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Aphthous Stomatitis (Mouth Ulcers) in the Elderly

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Mouth ulcers are a common condition which can arise suddenly and quickly disappear even without treatment. However, the condition may be more complicated in seniors who tend to suffer with this condition for longer periods. This condition is possibly aphthous stomatitis, a condition affect the inside of the mouth. Aphthous stomatitis is the most common type of non-traumatic ulcerative condition of the inner lining of the mouth. It is marked by single or multiple painful ulcers. These ulcers have a tendency to recur and in the elderly, it may persist and never heal fully.

Type and Sizes of Ulcers

The condition begins as single or multiple superficial erosions covered by a grayish membrane. Generally on an average 2 to 6 ulcers are present at each episode. An episode lasts for 7 and 14 days and in a year several episodes may be experienced. The lesions generally develop over the movable oral mucosa such as lip, cheek mucosa, tongue and soft palate.

The lesions below one centimeter are called as minor aphthous ulcers. These ulcers heal without scarring. The size of major aphthous ulcers could be from 1cm to 5cm – these ulcers heal slowly and leave scars. Before the lesion develops there is a burning and tingling sensation over the affected area. The affected areas become reddish in color with slight elevation. Eventually the lesion becomes well defined circular to oval in shape with a reddish border. The lesion then progresses in to painful ulcers.

The accompanying symptoms include fever and body pains.The lymph nodes in the head and neck region become enlarged. Due to painful ulcers, consumption of food may become difficult. Burning sensation on spicy food consumption is also experience.

Causes of Mouth Ulcers

  • Apthous ulcers of bacterial origin are caused by alpha-hemolytic Streptococci.
  • Immunological abnormalities also contribute to the development of aphthous ulcers. The condition may occur due to some autoimmune reactions or immunosuppression.
  • Nutritional deficiencies lead to development of aphthous ulcers. Deficiency of iron, vitamin B12 and folic acid are associated with its development.
  • The dental causes of the condition are repeated trauma to the oral mucosa. Improper brushing, faulty restoration, poorly fitting dentures and jagged teeth can cause repeated injury to the mucosa, precipitating development of an ulcer.
  • Pregnancy, menopause and menstruation make an individual susceptible to development of aphthous ulcers. Hence hormonal involvement is also suspected as a cause of this condition.
  • Food allergies, asthma and hey fever are also associated with repeated development of aphthous ulcers.
  • Stress, anxiety and lack of sleep are the psychological factors initiating an attack of aphthous ulcer.

Treatment of Apthous Stomatitis

  • Topical protective emollient base (orabase) and topical tetracycline mouthwash are the treatments of choice for aphthous ulcers. It is effective in majority of the cases.
  • Topical corticosteroid preparations can be used in major and very painful ulcers.
  • The patient is advised to maintain oral hygiene and consume a nutritious diet. Spicy foods should also be avoided to reduce the burning sensation.
  • Antibiotics such as tetracycline and chloramphenicol can be prescribed in severe cases of apthous ulcers.
  • Injection of corticosteroids directly in to the lesion in combination with systemic administration of cortisone is advised in severe cases of aphthous ulcers.
  • In extremely large ulcers, surgical procedures may be considered.

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