Silver Nitrate Cautery
Aphthous ulcers are very common mouth ulcers seen in my clinic on a daily basis. These ulcers are very painful… Women are generally affected more often than men. At least 1 in 5 people develop apthous mouth ulcers at some stage in their life. They can occur one at a time or as a group of ulcers… They are a shallow ulcer with a white or whitish/yellow base surrounded by a reddish border.
The term “apthous” is a derivative of the Greek word “aphtha” which means ulceration.
Apthous ulcers that occur in conjunction with symptoms of uveitis, genital ulcerations, conjunctivitis, arthritis, fever or adenopathy should prompt a search for a serious etiology.
The lesions may affect patients at any age although the peak occurrence is in young adults. The ulcers usually last one to two weeks.
Many of these conditions are associated with impaired immune systems and include Behcet’s disease, HIV/AIDS, gluten-sensitive enteropathy, Crohn’s disease and inflammatory bowel disease.
There are basically 3 types of apthous ulcers: RAD
and Recurrent minor apthous ulcers, which occur in up to 80% of apthous ulcer cases. They are usually less than 5mm in diameter and heal within 1-2 weeks.
and Major Apthous ulcers, which are large ulcers (more than 10mm) that take weeks or months to heal and do so with scarring.
and Herpetiform ulcers, which are multiple pinpoint ulcers that heal within a month.
Causes of Aphthous Ulcers
Around 250 causes!!!!Majority are idiopathic-unknown causes.
Current thinking is that the immune system has been disturbed by some external factor and this results in the development of aphthous ulcers. Also, approximately 40% of people who get ulcers have a family history of aphthous ulcers. In most cases, the ulcers develop for no apparent reason in people who are healthy.
They can also be caused by an autoimmune reaction, in which a person’s own immunity causes the blisters to form, and they have been reported to be caused by an allergy to chemicals in toothpastes and mouth washes.
Some factors that seem to trigger outbreaks of ulcers include:
and Emotional stress and lack of sleep
and Mechanical trauma, for example self-inflicted bite, tooth brush injury
and Nutritional deficiencies, particularly vitamins B, iron, and folic acid
and Certain foods including spicy food
and Certain toothpastes
and Menstrual cycle-hormonal
Treatment of Aphthous Ulcers
Methods for Treating Aphthous Ulcers are:
and Protective pastes that form a barrier over the ulcer so that exposure to irritating substances is reduced. TESS oral paste
and Numbing agents such as the local anesthetics benzocaine and lignocaine to help reduce pain.
and Improve diet or take dietary supplements of vitamins or minerals that you may be lacking in.
and Prescription topical corticosteroids such as Kenalog â€“steroid ,
and Avoid spicy foods, acidic fruit drinks, and very salty foods (such as crisps) which can make the pain worse.
and Use a very soft toothbrush.
Silver nitrate causes chemical cauterization of Apthous ulcer
It is a wonderful way of getting instant pain relief.
Years ago when I worked in Ipswich, Suffolk, England, I learned from one of my consultant-Mr. Bernard Juby, who was a senior veteran ENT surgeon, a simple and highly effective way to manage apthous ulcersâ€”touch them with a silver nitrate stick. Obviously, one needs to be sure there is no other apparent etiology but, because the most common cause is not related to underlying disease, the silver nitrate stick works wonders, the pain will disappear the next day.
The procedure is simple: Spray the area with 4% lignocaine, wet the tip of the stick and gently touch it to the ulcer. When the ulcer turns white, remove the stick. Have patients swish out the silver nitrate and send them home. You should warn them that the procedure may sting for a moment but, considering that they are already in pain, they don’t really notice much difference. Although silver nitrate cautery may cause more tissue necrosis and longer healing time if it is left in place too long.
The silver nitrate cause minor burn at the ulcer base and destroys the nerve endings causing pain relief and also promotes healing by granulation.
Riboblavine (B2) in very high dose.20 mg three times a day for a month or two may do wonders
10 Riboflavine tablets cost only Rs 2