Tongue Ulcers: Causes, Symptoms, and Treatments - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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1.
Treatment methods:
1.
You can visit the outpatient clinic where the physician will apply AgNO3 to the inflamed area.

2.
Alternatively, you can use Kenalog ointment.
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The term "mouth sores" should actually be "mouth ulcers." However, since today's topic is "mouth sores," we will borrow this phrase.
In the ENT outpatient clinic, we often encounter patients of all ages and backgrounds with this issue.
Although it may seem like a minor problem, mouth sores can cause significant discomfort for patients.
Similarly, do not underestimate these seemingly harmless sores, as they can be indicative of several conditions that require careful differential diagnosis.
Below are some common mouth sore conditions encountered in the ENT clinic, including chickenpox, hand-foot-and-mouth disease, herpetic pharyngitis, herpetic gingivostomatitis, herpes labialis, and recurrent aphthous ulcers.
Only the first two (chickenpox and hand-foot-and-mouth disease) may present with skin rashes on the patient, which aids in rapid differential diagnosis.
◎ Chickenpox: The causative agent is the varicella-zoster virus.
Diagnosing chickenpox is not particularly challenging, as it has a characteristic feature where different types of skin rashes (macules, papules, vesicles, pustules, etc.) can be seen simultaneously on the same area.
Patients typically report itching but not pain, with rashes concentrated on the trunk, shoulders, face, and limbs.
◎ Hand-foot-and-mouth disease: The causative agents are the Coxsackie viruses from the enterovirus group, particularly types A4, A5, A9, A10, A16, and B2, B5, with the more notorious enterovirus 71 being less common.
As the name suggests, the rashes are distributed on the oral mucosa and the extremities of the hands and feet, causing mild itching or pain, and often leading to oral ulcers that make eating difficult.
◎ Herpetic gingivostomatitis: The causative agent is the herpes simplex virus.
Ulcers are primarily located in the anterior part of the oral cavity, with swollen gums that bleed upon contact being common, and a foul odor in the mouth is characteristic.
Additionally, if the child has atopic dermatitis, special attention should be paid to the potential complication of "herpetic eczema," which can lead to bacterial infections, with reported mortality rates of 1% to 9%.
◎ Herpetic pharyngitis: Despite being named "herpetic" pharyngitis, the causative agent is unrelated to the herpes virus; it is caused by Coxsackie viruses from the enterovirus group (types 1 to 10, 16, 22).
Ulcers are typically found in the posterior part of the oral cavity, without the swollen gums and foul odor characteristic of herpetic gingivostomatitis, making it easier to differentiate.
◎ Recurrent aphthous ulcers: There is no specific causative agent.
This is the main topic of this article and is what is truly referred to as "mouth sores." Many people have experienced this condition, where yellowish-white depressions of varying sizes appear in the oral cavity, soft and hard palates, or lips.
If not treated specifically, these can sometimes take up to two weeks to heal on their own.
This condition tends to recur intermittently, initially presenting with mild pain or burning sensation, but not as severely as the systemic discomfort associated with herpes simplex.
Many patients become adept at predicting when and where they might experience an outbreak.
It starts with a red papule, which then erodes to form an ulcer.
The ulcer gradually enlarges, causing increased pain, and patients begin to complain about its impact on eating, sleeping, mood, and speaking.
After 7 to 10 days, the ulcer heals slowly without leaving any scars, and the injured mucosa returns to normal.
The occurrence of this condition is often seen in students during exams, business people during financial stress, or elderly individuals with anxious personalities, indicating that stress, pressure, or anxiety can trigger outbreaks.
There is also a familial tendency, with entire families seeking treatment together, and some female patients may notice a correlation with their menstrual cycles.
Regarding patients' inquiries about whether it is related to vitamin deficiencies, it is difficult to substantiate this claim in today's affluent society, where nutritional excess is more common than deficiency.
It is generally accepted that factors such as mental stress lead to changes in immune function, resulting in autoimmune lesions.
The following table outlines the classification and treatment methods for recurrent aphthous ulcers:
| Type | Mild | Severe |
|---------------|-----------------------|-----------------------|
| Number | 1-5 | 1-10 | >50 |
| Size | <1 cm | 1-3 cm | Not specified |
| Location | Non-keratinized oral mucosa | Non-keratinized oral mucosa and soft palate, oropharynx | Whole mouth affected |
| Duration | 4-14 days | <6 weeks | Not specified |
| Scarring | No | Possible | Not specified |
| Incidence | Highest | Second highest | Lowest |
| Treatment | Topical corticosteroid ointment or oral corticosteroids may be added | Oral corticosteroids are required |

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Reply Date: 2006/05/18