canker sores

[sister--*]

I've had a rash of patients lately that have had terribly sore mouths. Some from antibiotics, some from stomatitis, and some from an exacerbation of psoriasis. Most look like canker sores, definately not thrush. These people really suffer!

We've gone through the hydrogen peroxide/lidocaine swishes and spits to the troches. Nothing is helping.

Do you know of any medicinal (Dr. would have to order) or non-medicinal treatments (that a nurse could use without an order) that may make these patients more comfortable?

[JeanettePNP, MSN, RN, NP]

Simplest and most effective remedy is wet tea bags. Regular tea, dipped in hot water, applied to sores. I once had canker sores really bad in the area of my wisdom teeth. Went to the dentist and he gave me a referral to have the teeth extracted. Went home and applied the tea bags instead.... My wisdom teeth are still in there!

[Kyrshamarks, BSN, RN]

I don't know if this will help, but I always remember a very wise micro teacher that taught me this...

Canker sores are a virus that is latent and comes out in times of stress...a herpies! She told us to watch for midterms and finals times and see who had them.....she was right! This latent herpies virus comes when you are stressed or ill or both!

Your wise old micro tracher was not so wise. Canker sores are not a virus and certainly not a herpes virus. Almost everyone gets a canker sore ion their lifetime and it usually occurs in teens and your adults most often but can occur at any age. The etilogy of canker sores is unknown but it is not a virus. They can flare up during times of stress, allegies, acidic foos can cause it, biting the inside oy your cheek or lip can cause them.

[randybayrn]

There is a very rare disease called Behcet's Disease that has canker sores as one of the main symptoms. It is an autoimmune disease that attacks the blood vessels, kind of like Vasculitis, but the main symptom is canker sores. This is a highly under diagnosed disease and very few general practitioners know about it. It is treated by a Rheumatologist, and the meds that are commonly prescribed are Colchicine and Plaquenil. People who suffer from this disease can have other symptoms that range from genital lesions and small red spots on their legs all the way to blindness and other more devastating symptoms. Some of the patients have been known to complain to their doctors about mouth ulcerations on a continuous basis only to be told that they have Herpes of the oral kind and or genital Herpes when these mouth ulcers were accompanied by genital lesions as well. Behcet's is not at all sexually transmitted though some of the symptoms can mimic Herpes. These patients suffer tremendous pain as anyone who has these sores can attest to. The sores can be anywhere in the mouth though usually not outside of it on the lips. They can also have anywhere from 1 to like 20 sores at a time and the one sore may be as large as a quarter. Symptoms can be somewhat continuous or not as frequent as this disease is marked by exacerbations and remissions. The sores may also be the typical size as well. Behcet's is more common in Japan and the leading cause of blindness in males. In the US it is more common in woman and does not usually progress to such an extent that it causes blindness or severe problems. It does however cause extreme pain in these patients where they cannot eat, drink, sleep, concentrate, they sweat and have anxiety as it can be severe enough to activate the sympathetic nervous system just slightly. Again the pain is severe and often a pain med such as Vicodin is needed to help these people have somewhat of a normal life during exacerbations that can last 3 weeks out of 4, for months on end. The meds prescribed generally suppress the immune system just enough to prevent these symptoms from ruining there life. Just food for thought guys!