(Mouth ulcers, ulcer in the mouth, oral ulcer)

Aphthae are painful ulcers of pale, yellow-reddish color and appearing inside of the mouth, mainly on cheeks and lips, tongue, soft gum and gingiva. 18-20% the society faces this problem. It is often met in women. Aphthae can appear at some places simultaneously. Different researches have been made to find out the reasons of it. It is possible to state some factors accelerating the appearance of aphthae and delaying its recovery. 
Which factors play a role in Aphthae? 
·    STRESS 
Nowadays stress which is the reason of such diseases like migraine, high pressure and gastritis is also one of the most important reasons of the aphthae. Nervous tension which is met in women in pre-menstruation period is also a reason of aphthae. 
·    FOOD 
Food like citrus plants, essence, French fries, salty and spicy desserts inciting oral mucosa are also among the factors arising aphthae. Besides it, dry wheat, rye, barley, chocolate, nut, shelled sea animals, soya, tomato, eggplant, apple, fig and cheese also can provoke aphthae. 
·    DAMAGE 
Biting cheeks tongue and lips, as well as hard food and toothbrushes with hard bristles and corns formed by the prosthesis not adapted well, can cause aphthae. 
·    TOOTHPASTE 
Natrium lauryl sulphate" ( SLS ) which is added to the structure of toothpastes in order to improve its spumescence is a chemical substance provoking destruction of mucosa cells. SLS has a direct influence on formation of aphthae. There exist special toothpastes containing less SLS (%1.25) for persons who have aphthae problem.
·    OTHER REASONS 
Shortage of vitamin B12 and the bad habits like smoking can also cause formation of aphthae. 
     Treatment
Even if aphthae is not treated, it gets well spontaneously in 7-10 days. The patients with aphthae can have an easier recovery period if they apply one or several of the advices stated below: 
To reduce the pain and to shorten the recovery period:        
·    To avoid cold, hot and spicy food. 
·    The aphthae region can be cleaned with the cotton or gauze dipped into the liquid of 2% hydrogen peroxide. 
·    Cream with a light structure containing water and carbonate can be rubbed on the aphthae. 
·    To rinse the mouth with salty water (half-spoon salt added to a half glass of water) three times a day, 
·    Before the meal “xylocaine” or an anesthetic cream prepared for the mouth can be applied to the aphthae region. 
·    Creams like "orabase", "Gly-oxide", "Cankaid","Ambesol" can be spread on the aphthae. 
·    Mouth can be rinsed with the water in which "sucralfate" is dissolved. 
·    Especially in an early stage of aphthae it is useful to rinse the mouth with the water in which tetracycline is dissolved; it will prevent the aphthae to grow and soothes the pain. 
·    In an early stage of aphthae it is also possible to apply topical steroid triamcinalone %0.1 to the affected region or to rinse the mouth with “betamethasone sirob” prevents increasing of aphthae and soothes its pain. 
·    Rinsing mouth with "Chlorhexadine" shortens the recovery period.   

The differences between the AFT   (canker sores=mouth ulcers) and Herpes (fever blisters=cold sores):
As aphthae and herpes have the same symptoms, they can be mixed up. But there are the main differences between them: 

APHTHAE
1. It occurs only inside of the mouth. 
2. It is not contagious. 
3. Aphthae is not caused by viruses.

HERPES 
1. It begins in the form of small blisters full of liquid. 
2. It appears mainly on the outside of the mouth. But rarely they can appear inside of the mouth. Aphthae can occur in all regions of mouth. Herpes generally does not appear inside the mouth. 
3. It is contagious. 
4. It is caused by viruses. 

What are the symptoms of the herpes?
Before appearing, herpes shows itself in advance (0-24 hours in advance) by itching, burning and slight pain. In this stage reddening and swelling appear and then blisters full of liquid emerge. These blisters cause pain and anxiety during speaking, laughing, eating and drinking.   

HOW IS IT SPREAD?
Herpes is contagious from its early stage when its first symptoms appear until the open ulcer is closed. Herpes is spread from the towel, glass, fork, spoon etc. which is used by a person having herpes and kiss of such a person. Generally, a man is infected with herpes viruses since childhood (0-5 age). This infection can be passed to a child with a “kiss full of love” of one of the members of the family. Then there appears small redness which is not noticed by majority. 

ATTENTION! HERPES IS CONTAGIOUS! 
·    One must not touch herpes. In case if the person touched it, the hands must be washed thoroughly. 
·    Women must be attentive during make up. They eyes must not be touched categorically. 
·    Other people, especially babies and children must not be kissed.
·    The towel, glass, fork, spoon etc. which have been used by a person having herpes must not be allowed to be used by the others. 
·    The means used while eating and drinking must not be shared with children.
·    The person must not touch the ulcer.

When does it occur?
·    Stress
·    Exhaustion
·    Too much sunlight and UV
·    Other infections
·    Virus can be more active during pregnancy.

CAN IT BE CONTROLLED? 
One must avoid the conditions provoking herpes. For example, as stress incites the herpes, we must learn rules reducing stress. To avoid tiredness and insomnia one must have a regular rest and sleep. To avoid too much sunlight, protective cream or solar oil with high protective factor must be spread over the lips and hat must be worn to protect the face from the sun. But in spite of all these measures, the herpes still can emerge. When first symptoms (itching, burning, slight pain) are felt, antiviral cream must be applied to the affected region. In this case the herpes either will not appear, or will be felt slightly. 
 
HOW IS ITS MOST COMPLICATED FORM TREATED?
·    Alcohol and antiseptic medicines prevent spread of infection on the herpes 
·    Pain-killers soothe the pain caused by the herpes.
·    Applying ice can calm the pain
·    Nowadays it is possible to heal the ulcer using antiviral medicines. 
WHO ARE AT A RISK GROUP?
·    If a person often has herpes (for example, if it lasts more than 10 days, in spite of the treatment)
·    If a baby or a child under 6 age has the herpes
·    If the herpes appears on body organs, except lip, mouth or nose. Especially on eyes, fingers or genitals
·    If along with the herpes, you have headache, temperature, pain in muscles and other complaints
·    If the herpes is with yellow pus.