Friday, February 5, 2016

Canker Sores

Canker sores, also known as aphthous ulcers, are small, shallow lesions that develop on the soft tissues in your mouth, most commonly inside the cheeks or lips and at the base of the gums.  They are very common, affecting up to 20%-40% of the U.S. population at some point in their lives.  Canker sores are most common during adolescence and young adulthood, becoming less frequent as we get older.

What do canker sores look like? Most canker sores are round or oval and less than 10 mm (1/3 inch) in diameter.  A second type, known as "major" aphthous ulcers, can be much larger.  While the smaller sores heal in from 7-10 days, these larger lesions can take up to a month to heal.  A third type of aphthous ulcer, herpetiform ulcers, consists of multiple of small ulcers.
 
What causes aphthous ulcers?  The exact cause of aphthous ulcers is not known, although they often occur following an injury, such as when someone has bitten their tongue or cheek.  Other factors associated with their development include:
  • Stress
     
  • Viral infections
     
  • Certain foods including chocolate, coffee, strawberries, nuts and citrus foods
     
  • Toothpastes containing sodium lauryl sulfate
     
  • Food allergies
     
  • Hormonal changes
     
  • A diet deficient in Vitamin B12, folic acid or iron
How are aphthous ulcers diagnosed?  The diagnosis of aphthous ulcers is made based on the characteristic appearance and clinical course.  They can be confused with other mouth ulcers such cold sores or even mouth cancer. Unlike cold sores, which are caused by the herpes simplex virus (HSV), canker sores don't occur on the surface of your lips.  Mouth cancer may be suspected when a mouth lesion does not resolve by a couple of weeks.

How are canker sores best treated?  There are a number of prescription, over-the-counter, as well as "home remedies" available for treating canker sores.  Most minor canker sores heal on their own, however, so in many cases, specific treatment may not be necessary.

Self-care measures for easing the discomfort associated with aphthous ulcers include:
  • Rinsing the mouth with either a solution of ½ teaspoon salt dissolved in 8 ounces of water or diluted hydrogen peroxide. Another mixture that may be helpful consists of 1-2 tablespoons of Maalox mixed with ½ tablespoon of liquid diphenhydramine (Benadryl). A teaspoonful of this mixture can swished and then spit out, up to four times a day.
     
  • Applying a small amount of milk of magnesia or a paste made of baking soda.
     
  • Over-the-counter products that contain a numbing agent, such as Orabase-B, Anbesol and Orajel.
Some of the most commonly prescribed medications for  aphthous ulcers include mouth rinses containing the steroid dexamethasone or the antibiotic tetracycline, topical pastes containing either a steroid (Kenalog in Orabase) or amlesxanox (Aphthasol paste 5%), and topical cauterizing agents such as Debacterol (Sulfuric acid/Phenolic Solution).

Can aphthous ulcers be prevented?  In many cases, the answer is yes, but some detective work may be necessary to determine the factors that are responsible for their development.  If outbreaks follow eating foods such as nuts, chips, pretzels, or acidic fruits, such as oranges, the food that triggered the outbreak may need to be avoided.  Regular brushing after meals and flossing once a day can keep your mouth clean and free of foods that might trigger a sore.  Check out the toothpaste label to see if it contains sodium lauryl sulfate, which has been associated with the development of canker sores.   In some people, dietary supplementation with vitamins B and C, zinc, or iron or taking the probiotic, acidophilus, may prevent recurrences.  Avoiding injury to the mouth, e.g. use of a soft tooth brush, may also help prevent the development of canker sores.

Final word:  Most canker sores go away on their own in a week or two.  Because of the possibility of a more serious problem, such as mouth cancer, check with your doctor or dentist if you have unusually large or painful canker sores or canker sores that don't seem to heal.

Friday, January 29, 2016

Is itching really a sign of wound healing?

Most people have heard the common expression that itching indicates that a cut or wound is healing.  Is there any scientific basis to this belief or is this just an "old wives tale"?
   
Phases of wound healing. The body's initial response to a cut or break in the skin is to stop bleeding. This occurs through constriction of blood vessels and the formation of a clot. Following this, 3 major phases lead to healing of the wound.  The first is the inflammatory phase in which the body sends antibodies, white blood cells, growth factors, enzymes and nutrients to the area. These help to "clean up" damaged tissue and start the healing process. In the second phase, known as proliferation, new blood vessels grow into the area of damaged tissue and specialized cells known as fibroblasts lay down collagen to bridge the wound. The final phase, remodeling, can last for many months. During this phase, scar formation occurs and the collagen in the wound undergoes maturation, becoming more like tissue prior to the injury.
 
Do all wounds itch?  Although not always the case, at some point during the healing process, most wounds will itch. This has been noted to be particularly true in the case of burn wounds in which itching can be a highly distressing symptom.

What causes wounds to itch?  Several explanations for wound itching have been proposed, some based on chemicals released during the inflammatory phase of healing and others based on mechanical factors during proliferation.
  • Histamine is a chemical best known for its association with itching during allergic reactions.  Histamine is also released by cells in response to injury and is believed to contribute to itching, particularly in the early phases of wound healing.
     
  • Neuropeptides, small, protein-like molecules that help nerve cells "talk" to one other, are also believed to cause itching during wound healing. One particular neuropeptide known as "Substance P" transmits pain or itch-related information from nerves in the skin to the brain.
     
  • During proliferation, collagen and skin cells bridge the wound, pulling the edges of the skin back together. This mechanical process is thought to activate nerves that is perceived as itching by the brain.
The notion that itching is an indication of healing does appear to have basis in scientific fact.  A more accurate way of looking at this is that most wounds will eventually heal, and itching, whether because of chemical or mechanical reasons, is part of this process. Perhaps the next issue to be addressed in wound healing research should be "to scratch or not to scratch"!  

Monday, January 25, 2016

Choosing the right mattress

Some like their sleeping mattress to be firm, some like it soft, some prefer it to be filled with water and some had just as soon sleep on the floor.  To confuse things further, there are claims that adjustable beds, sleep number beds, or memory foam mattresses are best at achieving that elusive great night's sleep.  Almost everyone has heard that a firm mattress is the best type for those with back problems.  Is there scientific proof for this or is this another medical myth?  Let's look at some of the published reports pertaining to the type of mattress that we chose to sleep on, with special consideration for those with chronic back pain. 
In spite of spending about one-third of our lives lying on mattresses, there has been relatively little scientific study of mattress design.  In describing the ideal sleeping surface, Cornell University's Ergonomics group recommends that a mattress:

1)  Conforms to the spine's natural curves and to keep the spine in alignment when you lay down.

2)  Distributes pressure evenly across the body to help circulation, decrease body movement, and enhance sleep quality.

3)  Minimizes the transfer of movement from one sleeping partner to the other.

4)   Has perimeter edge support.

The Cornell group, however, was unwilling to go out on a limb to suggest one brand or type of mattress over another, since sleeping comfort is to a large degree a personal preference.

Some of the more interesting (and expensive) mattresses on the market, are those made with NASA-developed Visco elastic material that conforms to the body.  The Tempur-Pedic line of mattresses is made with this so-called "memory foam", touted to relieve pressure points and lead to a better night's sleep.  While consumer approval of these mattresses is high, scientific evidence of their superiority in those without special concerns such as diabetes or arthritis is lacking.  There is, however, scientific evidence that "memory foam" mattresses are effective in reducing pressure sores in those confined to bed.

One very interesting study reported in the medical journal, Applied Ergonomics, challenged the notion that firmer is better. In this study, medium firm mattresses specifically modified with foam or latex based on sleeping position was found to reduce discomfort and to increase sleep quality in those with chronic back pain.  Of course not many of us have the opportunity to consult with an ergonomic expert to design a "prescribed" mattress.

Owner experience data reported by the claimed "unbiased and independent"; consumer web site, Sleep Like the Dead,  indicates that most people rate memory foam, air, and latex mattresses highest in owner satisfaction, while innerspring mattresses overall rate the lowest.  They also found from owner's experience that greater the sagging depth of a mattress, the more likely the mattress will cause back discomfort.

Choosing the ideal mattress seems to be a highly individual consideration.  Rather than taking the advice of a review or someone else's word, spend some time trying out mattresses where they are sold.  Don't feel self-conscious about lying down for a few minutes on each one that you are considering.  Some mattress outlets even offer a 30-90 day return warranty if once you get the mattress home you find that it's just not right for you.  One-third of your life is too long a time to spend on an uncomfortable or, worse yet, harmful mattress.