All About Aphthae, Periodontitis and Cancer in Dentistry

Watch Dental Video about Aphthae, Periodontitis and Cancer

Aphthae – those painful little things in the mouth – how can they be cured?

An aphthae is a disease of the oral mucosa, or a type of mouth ulcer. Anyone who has ever had such a small lesion in the mucous membrane knows how unpleasant aphthae can be. Eating and drinking are impaired; in most cases, dental care suffers as well. Three different clinical manifestations exist: Minor ulcerations, major ulcerations, and herpetiform ulcerations. This differentiation is made on the basis of their appearance and localization!

Minor ulcerations are the most common form; these are flat round or oval ulcerations with a diameter of less than five mm. They normally occur on the flexible gingiva (the oral mucosa) and heal after one to two weeks without any scarring.

Major ulcerations are rarer; they are primarily found on the palate, the lips, and on the palatal arches. In many cases, they take several weeks to heal (up to six weeks), and scarring may occur.

Herpetiform ulcerations are characterized by several hundred small lesions that may appear anywhere in the oral cavity.

Where do these ulcerations come from? In general, this medical condition occurs concurrently with many systemic diseases, such as:

  • Behçet’s Disease
  • Sweet’s Syndrome
  • Familial Neutropenia
  • HIV Infection

However, healthy people can also suffer from ulcerations of the aphthae type. The causes of apthae are not known exactly. Various factors, such as iron deficiency, vitamin deficiency, gluten intolerance, food intolerance, possible infectious causes, and genetic factors, have been mentioned as possible causes. Oftentimes, healthy people experience these ulcerations after the consumption of nuts, pistachios, and/or citrus fruits. What can be done to fight them? Since their causes are unknown, only symptomatic treatment can bring relief. Options include:

  • Mouth rinses with astringent solutions, such as sage tea
  • Local corticosteroids (Volon A adhesive ointment)
  • Chlorhexidine mouth rinse
  • Topical analgesics as lozenges

If aphthae occur after the consumption of certain food products, then the only remedy is to avoid such foods! Despite the painful changes (i.e., the aphthae), good oral hygiene is particularly important; many people reduce their oral hygiene because of the associated pain, but this may lead to a vicious circle. Increased plaque leads to an inflammation of the gums, and untreated inflammation of the gums may turn into a chronic inflammation of the periodontium.

Chronic infections are unhealthy and may increase the risk of cancer.

Our immune system constantly produces substances (charged proteins called defensins) that target bacteria, fungi, and viruses. The immune cells release these defensins into the bodily fluids, where the “defensin cocktail” protects the body from assailants such as bacteria, fungi, and/or viruses. Defensins are about as old as insects; thus, they form an old component of our immune system, which means that they can be found throughout the entire animal kingdom. Immune cells release these proteins in high concentrations to the eye fluid, saliva, lungs, and vaginal mucus, for example. These proteins can be found wherever our body fights intruders! The development of defensins only functions well in a healthy body. A healthy body is understood as balanced interaction among our organs. Thus, for example, the non-microbial digestion of food takes place in the small intestine, which the microbial digestion dominates in the colon; the colon is a fermentation organ, so to speak. When an “imbalance” develops between the colon and the small intestine, it may negatively affect defensin production. Decreased defensin levels result in less resistance against microorganisms.

die drei Hauptformen von Aphthen


But how does an imbalance develop? For example, intolerance to carbohydrates leads to excessive fermentation in the colon. This in turn leads to excessive flatulence, which leads to the colon being – figuratively speaking – inflated. The closing mechanism between the small intestine and the colon no longer functions properly and bacteria migrate from the small intestine to the colon. This causes an infection of the small intestine and, together with reduced production of defensins, this combination frequently leads to colon cancer over time.

Thus, our cells and organs use various substances to communicate among themselves; the umbrella term for these substances is “cytokines.” Defensins are a group of cytokines. These cytokines lead to the activation of signaling pathways in the cell. Try to imagine it this way: Cell A (an immune cell) tells Cell B (an oral mucosa cell): “Produce more mucus, because there are bacteria present.” However, Cell A doesn’t talk to Cell B, but releases signaling molecules, called cytokines. Like a key-lock system, these cytokines lead to signaling pathways being activated in Cell B. In the end, this leads to increased production of mucus. Think of the signaling pathways as a factory: The boss gives the foreman an order, which he in turn announces over the microphone, which leads to the workers immediately getting to work. The same signaling cascade takes place in the cell. At the end of this sequence, the cell organelles of the cells produce more mucus! Interestingly, it was found that signaling pathways are activated by bacteria in the gingival pockets (in patients with periodontitis) similarly to how they are in cancer patients. Hence, there may be a correlation between these diseases.

Click here to see the video: Periodontosis


This post is also available in: German

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