcers are also seen in healthy people. Only major-type ulcers that recur very often or reach nearly 1 cm in size and cause swelling in the throat may herald a systemic disease. In this case it is advisable to see a doctor.
Scrotal Tongue
The tongue is known to be the strongest muscle in the human body, and we can say that it is a muscle that works very hard. Sometimes one or more deep cracks may form on the tongue, and these cracks may extend over the surface, the back and even the sides of the tongue. This condition, known as cracked tongue, is called fissured tongue or scrotal tongue in medical terminology.
A cracked tongue may arise from many factors, from anaemia to nutritional deficiency. Understanding the possible causes of the cracks on the tongue can help prevent tongue sores and reduce the associated symptoms. It also allows your doctor to determine the most effective treatment for you as quickly as possible.
WHAT ARE THE CAUSES OF A CRACKED TONGUE?
There is no very specific cause for a tongue that is cracked or looks as if it were torn. Many experts have put forward various theories to explain it. However, to date no single theory has been accepted as satisfactorily explaining the cause of this condition.
1- Tongue Injury: Constant rubbing of the tongue, especially its back and sides, through brushing, or constant trauma to the tongue while speaking or eating because of a broken tooth or ill-fitting dentures, can cause cracks to form on the tongue.
2- Hereditary Cause: Some people may be hereditarily predisposed to this condition (fissured tongue). However, this claim has not been supported by conclusive studies.
3- Tongue abnormalities: Conditions such as geographic tongue and hairy tongue can cause cracks in the tongue. In geographic tongue there is a loss of the filiform papillae on the tongue, and the affected area looks patchy. These patches can occur on the sides of the tongue as well as on its surface and can cause tears in that area. Hairy tongue is a condition in which keratinisation and overgrowth of the thread-like papillae on the tongue make the tongue look hairy. In addition to this appearance, the condition can lead to a cracked tongue.
4- Other Causes: Factors such as stress, clenching or grinding of the teeth and eating very spicy foods can also cause cracks in the tongue.
Sometimes oral thrush or an oral fungal infection can lead to fissures in the tongue. Oral thrush is a mouth infection of the lining of the mouth caused by the Candida fungus when the immune system is weakened.
Melkersson-Rosenthal Syndrome
Because the facial nerve is long and runs a winding course through a narrow bony canal, it is the cranial motor nerve whose function is most often impaired. Many factors such as infections, trauma, tumours, metabolic disorders, congenital anomalies and collagen tissue diseases can cause facial paralysis. However, in most cases no cause is found. Bell’s palsy and Melkersson-Rosenthal syndrome (MRS) belong to this idiopathic group. MRS is a neuro-mucocutaneous granulomatous disease characterised by the triad of recurrent peripheral facial paralysis, painless non-pitting orofacial oedema and fissured tongue. This syndrome, rare in childhood, is more common in the 2nd and 3rd decades of life. The classic triad may not always be present together. The findings may also appear one at a time at different times. The most common finding is orofacial oedema, present in 80% to 100% of cases. Fissured tongue is seen in 30–40% of cases.
Geographic Tongue
Geographic tongue is a bothersome but harmless condition that usually affects the upper surface and sides of the tongue. Because of its map-like shapes, the condition is called geographic tongue (map tongue). Geographic tongue is caused by the papillary areas of the tongue whitening and becoming prominent. Over time, red areas and white and pink patch shapes may be seen on the tongue. In this condition your tongue may also be more sensitive to hot, acidic and spicy foods. The red area on the tongue can sometimes become infected with thrush (candida). Burning, soreness, pain and bad breath may be seen with geographic tongue.
The causes of geographic tongue are not definitely known at present. Factors that may trigger geographic tongue include:
- Nutritional deficiency,
- Allergy,
- Oral parafunctional habits,
- Emotional stress and other psychological factors,
- Diabetes and hormonal disorders
Geographic tongue is also more common in people with psoriasis. Some doctors state that geographic tongue is psoriasis occurring on the tongue. Based on the research carried out, nothing definitive can be said on this subject.
There is not yet any established treatment for geographic tongue. You can use natural methods to relieve discomfort such as irritation caused by geographic tongue and to improve your quality of life. For a correct diagnosis, and to make sure it does not lead to serious problems, you should consult a specialist doctor.
Black Hairy Tongue
Black hairy tongue (BHT), also known as lingua villosa nigra, was first described in 1557 by Amatus Lusitanus. The disease is characterised by reactive hypertrophy of the filiform papillae together with a defect in desquamation on the dorsal surface of the tongue. The hairy appearance of the tongue is associated with increased keratinisation of the filiform papillae. The aetiopathogenesis of the disease is not fully known. However, poor oral hygiene, smoking and alcohol use, the use of oxidising agents such as sodium peroxide for oral hygiene, the use of certain systemic medicines and candidal infection are among the factors implicated.
Atrophic Glossitis
Atrophic glossitis is an inflammatory disease of the tongue that leads to atrophy of the papillae in the structure of the tongue. Papillae are small projections on the surface of your tongue that contain sensors called taste buds. In this disease the tongue appears red with a smooth surface.
What causes atrophic glossitis?
Atrophic glossitis can arise from many causes. These can be listed as follows:
- Nutritional deficiency (iron deficiency, low B12 and folic acid levels and vitamin deficiencies)
- Dry mouth
- Sjögren’s syndrome
- Candida (fungal) infection in the mouth
- Protein-calorie deficiency in elderly people
- Coeliac disease
- While taking certain medicines
What complaints occur in atrophic glossitis?
Patients with atrophic glossitis mostly complain of a dry mouth, a burning sensation in the tongue and increased sensitivity, especially when eating acidic and salty foods. For this reason the patient may describe difficulty swallowing and speaking. The diagnosis is made with a thorough physical examination. The appearance of the tongue is typical, and investigations are carried out to diagnose the underlying disease in order to guide treatment.
How is atrophic glossitis treated?
The main aims of treatment are ensuring good oral hygiene, reducing inflammation and pain, avoiding substances that irritate the tongue and treating the underlying disease.
Exfoliative Cheilitis
Exfoliative cheilitis is also known as cheilitis exfoliativa or tic de lèvres. It is a chronic disease that affects only the red border (vermilion) of the lips. Hereditary factors and a disorder of the autonomic nervous system, which innervates the internal organs and blood vessels, play an important role in the development of this type of cheilitis.
The inflammation spreads along the red border of the lips from one corner of the mouth to the other. In the dry form of cheilitis the lesions consist of grey or brownish-grey, mica-like scales that are firmly attached at the centre and lift at the periphery.
There is another, exudative form of exfoliative cheilitis, in which massive yellow-brown crusts form. After the crusts are removed, a moist, smooth, bright red surface is exposed. Patients are troubled by tightness and a burning sensation in the lips. Because the lips stick together, they try to keep the mouth half open. The disease persists for a long time. Treatment includes sedative medicines, physiotherapy to relieve the inflammation and the application of corticosteroid ointments. In the differential diagnosis, psychiatric processes, thyroid dysfunction and HIV infection should be investigated.
Glandular Cheilitis
A disease in which there is congenital or acquired hyperactivity, hyperplasia or heterotopia of the salivary glands at the border of the red margin of the lips (the Klein zone). A characteristic feature of this disease is dilatation of the salivary gland ducts and continuous saliva production. Histomorphological studies are used to confirm the diagnosis. Treatment involves a range of general and local drug treatments and, in some cases, surgery. If glandular cheilitis is the result of other diseases of the lips, the first essential step is to eliminate the underlying cause.
- Causes of glandular cheilitis
- Symptoms of glandular cheilitis.
- Diagnosis of glandular cheilitis.
- Treatment of glandular cheilitis.
- Prognosis and prevention of glandular cheilitis.
- Glandular cheilitis – Treatment
In glandular cheilitis there are congenital or acquired changes in the structure and function of the salivary glands in the Klein zone, mainly with continuous release of saliva. The pathological process usually affects the glandular tissue of the lower lip; the salivary glands of the upper lip are affected less often. The disease is chronic and is usually diagnosed between the ages of 50 and 60. Glandular cheilitis is extremely rare in patients younger than 20. Men have twice the risk of developing the disease compared with women. The condition is more common in people with poor oral hygiene, inflammatory diseases of the teeth and gums neglected by the dentist, and smokers. Glandular cheilitis is not a precancerous disease, but it can lead to malignant transformation of the epithelium of the lips.