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Approach with confidence Treating aphthous ulcers effectively means treating them comprehensively.  When dental oral healthcare professionals treat problems that occur in the mouth, we’re often dealing with conditions that result from much broader and more general health issues. As a result, we’re often called on to make treatment recommendations that go beyond preventive, therapeutic, and restorative procedures. An example of this trend is the challenge we are confronted with when dealing with a very common condition: aphthous ulcers. Although they occur in the mouth, their presence often suggests a systemic problem. Cause and effect Aphthous ulcers occur only on mucosal tissue, usually under the tongue and/or on the cheek. About 80% of aphthous ulcers are described as “moderate,”4 being relatively small lesions that, while painful, tend to heal within 10 days to two weeks. Unlike lesions caused by the herpes simplex virus, they have no vesicle or pustule, but consist of an irregular yellowish lesion surrounded by a red halo and are accompanied by localized inflammation. Occasionally mistaken for herpes simplex lesions, aphthous ulcers represent a recurring condition that is currently thought not to be caused by a virus or bacterium. Although the etiology has yet to be identified, some research shows that recurring aphthous ulcers (RAU) may be the result of a condition that results from the body’s exposure to a commonly used chemical — Sodium Lauryl Sulfate (SLS) — that is found in more than 90% of products such as toothpaste, shampoo, and suntan lotion.1,2 Although current research continues to provide conflicting and sometimes confusing data, the use of toothpaste containing SLS is considered by some dental professionals to be implicated in the formation of aphthous ulcers.3 Not everyone responds to SLS exposure in the same way; some people are simply more sensitive to this chemical than others, and mechanical trauma and hormonal changes can exacerbate the body’s response to this chemical.substance. In addition, people with compromised immune systems or with certain chronic diseases, such as celiac disease and Sjögren’s Syndrome, may be more sensitive to SLS. In offering comprehensive treatment to patients with aphthous ulcers, it is important to consider both the products that can help heal or at least relieve the pain of the sores, but also consider products and chemicals that can help prevent them from happening in the first place. From risk to relief
When a patient exhibits an aphthous ulcer, I recommend that you ask the patient a few questions about his or her general health. You will want to find out if there is any evidence of compromised immune system function. You then can ask if they’re susceptible to frequent colds or infections, another possible sign of immune system problems. There may be a correlation between certain chronic diseases, especially celiac disease, and a propensity toward recurrent aphthous ulcers, so it’s advisable to ask your patients about any chronic medical conditions they may have. Even though there’s not a high degree of correlation between other chronic diseases and aphthous ulcers, chronic conditions can also be an indicator of immune system overload. In addition to underlying physiological causes, it is possible that SLS also is playing a role in the outbreak. The simplest immediate action may be to identify the use of toothpaste that contains SLS and, as a primary corrective measure, suggest that the patient begin using an SLS-free toothpaste. There may be a correlation between certain chronic diseases, especially celiac disease, and a propensity toward recurrent aphthous ulcers, so it’s advisable to ask your patients about any chronic medical conditions they may have. Even though there’s not necessarily a high degree of correlation between other chronic diseases and a tendency toward aphthous ulcers, chronic conditions can also be an indicator of immune system overload. Also ask about the health and beauty products your patient uses; point out that synthetic SLS is an ingredient in most shampoos, suntan lotions, and deodorants. You can then recommend eliminating these products. In considering treatment of the current ulcer, it is important to remind the patient that there is no “cure.” Laser treatments can be effective, providing both pain relief and faster healing time. There also are a variety of “surface” treatments—gels, patches—that the patient can employ at home. A healthy diet, lowering stress, and excellent oral hygiene are always helpful in fighting a variety of oral health problems. Shelby Kahl, RDH, ND, PC, owns and operates an integrative dental hygiene practice on the Front Range of northern Colorado. FULL DISCLOSURE: Ms. Kahl is an education specialist for Rowpar Pharmaceuticals Inc.. References available upon request. E-mail mh@advanstar.com.
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