Ayurvedic Treatment for RECURRENT MOUTH ULCERS

Ayurvedic Treatment for Idiopathic aphthous ulceration is common and affects up to 25% of the population. Recurrent painful round or ovoid mouth ulcers are seen with halos around them with inflammation. They are more common in females and non-smokers, usually appearing first in childhood and tend to reduce in number and frequency by age. Mouth ulcers, as they are called in common usage, are largely annoying and recurrent diseases, sometimes developing as a hint to the underlying condition.

Though not a fatal condition or medical emergency, mouth ulcer needs to be diagnosed and treated well because if not treated they can cause deficiencies and other complications due to lack of food intake. Sometimes, like in chemotherapy, mouth ulcers develop as the side effect of treatment which should be managed differently.

SIGNS AND SYMPTOMS of Recurrent Mouth Ulcers

Typically seen on the buccal mucosa, the labial mucosa, the floor of the mouth or the tongue.

Severe pain or burning sensation develops one day before the actual development of the ulcer.

Painful lesions with well-defined margins and shallow necrotic centre.

Yellow-greyish membrane at the base of the lesion and surrounded by raised margins and erythematous haloes.

The pain is severe and gets aggravated on eating, swallowing and speaking. The pain usually lasts for around three or four days.

CAUSES of Recurrent Mouth Ulcers

Idiopathic

Gastrointestinal diseases-Inflammatory bowel disease, coeliac disease

Infection- Viral: HSV, HIV, Coxsackie; Fungal: candidiasis; Bacterial: syphilis, Tuberculosis

Systemic disease- Reactive Arthritis, SLE,

Trauma- dentures

Neoplasia- Squamous cell carcinoma

Drugs- Chemotherapy: antimalarials

Skin disease- Pemphigus, Lichen planus

PATHOPHYSIOLOGY of Recurrent Mouth Ulcers

The complex interactions of various factors together can cause the development of an ulcer. Etiological factors can be classified into predisposing factors and precipitating/triggering factors.    The factors like HLA associations, immune dysregulation, nutritional deficiency, personality type A are the predisposing factors. Microtrauma, infections, stress could be the initiating or triggering factors for ulcer formation.  Those individuals who are susceptible when exposed to the triggering factors for a certain duration tend to develop ulcers. Based on the intensity and duration of the triggering factors, the ulcer starts growing till the factors are removed.  The pain suffered by the patients is more in bigger ulcers and with strong etiological factors.  For example, the serum cortisol level, which is a biomarker of stress was increased in the subjects with RAS and the increase was directly proportional to the ulcer size.

DIAGNOSIS of Recurrent Mouth Ulcers

Physical examination – confirmatory in most the cases

Fever suggests the chance of an associated herpes simplex infection

Blood tests – to check for signs of infection and iron and folate deficiency

Skin biopsy – a small tag of tissue from the ulcer is taken and examined to rule out neoplasms.

TREATMENTS of Recurrent Mouth Ulcers

There are no specific therapies. Patients are advised to avoid oral trauma and acidic foods and drinks which cause pain. Topical or systemic corticosteroids may lessen the duration and severity of the attacks. Other options of treatment are chlorhexidine gluconate or tetracycline mouthwash, dapsone, colchicine, thalidomide and azathioprine.

PROGNOSIS of Recurrent Mouth Ulcers

Most ulcers clear up without treatment and do not leave scars, although they usually return.

COMPLICATIONS of Recurrent Mouth Ulcers

Untreated, mouth ulcers can occasionally lead to complications including Bacterial infection; Inflammation of the mouth (cellulitis) and Tooth abscess. In chronic cases, food intake is affected both in quantity & quality which can lead to deficiency diseases.

Ayurvedic Concept of Recurrent Mouth Ulcers

Mukhavrana

Ayurvedic NIDANA of Recurrent Mouth Ulcers

Causative factors for the vitiation of Pitta, especially

Food that is not habitual or suitable to the body

Alcohol intake

Haemorrhoids

Intestinal parasites

Suppression of natural urges

Ayurvedic PURVARUPA of Recurrent Mouth Ulcers

        Not mentioned

Ayurvedic SAMPRAPTI of Recurrent Mouth Ulcers

        Due to the causative factors, Pitta dosha vitiates along with rasa-raktadhatus.  When these dosha-dooshyas get lodged inside the mouth, skin and mucosa are affected and rashes appear.

Ayurvedic LAKSHANA of Recurrent Mouth Ulcers

                                Pain & burning sensation inside the mouth

                        Painful, reddish, round or oval-shaped ulcers with well-defined margins that develop inside the mouth

Ayurvedic Divisions of Recurrent Mouth Ulcers

        Not mentioned

Ayurvedic Prognosis of Recurrent Mouth Ulcers

Saadhya in most the cases     

Ayurvedic Treatment (Chikithsa) for Recurrent Mouth Ulcers

        Ayurveda treatment for mukhavrana includes avoiding the causative factors. Treatment depends upon the disease or condition that is causing the disease. For example, if arsas is causing recurrent mouth ulcers, treatment for arsas should be done and the lesions will be less. Mild fasting is advised if indigestion is present in adults. It cannot be done in small babies & weak people. Management of aggravated Pitta and bringing back the normalcy of Rasa-raktadhatus are the treatment methods.

Samana

Internal medicines with tiktarasa and rookshaguna

Fasting in cases of indigestion & obesity

Kabalagraha & gandoosha with vranahara kwaatha

Sodhana

No sodhana is done in children unless fatal & emergency condition.

Therapies done in adults for sodhana include:

Vamana

Virechana

Snehavasti

Kashayavasti

Commonly used medicines for Recurrent Mouth Ulcers

                Triphalachoornam

                        Chiruvilwadi Kashayam

                        Dusparsakadi Kashayam

                        Chitrakadi kashayam

                        Gandharvahastadi kashayam

                        Amruthotharam kashayam

                        Vilwadi lehyam

                        Khadiradi Gulika

                        Kalaka Churna

                        Peethaka Churna

                        Thakrarishta Churna

                        Hinguvachadi choornam

                        Dadimashtakachoornam

                        Sutshekar Ras

                        Laghu Sutshekar Ras

                        Gairika Churna

                        Nayopayam Lehyam

                        Kalyana Gulam

Brands available for Recurrent Mouth Ulcers

AVS Kottakal

AVP Coimbatore

SNA Oushadhasala

Home remedies for Recurrent Mouth Ulcers

Following are used in traditional ways as home remedies for recurrent mouth ulcers:

            Honey

Coconut oil

Aloe vera juice

Tulsi (Holy basil) leaves

Apple cider vinegar

Saltwater gargling

Garlic

Turmeric

Orange juice

Lemon juice

Diet for Recurrent Mouth Ulcers

  • To be avoided

Heavy meals and difficult to digest foods – cause indigestion.

 junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

 carbonated drinks – makes the stomach more acidic and disturbed digestion

refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)

 curd – causes vidaaha and thereby many other diseases

  • To be added

Drink only boiled water

Light meals and easily digestible foods

Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves

Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc

Behaviour:

Better to avoid extreme hot climate

Better to avoid exposure to excessive sunlight wind rain or dust.

Avoid lifting heavy weights and other vigorous physical activities.

Maintain a regular food and sleep schedule.

Avoid sitting continuously for a long time and avoid squatting.

Avoid holding or forcing natural urges like cough, sneezing, urine, faeces etc.

Yoga for Recurrent Mouth Ulcers

Following a daily exercise routine will help the person to improve digestion & health. Balanced normal digestion lessens the chance of the development of mouth ulcers.

Stretching exercises and specific yoga asanas like pavanamuktasana, vajrasana, bhujangasana etc are recommended.

Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.

 Yoga can maintain harmony within and with surroundings.

Pavanamuktasana

Vajrasana

Bhujangasana

All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.

RESEARCH ARTICLES on Recurrent Mouth Ulcers

https://doi.org/10.1111/j.1346-8138.1995.tb03947.x

The prognosis of Recurrent Oral Ulcers (ROU) by performing prospective evaluations of 67 patients who had only a history of ROU and were registered at the Behçet’s Disease Specialty Clinic at Severance Hospital of Yonsei University, Seoul, Korea was studied. Thirty-five patients (52.2%) developed overt manifestations of BD at an average of 7.7 years after the onset of ROU. The frequency of recurrence was 9.8 times per year in the progressive disease. From these results, it appears that highly recurrent ROU is a warning signal for BD. Careful examinations of patients, including their minor symptoms, additional laboratory tests, and regular follow-ups by physicians are required for proper diagnosis.

DOI: 10.1111/j.1468-3083.2007.02564.x

The efficacy and safety of the topical application of Hyaluronic acid (HA) gel on recurrent oral ulcers was studied. Thirty-three outpatients with recurrent oral ulcers were included in the study. The patients used topical 0.2% HA gel twice daily for 2 weeks.  A subjective reduction in the number of ulcers and a decrease in the ulcer healing period was observed in 72.7% of the patients. 75.8% experienced an improvement in the visual analogue scale for pain. Objective inspection of the ulcers showed a reduction of numbers in 57.6% of the patients, and 78.8% of the ulcers showed a decrease in area. Among the inflammatory signs, swelling and local heat were significantly improved after treatment. The study concluded that topical application of 0.2% HA gel seems to be an effective and safe therapy in patients with recurrent oral ulcers.

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