Recurrent Mouth Sores?

You feel a small, sore area on the inside of your lip or tongue. It wasn’t there yesterday. It just showed up. You have a canker sore, or in our terms, an aphthous ulcer. They are usually less than a 1/2 inch in diameter, oval, and have red border and a whitish or yellowish center. We’ll sometimes feel a tingling sensation in the area for a couple of days before they actually show up.

Don’t confuse a canker sore with cold sore. Cold sores are from viruses and are usually on the dry portion of the lip or on hard surfaces in the mouth such as the palate. Cold sores are from the Herpes virus, are contagious, and respond to anti-viral medications. Canker sores are on the loose wet tissue of the inner lips, below the gum line, and under the tongue. They are not viral nor contagious.

What causes canker sores? Most often, they just appear for no reason. However, they can be caused by rough edges on your teeth, sensitivities to foods, particularly chocolate (Sorry!), coffee, strawberries, eggs, nuts, cheese, as well as highly acidic foods. They can be related to food allergies as well as a diet lacking in vitamin B12, zinc, folate, and iron. Canker sores can also be caused by Helicobacter pylori, the same bacteria that cause stomach ulcers, and can be related to gluten sensitivities and inflammatory bowel diseases. And occasionally, I’ll see a patient whose canker sores clear up just be their changing toothpastes away from one that has the additive, Sodium Lauryl Sulfate. They are genetically related about a third of the time.

One key that we use in helping you is a diet and medication history. When did they start? What were you eating? Have there been recent changes in your diet? Have you started a new medication?

While canker sores are a nuisance, they’re usually not dangerous. If they are large or if you often get clusters of them, it will be worthwhile to get some blood tests and maybe a biopsy, but that’s the rare exception.

What are the treatments? The best treatment is no treatment. They’ll usually go away by themselves. If they are a nuisance, then your dentist or physician can prescribe antibacterial mouth rinses, topical pastes, and sometimes drugs that are used for heartburn or gout, and even cortisone preparations. There is a topical solution called Debacterol that your dentist or physician can paint on the sore to cauterize it. Nutritional supplements can also be prescribed. And I even had one patient with the most severe canker sores for years completely clear up after one chiropractic adjustment.

The key is that if canker sores are just now showing up, look at the changes that you’ve made in your medications. Usually, you can be the best detective in determining why they started. Your doctor can then help you find an alternative.

You DO Have Enough Bone for an Implant

It happened again. A patient comes into my office and says that she was told that she doesn’t have enough bone for a dental implant. There may have been a reason to say that 20 years ago. But now?

There are two major advances which make a lack of bone a thing of the past: 1. The method of x-ray diagnosis and 2. The graft materials to help you to replace missing bone.

Let’s look at the x-ray first. The traditional x-ray views your mouth in two dimensions. It can see height and width. It can’t see thickness, the most important third dimension. The way we see that third dimension is with a CT-Scan. Yes, there are dental CT-Scans, made specifically to determine bone availability for dental implants. There are several dental CT-Scans in dental offices throughout Brevard County. There’s even a mobile dental CT-Scan van that will go to dental offices that are without that technology. And what is really great is that dental CT-Scans produce only about 2% of the radiation of a medical CT-Scan. CT-Scans give us a complete surgical view of your bone before we do the surgery. I can’t tell you how often I find good dental implant-supporting bone in a CT-Scan that I am unable to see in traditional dental x-rays.

What’s even better is that we can do your dental implant surgery first on the computer, and design a template from that virtual surgery that we place In your mouth, making your actual surgical procedure easier and faster.

While dental implants have made improvements since the basic design was introduced in 1982, the monumental improvement that has occurred is in the materials available to graft bone. There are dental bone powders that are used to fill extraction sites to prevent bone shrinkage. There is bone putty that we place on your existing bone to increase its thickness. There are blocks, and wafers, and sponges all designed for the same function, to restore missing bone. There are methods to harness the growth factors from your blood to increase the speed of bone healing. And there are liquid grafts that recruit your own stem cells from surrounding tissue to produce new bone as well as grafts that have “built-in” stem cells.

So whether your sinus is too low or your bone has diminished, or you’ve been told that you don’t have enough bone, there are answers for you.

No bone? Get a dental CT-Scan. Once the diagnosis has been made, the answers are simpler and more predictable than ever before.

Dr. Lee Sheldon practices dental implant and periodontal therapy in Melbourne. He is an associate clinical professor at the University of Florida. Dr. Sheldon is a featured guest on “The Elder Hour” on WMEL radio and “Aging with Dignity” on WBCC television.