An Interview with Steven R. Pohlhaus, DDS, FAGD

Dr Steven R Pohlhaus has a private dental practice in Linthicum, Maryland, and is Clinical Instructor at the Department of Diagnostic sciences and Pathology, Dental School, University of Maryland Baltimore. He is a Fellow of the Academy of General Dentistry. He has a web-site absolutely full of information about all things oral. While talking about web-sites, I took the opportunity of asking him a few questions:

What would you put at the top of the list of causes of mouth ulcers ?

Stress in it’s various forms whether it be emotional, allergenic, hormonal, etc.

Sodium Lauryl Sulphate (SLS), is accused of being a major contributor in causing and exacerbating mouth ulcers. What is your opinion of this agent?

It definitely plays a role in susceptible individuals. The only way to find out is through simple trial and error eliminating SLS toothpaste for a while. I wouldn’t call it major but it is an important trigger to consider.

How significant do you consider the role of allergic reactions to be in causing and exacerbating mouth ulcers?

Very significant. Though the term allergy may be a bit misleading. I would prefer to call these substances immunological triggers and the response a form of delayed hypersensitivity. An apthous is not a true allergy in the classical sense but seem to result from some overzealous immune reaction which damages the mouth tissues.

Topical steroids certainly help to get troublesome ulcers to start healing (or to be precise, stop becoming inflamed). Are there any contraindications to be aware of in the repeated use of such products in the mouth ?

Most studies have shown minimal systemic absorption of the steroids as application to oral tissues is considered a topical treatment. However one must watch for fungal infections emerging if someone is using a rinse such as Decadron a lot. This is more of a local effect due to the immunosuppressive effects of steroids.

Some preparations make use of chemical cauterising agents. Is it really a good idea to use these on the top surface of the tongue where all your taste buds are?

Debacterol is a safe and effective treatment, but it stings quite a bit when applied and tastes awful.

What do you consider, if any, the role of bacteria in recurrent mouth ulcers?

No one has proven such a link. Clinical experience and common sense due seem to indicate that treatments such as Laser or Debacterol seem to disinfect along with the cautery effects and these are the two most effective treatments. It would seem eliminating any superinfection of bacteria within the ulcer can only help speed healing.

It has been suggested on the message board that cadmium in fillings (the old metal coloured ones) is a trigger for some people, and that they should all be replaced with new white ones. What do you think about this?

I have no knowledge of this connection.

Common recurrent apthous stomatitis, and major apthae are different degrees of the same thing, but, what about herpetiform ulcers ? Do you think they the same thing or are they a viral outbreak as suggested by some people?

Herpetiform ulcers are simply a variant of apthous stomatitis and are fairly uncommon.

In your opinion what is the best course of action for someone to:

Reduce the frequency and severity of their mouth ulcers ?

Try to pay attention to what triggers them and avoid them. Also reduce stress through a healthy diet, exercise and the like. Practice good oral hygiene and keep your teeth in good shape. Listerine rinses twice a day seem to help some people have less attacks. Treat the ulcers with whatever treatment you have as soon as symptoms begin.

Ease the intense pain caused by mouth ulcers?

In order of effectiveness and rapid response……Laser Treatments, Debacterol, OTC analgesics, Topical Steroids.

Get them to heal as quickly as possible?

Absolutely, laser treatment is the best; we use a Waterlase in our office. It gives immediate pain relief with minimal discomfort during the session, which only takes about a minute. Healing occurs in 48-72 hours even with large ulcers.

Many thanks for your time and sharing your knowledge Steven, very informative and much appreciated.
Dom Walton, 5 June 2004.