What foods are responsible for mouth ulcers?

Changes in the mucous membrane of the mouth

The oral mucosa is exposed to a multitude of influences that can lead to changes in surface texture and color. In addition to harmless diseases, this can also be caused by precancerous lesions and malignant neoplasms. About 5 percent of all tumors are located in the head and neck area. The majority is due to squamous cell carcinoma of the oral cavity. Major risk factors are smoking, alcohol consumption and poor oral hygiene. Cornification disorders of the mucous membrane occur six times more often in smokers than in non-smokers. Viruses can also be responsible for the development of cancers in the mouth. Chronic mechanical irritation caused by sharp tooth edges and denture edges are just as important risk factors as chronic inflammatory conditions.

Since almost all areas of the oral cavity are relatively easily accessible for diagnosis and therapy, an oral, maxillofacial and facial surgeon or a dentist have favorable conditions for early detection and diagnosis. In this context, primary tumors of the oral cavity can be detected as well as the suspicion of a systemic disease based on the oral manifestation. A specialist examination can of course also help identify completely harmless changes in the oral mucosa.

Changes in the oral mucosa can be classified into five broad categories. To the natural variationsThe Fordyce spots, lingua geographica, lingua fissurata, oral varicosis, leukedema and white spongy nevus, which usually do not require surgical intervention.

Epithelial changes such as the melanotic macula, smoker's melanosis, nicotine stomatitis, traumatic ulcerative granuloma (TUG), naevi, melanoma, leukoplakia, erythro (leuko) plakia, proliferative verrucous leukoplakia and squamous cell carcinoma, however, make close-knit biopsies control necessary .

Connective tissue changes are subdivided into reactive-proliferating changes (hyperplastic gingivitis, drug-induced gingival hyperplasia, focal fibrous hyperplasia, inflammatory fibrous hyperplasia, papillary hyperplasia, pyogenic granuloma, fibroid-ossifying epulis) and neoplasms (hemangioma, sarcomangioma). Here either a causal therapy of the cause, the application of a local therapy or an excision takes place.

Local and systemic forms of therapy are also used immune-mediated changes applied. These changes include chronically recurrent aphthae, minor naphthas, major naphthas, herpetiform aphthae, oral lichen planus, mucosal pemphigoid, pemphigus vulgaris, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and lupidermal necrolysis.

Infectious changes are acute primary herpetic gingivostomatitis, recurrent oral herpes simplex, infectious mononucleosis, oral hairy leukoplakia, herpangina, hand-foot-mouth disease, rubella, measles, mumps, squamous cell papilloma, acuminata verruca vulgaris, condylomata ), multifocal epithelial hyperplasia (M. Heck), scarlet fever, oral-cervicofacial actinomycosis, candidiasis and candida-associated lesions.

In principle, changes in the oral mucosa must be classified as suspicious of tumors until the opposite is proven. Photo documentation is recommended for clinical follow-up. If the suspicious lesion noticeably regresses within 2 weeks of eliminating the cause, a biopsy is usually not required. Changes in the oral mucosa that persist for 2 weeks after the start of treatment or that have increased in size require histopathological confirmation of the diagnosis in the form of a biopsy. Depending on the type, size and extent of the changes in the oral mucosa, an excisional or incisional biopsy is performed under local anesthesia. This is followed by the histological examination by a pathologist. The result of the findings can usually be reported after 7 to 10 days.

Frequent changes in the lining of the mouth

The oral lichen planus is common, affects mainly women between the ages of 30 and 65 and is often found in the cheek mucosa and in the oral vestibule. In contrast to cutaneous lichen, oral lichen planus tends to become chronified. Characteristic are raised whitish stripes (the so-called Wickham stripes) on a reddened ground. Symptom-free forms are checked annually. The symptomatic forms are usually treated with glucocorticoid preparations or immunosuppressants.

Chronically relapsing Aphthous ulcers are widespread affections of the oral mucosa. Clinically, they are characterized by recurring rounded ulcerations with a sharp edge, reddened edge and yellowish background. Aphthae are caused by mechanical microtraumas, food intolerance, psychological stress and gastrointestinal disorders. Clinically, the distinction is made into Minoraphthis, the Major naphthas and the herpetiform aphtha. Minoraphtha occurs in bursts in the form of several tender lesions with a diameter of <10 mm. After eliminating the triggering cause, it takes about 2 weeks for the skin to heal without scars. The intensity and duration of the painful phase can be reduced by using anesthetic solutions and glucocorticoid ointments. Majoraphtha have a lesion diameter> 10 mm with deep ulceration and heal with scarring. Herpetiform aphthae are the presence of many small ulcerations <5 mm, which are very painful. Herpetiform aphthae primarily affect women and tend to recur. In this context, systemic corticosteroid therapy may be necessary.

A melanotic macula is characterized by a brownish pigmentation of the oral mucosa measuring <5 mm. This is caused by the overproduction of melanin granules. A Melanoma should be excluded by taking a sample. The melanoma appears as a dark brown, black-bluish lesion and is mainly localized in the hard palate area. Due to the poor prognosis, early diagnosis is essential here.

Cancer precursors (precancerous lesions) of the oral mucosa

A precancerous condition is a histologically defined tissue change that is associated with an increased risk of degeneration. Leukoplakia is one of the precancerous diseases of the oral mucosa.

Leukoplakia are defined by the World Health Organization (WHO) as "white, non-wipeable areas of the mucous membrane that cannot be assigned to a defined disease". Leukoplakia has various clinical manifestations. A distinction is made between homogeneous (approx. 90%) and non-homogeneous (approx. 10%) leukoplakias. Leukoplakia is a premalignant change in the oral cavity and, depending on its degree of development, is subject to an increased risk of developing into a malignant tumor. According to the literature, 3 - 8% of all leukoplakias develop into squamous cell carcinoma within 5 years. Leukoplakic changes in the oral mucosa therefore require a specialist examination and a biopsy to rule out possible differential diagnoses.

Erythro (leuko) plakien are noticeable by the characteristic "red spot" in the area of ​​the oral mucosa. The reddish lesions usually do not cause any symptoms and are mainly located in the area of ​​the floor of the mouth, the lateral and ventral surfaces of the tongue, the buccal mucosa and the soft palate. A biopsy to plan how to proceed is mandatory.

prevention

In principle, timely, diagnosis-based therapy can only be guaranteed through an early visit to the doctor. As part of the individual precaution with regard to the prevention and early detection of tumors within the oral cavity, the following recommendations apply:

  1. Regular examinations by the family doctor and family dentist are mandatory. The early detection of cancer in the oral cavity should be part of the routine dental examination. It makes sense because most changes in the oral mucosa can be diagnosed early on by carefully examining the oral cavity. The early diagnosis of malignant changes in the oral mucosa improves the prognosis.
  2. It is advisable to use luxury foods such as tobacco and alcohol responsibly. Tobacco consumption should be given up and alcohol consumption largely reduced. Nicotine and alcohol consumption, especially in combination, are considered to be the main risk factors for the development of malignant changes in the oral mucosa.
  3. Targeted, efficient and regular oral hygiene using commercially available products is important for successful primary prevention.
  4. Whole food and fresh food as well as a Mediterranean diet (fresh vegetables, lettuce, nuts, fish and olive oil) should be main components of the diet. You can download a nutrition brochure from our clinic here.