啤酒，老白干呢？

好几个人提到beer 或 liquor也可以控制口腔溃疡。 根据我的理论，很有道理，因为酒精杀菌嘛。浓度越高的，是不是越有效(less than 75%, though)？这么看来，估计各种杀菌的rinse都会有一定效果，哪种最有效，就跟the specific culprit的特性有关了。root beer也有antiseptic的效用。

Medical records

these are a partial list of important information to record for the disease and treatment. please feel free to add your suggestions :-).

[color=006600]paitent information:[/color]
age, gender, dietary habits, lifestyles...

[color=006600]canker sore history:[/color]
age of onset
affected years

sore frequency
sore size
sore duration
degree of pain
consequence of wounds
reactions to dental cleaning

[color=006600]listerine treatment:[/color]

rinse frequency
rinse duration
start time
record time1
record time2....

sore frequency
sore size
sore duration
degree of pain
consequence of wounds
reactions to dental cleaning

维生素和口腔溃疡

从小一溃疡，父母，医生就提到缺VB12，除了用药之外，常建议喝小米粥。 但是，对我来说，这个办法并不管用，至少从没有坚持到看见效果。这个说法如此深入人心，证明在哪儿呢？

我 能查到的最早的一篇文献，是1954年发表的，但没有摘要。 英国医学杂志1974发表的这篇文章(1)， 发现130 个病人里， 有5个缺B12， 7个缺folic acid，15个缺铁。 对这些几个病人，针对治疗有一定效果 (缺什么补什么)。但是，这随后30多年，进一步的文献寥寥无几，我一共找到十几篇。大致说来，缺B12的病人很少，用B12，或复合维生素治疗，不同的 实验，效果并不显著，一致。

所以，如果查血查出缺VB12 (或任何其它维生素)，一定需要补充 (既使没有口腔溃疡)；但如果身体维生素正常的话，用维生素治溃疡，临床证据严重不足。换句话说，不管用。


12。 Oral Dis. 2005 Nov;11(6):374-8.
Norwegian LongoVital and recurrent aphthous ulceration: a randomized, double-
blind, placebo-controlled study. Kolseth I, Herlofson BB, Pedersen A.
OBJECTIVE: LongoVital (LV) is a herbal-based tablet enriched with the recommended
daily doses of vitamins. The present study was undertaken to investigate possible prevention of recurrent aphthous ulceration (RAU) during 4 months daily intake of the Norwegian LV. DESIGN: The study was a placebo-controlled, double-blind, randomized, clinical trial. SUBJECTS: Sixty otherwise healthy patients with at least one attack of minor RAU per 2 months were included in the study. METHODS: After an introduction period (IP) of 60 days, the patients were randomly divided into three groups and given either LV, the herbs of LV only, or placebo. Three test tablets were taken every day together with breakfast for 4 months [tablet period (TP)] and the patients followed up for another 4 months (F-UP). The number of new ulcers (NU) and ulcer-free days (UFD) were observed. RESULTS: Fifty-two patients completed the study. Neither NU nor UFD showed any statistical significant differences between any of the groups in any of the periods. All three groups, however, showed a significant increase in UFD during the first 2 months of TP compared to IP. Within the LV group only, there was a further increase in UFD after 2 months intake of the tablets. The number of NU and UFD decreased significantly in both the LV and the herbal group in F-UP compared with TP. CONCLUSION: Neither the Norwegian LV nor the herbal component alone was superior to
placebo in the prevention of RAU. The results, however, indicate that neither the LV nor the herbal group benefited from the treatment.

11。 Oral Health Prev Dent. 2005;3(1):3-8. The effect of LongoVital on recurrent aphthous stomatitis in a controlled clinical trial. Bratel J, Hakeberg M, Jontell M.
PURPOSE: The aim of this study was to evaluate the effect of daily intake of LongoVital (LV) (herbal vitamin tablets) in the prevention of RAS. MATERIALS AND METHODS: A group of 78 consecutively referred patients was enrolled to a three-months pretreatment period. Fifty subjects were then randomly allocated to an LV-group (n = 25) or a placebo group (N = 25). A double blind, stratified-randomised clinical case-control study was performed during six months. Number and size of the ulcers were registered by the patients using a standardized chart. The degree of discomfort was recorded on a 100 mm horizontal visual analogue scale (VAS-scale). RESULTS: The three-months pretreatment period revealed that the most dominant symptoms were pain (78%) followed by burning sensation (18%). No significant differences between the two groups were found during this period when a comparison was made
at the end of the study. After the intervention period the number of aphthous ulcers/month decreased significantly in the LV-group (p = 0.02). The number of days in pain/month were also reduced (p < style="color: rgb(204, 0, 0);">10。 Southeast Asian J Trop Med Public Health. 2002 Dec;33(4):872-7. Hematologic abnormalities in recurrent oral ulceration. Thongprasom K, Youngnak P, Aneksuk V.
The aim of this study was to analyse the hematologic status in patients with recurrent oral ulceration (ROU). Twenty-three patients with ROU and
19 control subjects were examined consecutively for hematological abnormalities
including serum folate, red cell folate and vitamin B12 levels. Their complete
blood counts, hemoglobin typing, serum and red cell folate and serum vitamin
B12 levels were studied. Low red cell folate levels were found in 11 out
of 23 patients (47.83%) with ROU. They were defined as having folate deficiency
(n=5), folate deficient erythropoiesis (n=1), and folate depletion (n=5).
The serum and red cell folate levels in the control group were within normal
range. There was a statistically significant low red cell folate in the
ROU compared to the control group (p=0.000). The serum vitamin B12 levels
were within normal range in both ROU and control groups. Hemoglobin, hematocrit
and mean corpuscular hemoglobin concentrations were in the normal range
in both groups and none had anemia or macrocytosis.

9。 J Am Dent Assoc. 2003 Feb;134(2):200-7. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. Scully C, Gorsky M, Lozada-Nur F. BACKGROUND: Recurrent aphthous stomatitis, or RAS, is a common oral disorder
of uncertain etiopathogenesis for which symptomatic therapy only is available.
This article reviews the current data on the etiopathogenesis, diagnosis
and management of RAS in a primary care setting. METHODS: The authors reviewed
publications on Medline from 1995 through 2000, the period since the last
major reviews were published. RESULTS: RAS may have an immunogenetic background
owing to cross-reactivity with Streptococcus sanguis or heat shock protein.
Predisposing factors seen in a minority include haematinic (iron, folate
or vitamin B12) deficiency, stress, food allergies and HIV infection. While
topical corticosteroids remain the mainstay for therapy, a number of other
immunomodulatory modalities now are available. CONCLUSIONS: There is still
no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore
therapy can attempt only to suppress symptoms rather than to address the
basic issues of susceptibility and prevention. CLINICAL IMPLICATIONS: In
the majority of patients, symptomatic relief of RAS can be achieved with
topical corticosteroids alone, with other immunomodulatory topical agents
or by combination therapy.

8。 J Eur Acad Dermatol Venereol. 2002 Jan;16(1):66-7. Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis. Piskin S, Sayan C, Durukan N, Senol M.
BACKGROUND: The exact aetiology of recurrent aphthous stomatitis (RAS) is
still unknown, but different predisposing factors, including iron, vitamin
B12 and folic acid deficiencies, have been proposed. MATERIAL AND METHODS:
Serum iron, ferritin, folic acid and vitamin B12 levels were investigated
in 35 patients with RAS and in 26 healthy controls. RESULTS: Vitamin B12
levels were found significantly lower in subjects with RAS than in controls.
No significant differences were found in other parameters. CONCLUSION: We
concluded that vitamin B 12 deficiency may be an aetiological factor in recurrent
aphthous stomatitis.

7。Neth J Med. 1998 Oct;53(4):172-5.Aphthous ulcers and vitamin B12 deficiency. Weusten BL, van de Wiel A.
Aphthous ulcers of the oral cavity are frequently encountered in general
practice. Although the exact pathophysiology remains obscure, many factors
can contribute to the pathogenesis of these lesions, such as immunological
factors, local trauma, smoking, stress, hormonal state, family history,
food hypersensitivity, and infection. We describe three patients in whom
a clear relationship appeared to exist between recurrent aphthous ulcers
and a deficiency of vitamin B12. It is concluded that in all patients with
recurrent aphthous ulceration, deficiency of vitamin B12 should be considered.

6。 Ann Dent. 1992 Winter;51(2):14-6. Recurrent aphthous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies. Porter S, Flint S, Scully C, Keith O.
A group of thirty-four patients with recurrent aphthous stomatitis (RAS)
and single hematinic deficiencies were given replacement therapy after any
reason for the deficiency had been sought and excluded. The response of
the RAS was assessed in an open trial. The aphthae in 70% of patients subjectively
improved with hematinic replacement therapy, a benefit exceeding the defined
placebo response in recurrent aphthous stomatitis.

5。 J Oral Pathol Med. 1991 Sep;20(8):389-91. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. Nolan A, McIntosh WB, Allam BF, Lamey PJ.
An evaluation of the thiamine, riboflavin and pyridoxine (vitamin B1, B2
and B6) status of 60 patients with recurrent mouth ulcers was performed.
Seventeen patients (28.2%) were found to be deficient in one or more of
these vitamins. Replacement therapy of these vitamins was given to a study
group of deficient patients and a non-deficient group for one month. At
the end of therapy and after a follow-up period of 3 months, only those patients
who had a B complex deficiency had a significant sustained clinical improvement
in their mouth ulcers. Vitamin B1, B2 and B6 deficiencies should, therefore,
be considered as another possible precipitating factor in recurrent aphthous
ulceration.

4。 J Oral Pathol Med. 1990 Sep;19(8):371-5. LongoVital in the prevention of recurrent aphthous ulceration.Pedersen A, Hougen HP, Klausen B, Winther K.
LongoVital (LV) (DK. Reg. No. 5178/75) is a herbal based tablet enriched
with recommended doses of vitamins. The present study was undertaken to
investigate prevention of recurrent aphthous ulceration (RAU) during 6 months'
daily intake of LV as compared with placebo in a double-blind, randomized
clinical, cross-over 1-yr study. The population comprised 29 otherwise healthy
minor RAU patients (18 F, 11 M), mean age 36 (18-67), with an estimated
average number of recurrences the previous year of 12.8 (3-30). The number
of recurrences was significantly reduced on LV the latter 4 of the 6 months
(P less than 0.01) where 31% were totally free of recurrences. Subjective
all-over evaluation of treatment period was significantly in favor of LV.
LV induced no adverse reactions and is the first harmless systemic treatment
which has proved better than placebo in the prevention of RAU.

3。 Oral Surg Oral Med Oral Pathol. 1988 Jul;66(1):41-4. Hematologic status in recurrent aphthous stomatitis compared with other oral disease. Porter SR, Scully C, Flint S.
The hematologic status of 144 consecutive patients in the United Kingdom
with oral disease (69 with recurrent aphthous stomatitis; 75 with other
disorders) was examined in an attempt to resolve the controversy as to whether
levels of hemoglobin, blood cell numbers and indices, and blood film are
adequate in the screening of patients with aphthae. Though hemoglobin levels
and red blood cell indices were normal in patients with recurrent aphthous
stomatitis, there was still a small minority of patients with deficiencies
of iron (low serum ferritin), folate (low red blood cell levels), or vitamin
B12 (low serum levels) that would have remained undetected. Full hematologic
screening of patients with recurrent aphthous stomatitis thus reveals latent
deficiency states, at least in some parts of the world, and there are good
reasons for elucidating the underlying cause and correcting these deficiencies,
particularly vitamin B12 deficiency. Therapeutic studies are now required
to establish the frequency with which deficiencies actually predispose to
recurrent aphthous stomatitis.

2。 Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration.Olson JA, Feinberg I, Silverman S Jr, Abrams D, Greenspan JS.
Hematologic deficiencies have previously been described in some cases of
recurrent aphthous ulceration (RAU). Ninety patients with RAU and twenty-three
healthy control subjects were evaluated by complete blood count, serum iron,
and total iron-binding capacity, serum vitamin B12, and serum or red blood
cell folate. Only three of ninety RAU patients proved to have abnormalities.
There were no statistically significant differences between the patient
and control populations, and no one in either group had abnormal serum vitamin
B12 or serum or RBC folate assays. None of the patients or controls gave
a history or symptoms suggestive of iron-deficiency or megaloblastic anemia,
and all were without gastrointestinal complaints. These results suggest
that hematologic tests other than a complete blood count are not routinely
indicated for patients with RAU.

1。 Brit Med J. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Wray D, Ferguson MM, Mason DK, Hutcheon AW, Dagg JH.
A series of 130 consecutive outpatients with recurrent aphthous stomatitis
were screened at the oral medicine department, Glasgow Dental Hospital,
for deficienciesin vitamin b12, folic acid, and iron. In 23 patients (17.7%)
such deficiencies werefound; five were deficient in vitamin B12, seven in
folic acid, and 15 in iron. Four had more than one deficiency. Out of 130
controls matched for age and sex 11 (8.5%) were found to have deficiencies.
The 23 deficient patients with recurrent aphthaewere treated with specific
replacement therapy, and all 130 patients were followed up for at least
one year. Of the 23 patients on replacement therapy 15 showed complete remission
of ulceration and eight definite improvement. Of the 107 patientswith no
deficiency receiving local symptomatic treatment only 33 had a remission
or wereimproved. This difference was significant (P less than 0.001). Most
patients withproved vitamin B12 or folic acid deficiency improved rapidly
on replacement therapy;those with iron deficiency showed a less dramatic
response. The 23 deficient patientswere further investigated to determine
the cause of their deficiencies and detect the presence of any associated
conditions. Four were found to have Addisonian perniciousanaemia. Seven
had a malabsorption syndrome, which in five proved to be a gluten-induced
enteropathy. In addition, there were single patients with idiopathic proctocolitis,
diverticular disease of the colon, regional enterocolitis, and adenocarcinoma
of thecaecum. We suggest that the high incidence of deficiencies found in
this series andthe good response to replacement therapy shows the need for
haematological screening of such patients.

Listerine的主要成分

几种常用mouthrinse的成分比较

Listerne
Thymol 0.064%: antiseptic, fungicide, and a preservative.
Eucalyptol 0.092%: flavoring, and perfumery
Methyl Salicylate 0.060%: minor muscle and joint pain
Menthol 0.042%: flavoring

Crest Pro-Health Rinse
Cetylpyridinium Chloride 0.07%: antiseptic agent

Scope
Cetylpyridinium Chloride: antiseptic agent
Domiphen Bromide: antiseptic agent
Alcohol

怎样小心求证？

只查到一篇文献。

Effect of an antimicrobial mouthrinse on recurrent aphthous ulcerations.

Meiller TF, Kutcher MJ, Overholser CD, Niehaus C, DePaola LG, Siegel MA.

Baltimore College of Dental Surgery, Dental School, University of Maryland.

Recurrent aphthous ulceration (RAU) remains a clinical problem for many patients. Efforts in prevention and/or treatment with prescription and nonprescription formulations have to date resulted in minimal success at best. A 6-month double-blind clinical study of 96 adults compared a commercially available antimicrobial mouthrinse (Listerine Antiseptic [LA], Warner-Lambert Co., Morris Plains, N.J.) and a hydroalcoholic control to evaluate the effects of vigorous twice-daily rinsing on the incidence, duration, and severity of RAU in persons prone to this disorder. LA rinse and the hydroalcoholic rinse resulted in a statistically significant reduction in the incidence of RAU occurrences from baseline. The duration of lesions and the severity of pain in subjects with ulcers during the treatment period were also significantly reduced in the LA rinse group of patients when compared with baseline. The hydroalcoholic rinse did not show a significant effect versus baseline for either severity or duration of the lesions. Rinsing therefore can be of clinical value in reducing the occurrence of RAU in susceptible patients, and LA rinse can be of significant additional value in decreasing the duration and severity of RAU.

路过的大胆假设

溃疡的发生跟身体的免疫功能失调有关，而这又受体内激素的控制。 最有力的证据是，很多人都发现，在怀孕期间，溃疡会完全消失。 平常的发作频率和严重程度，也有月周期性。 体内激素水平的个体差异很大，这就能够解释， 为什么有的人更容易患病；另外，women更容易得口腔溃疡。

这个假设，也可以解释，为什么生活压力大了，睡眠失调，有些食品，甚至牙膏，会引发溃疡。

使用Listerine的经历，使我认识到，口腔溃疡更是一个infectious disease (病毒，细菌，具体尚不知道)。 我因此查过各种常用的mouth rinser产品的成分。 只有Listerine含有好几种杀菌的化学物。

刚 开始用时，完全受不了Listerine入口的疼痛刺激，现在却跟使用其它的产品，没有区别。 推测原因，口腔里，除了明显的溃疡之外，大概更有很多小病灶，小伤口。这大概也是溃疡能够反复发作的原因。 另外，不小心咬破口腔，舌头，使用太硬的牙刷，正好给病菌造成可趁之机，也就不奇怪了。

总结起来，口腔溃疡是一个two-hit的疾病。 身体的免疫功能，激素调控的失常是主要的susceptibility因素；而微生物感染是真正的致因。

这样看来，口腔溃疡跟胃溃疡的致病基理其实是一样的。 下一步，就是找到致病的那种口腔病菌。

个人经历

当属于最严重的一类。 一年内，完全没有症状的时候几乎没有。 甚至常常引起咽喉
发炎，误作感冒。 习以为常后，并不影响日常生活。一般的溃疡持续一星期左右，自动愈合。但每年，总会暴发几次严重的 - 往往是因为用餐时，不小心咬破什么地方 (顿时，心都凉了)，但有时并没有明显的原因 - 一周后，伤口反而越来越大，疼痛难忍。 往往需要一个月左右，才能熬过去。 不光daily routine受干扰，心情也沉到谷底，怨天尤人起来。

从中国到美国，看的医生无数，所有的药都试遍，并没有什么效果。 唯一管过一点用的是易口帖，一度甚至治愈。 多用以后，效果递减，直至无效。

几个月以前，在别人的推荐下，开始用Listerine漱口(以前都是用SCOPE之类)。 意想不到的，一两星期后，溃疡完全没有了。 至今，偶而还会有一点小症状，最“严重”的一次，我把灯光打亮，仔细观察，才能看见那么小小的一点溃疡。

这对我来说，无异于奇迹，也是建立这个blog的动力。

治疗

没有确凿的致因，治疗的方法既多又杂，疗效却有限。

最常用是抗炎症的激素一类。比如国内近年畅销的“易可帖”，其实是肾上腺皮质激素。 美国同类的处方药有：Apthasol (Amlexanox); Kenalog in Orabase; Synthetic Corticosteriod; Lidex (fluocinonide); Diprolene (betamethasone); Temovate (clobestasol).

总的说来，这些药效果都不好。 很大一个原因是由于口腔用药不方便，药常常不能到位；有时，使用过程本身还给患者增加额外的痛苦。跟其它类似药物相比，易可帖的最大优点是用起来容易一点。 但反复使用后，效果似乎递减，最终无效。

用抗菌素，比如四环素水漱口，似乎有一定的疗效。有时候，医生干脆就让买一点麻醉药benzocaine，止痛了事。

病因

除去因为其它疾病并发的情形， 造成口腔溃疡的原因仍然没有搞清楚，所以说法很多。 最常提到的一个致因是病人缺微生素B12 (或缺叶酸， 缺铁)。 性激素失调也有一定关系，很多妇女发现，本来很严重的溃疡，在怀孕期间，竟然会完全消失；既使平常， 发作的时间和严重程度似乎也有一定的周期性。另外生活的突然紧张，缺乏睡眠，以及意外事故发生，都会明显地增加发病率和严重程度。 最后，食用过辣过酸的食品，也会使病情恶化。

最新的科研还找到一些证据表明口腔溃疡可能是一种自身免疫的疾病。

因为口腔是微生物最容易滋生的场合，微生物感染致病是很有道理的假设。但是，研究早已排出了疱疹病毒的致病性；最近的一些小型实验， 采用最敏感的分子生物学方法， 也没有找到幽门螺杆菌造成口腔溃疡的有力证据 (幽门螺杆菌是胃溃疡的罪魁祸手)。

简而言之，口腔溃疡可能是多因素造成的，得病的原因大概还有个体差异。另一个可能是，真正的致病因素并没有找到。 在科学家发现幽门螺杆菌是胃溃疡的罪魁祸手之前，胃溃疡的致因，也是这么罗列一大堆“多因素”。

定义

口腔溃疡 (英文常用语：canker sore; meidcal term: aphthous stomatitis) 是最常见的口腔疾病之一。 绝大多数人一生中都得过至少一次。 发作初期，溃疡的部位发红，随后转为几平方毫米左右的白色园圈，几天后会自然愈合。 病情严重者，溃疡也可能终年不断，在口腔不同部位，反复发作，伤口面积可以大至平方厘米，每次持续时间也经常超过一两星期。 伤口部位的剧烈疼痛，以及由此带来的负面心理作用，对病人的生活质量往往造成很大影响。

另一个常常混淆的口腔疾病叫cold sore，或r fever blister。 sore长在嘴唇外附近的部位， 而不是在口腔内。 cold sore是由Type 1 herpes simplex virus引起的。