From mildly relaxed to
"I thought I was asleep"
You can be as relaxed as you wish.
www.villageortho.com Treatment Info/Apthous Ulcers & Herpetic Lesions
The following is From:
Dr. Trey L. Petty
Foothills Medical Centre
Calgary, Alberta
I would also like to pass on the connection between the foaming agent in most
toothpastes (typical ingredient is SLS) and RAU. (I forgot to mention this on my earlier iCanaden posting). SLS (sodium lauryl sulfate) in toothpastes as a causative agent for RAU: (note: those without include Herbal Tooth and Gum Tonic, Rembrandt Naturals, Supersmile)1. Chahine L, Sempson N, Wagoner C. The effect of sodium lauryl sulfate on
recurrent aphthous ulcers: a clinical study. Compend Contin Educ Dent.1997Dec;18(12):1238-40.2. Herlofson BB, Barkvoll P. The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontol Scand. 1996Jun;54(3):150-3.
3. Herlofson BB, Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. Acta Odontol Scand. 1994 Oct;52(5):257-9.
As for differentiating between RAU and herpetic ulcerations (herpes simplex virus - HSV): Use your operatory chair-side electron microscope to see if the gingival cells have viral particles or not...
Just kidding.
Here is a simple comparison to help differentiate:
Location:
RAU - all areas EXCEPT gingiva, hard palate, vermilion border
HSV - vermilion border, gingiva, hard palate (particularly where the major nerves exit: posterior and incisive palatine and mental nerve areas.)
Appearance prior to ulceration:
RAU - non-specific; presents as ulceration
HSV - clear vesicles
Prodromal symptoms:
RAU - no
HSV - typical (burning, tingling, itching)
(As soon as you get someone in complaining of an itchy palate, check for vesicles and/or ulcers between their second premolar and first molar; and then watch the expression on their face when you tell them they have a cold sore in their mouth!)
Number of ulcers:
RAU - usually only one; oval
HSV - multiple; confluent
Cause:
RAU - focal immunodysregulation
HSV - viral HSV-I
Treatment:
RAU - corticosteroids (if necessary; I use prednisone as mentioned earlier.)
HSV - antiviral drugs, i.e. parenteral acyclovir
The acyclovir ointment has been shown in a couple of nice double-blind studies to be no better than Vaseline, although I certainly have patients that swear by it. The pills, however, work every time. The problem with the pills is that they are so expensive. I will offer a prescription only for those patients that suffer from large cold sores that cover their chin or go up into their nose, or to people where the appearance is particularly distressing, e.g. salespeople, teachers, etc.
I prescribe Acyclovir 200mg X52 tabs
Rx: Take 1 tab p.o. at the onset of symptoms, and then q4h during waking hours
(5 X day) X 10 days with five repeats.
(The newer anti-virals, ganciclovir and famciclovir, are basically precursors of acyclovir where the only advantage is lesser frequency, but at three to four times the cost. I hate making decisions for my patients, but I certainly can't justify suggesting these just because they are new. As it is, the acyclovir prescription is still around $50. This is why I don't suggest it to everyone.)
Of course, emphasize to the patient the importance of taking the first pill IMMEDIATELY when they feel the prodromal symptom(s), and then to keep taking the pills for the full ten days. Otherwise, if they wait until the vesicles form, it is too late. Or, if they quit too early, it will take off again until it has run its course.
If you do the math, you'll see that after the ten days, there will be two tabs left. I tell them to keep those in their purse, backpack, desk, etc. so that when it happens again (as it certainly will) they can start immediately while they are making their way back to the drugstore to refill their prescription.
I can't tell you how thrilled patients are to finally be able to control these outbreaks. The people that have public jobs, or where they get large lesions, generally don't complain much of the cost; they are just happy something works.
Of course, answering the question of why their physician has never suggested this is always difficult...
Rohrmann et al.: Trait Anxiety – Possible Consequences for Health 19-25 PDF version of this article www.gwdg.de/~bbandel/
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