Mouth Ulcers and Bad Breath (Halitosis)

Mouth ulcer has become progressively less common since the last 10 years; it is a disease which mainly affects those over 45 and is seen twice as often in men. Improved dental care and mouth hygiene may be factors in its decrease, but the best proven link is with pipe and cigar smoking, particularly when associated with drinking. Mouth ulcers also cause a problem of bad breath. As pipes have given way to cigarettes, cancer of the lung has increased and cancer of the mouth decreased.

The mouth is the proximal part of the long digestive tract. It can be prone to trauma and infections and such causes can be varied.

o Infection: Those affecting the oral cavity could be viral, bacterial, and at times even fungal. Patients on antibiotics and steroid therapy or a prolonged period of time have been noted to get fungal infections of the mouth, due essentially to a change in the bacterial flora of the mouth. These microbes many a times causes bad breath.

o Chemical Causes: Chronic cigar and cigarette smoking, habitual chewing of strong peppermints, betel nuts and alcoholism are possible causes as are industrial chemicals such as mercury or nitrous oxide (the latter combines with saliva, causing a corrosive action in the mouth, damaging its mucous membrane).

o Traumatic Causes: Injuries from sharp teeth, accidental biting, badly- fitted dentures, sharp toothpicks are some of the possible causes. Also the oral cavity mucosa could have been damaged by swallowing extremely hot drinks and food.

o Allergies: Frequent allergens to some sensitive oral cavities are the certain lozenges, mouth washes, and at times even drugs. In women, lipstick can be a cause.

o Vitamin Deficiency: Degenerative and ulcerative changes in the mouth can be due to a deficiency of the Vitamin B group and Vitamin C.

o Diseases: Diseases of indeterminate origin, such as lichen planus, erythema multiforma and oral pemphigus can easily affect the oral cavity.

o Brushing Methods: Using improper toothbrushes and unsuitable toothpaste, combined with vigorous brushing, can subject the mucous membranes especially around the teeth, to ulceration, and later too superimposed infections.

o Salivary Gland Deficiency: When there is saliva deficiency, the oral cavity is dry and the mucous membrane easily damaged.

o Nervous State: Those who are extremely depressed, worried and unduly concerned have been noted to get frequent mouth ulcerations and infections.

The ulcers which commonly occur are recurrent aphthous ulcers. These, unlike malignant ulcers, are found more often in females and are most troublesome at an earlier age, between 10 and 40.

The development of an abscess ulceration is usually heralded by soreness or a burning feeling in the mouth; they are round or oval, less than five in number and under 10mm in diameter. Treatment is by the local application of steroids: Adcortyl (Triamcinolone) in Orabase, or by holding a steroid pellet containing either weak hydrocortisone or betamethasone, against the ulcer.

Abscess ulceration runs in families; in some women it is associated with the premenstrual period, and in other patients can be precipitated by minor injury or emotional stress. Eighty per cent of abscess ulceration can be classified as minor. In the remaining 20 per cent of cases the ulcers are larger, often more than five in number, recur more frequently, heal more slowly, are accompanied by feelings of general ill health and frequently respond less well to locally applied weak steroids.

The occasional patient may need a course of full-strength steroid tablets. The persistent abscess ulcer, which can last for up to six weeks, may be mistaken for a cancerous growth. The clue to the correct diagnosis of major abscess ulceration is that there is a history of recurrent attacks, but both types of ulcers can be confused with a chronic sore due to ill-fitting false teeth.

Any persistent abnormality in the mouth whether an ulcer or a hard lump, should be shown to your doctor, who, unless he is absolutely sure of its nature, can always arrange for it to be examined microscopically.