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Bednar's Ulcer

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Bednar’s ulcers occur due to feeding intolerance. Read the article to know the diagnosis, management, and preventive measures to avoid these ulcers.

Medically reviewed by

Dr. Infanteena Marily F.

Published At December 29, 2021
Reviewed AtAugust 10, 2023

What Are Bednar’s Ulcers?

The origin of any oral ulcer, especially in an infant, can be mainly of two sources:

  • A traumatic causative.

  • An underlying infection (infectious origin ulcers).

The occurrence rate in newborns regarding these ulcerative lesions is often elusive or somewhat unclear but is commonly found in a few cases during routine health check-ups. Also called Bednar’s aphthae, these ulcers are mainly attributed to feeding intolerance. As per research, the potential linkage to the exact cause is because the baby’s palate is exposed to trauma in such cases.

These neonatal ulcers' name is derived from the Austrian Physician or Pediatrician Alois Bednar, who first discovered it in 1950. Bednar’s ulcers' features are commonly confused by some physicians with the RAS group of lesions (Recurrent aphthous stomatitis), but they are different entirely and hence are not associated.

What Is the Origin of the Bednar’s Ulcer?

These mucosal lesions that appear ulcerative on the posterior borders of the hard palate or the soft palate usually are symmetrical, connecting both the maxilla and mandible (upper to lower jaw soft tissue region). They are pretty standard if diagnosed during a routine check-up, especially if the physician suspects the infant's response to trauma from its palate.

Also called “ulcera pterygoida,” Bednar ulcers commonly are referred to colloquially as the ulceration of palatine angles and hence the term. The ulcers are small and shallow with traumatic causative from the mother's breast nipple or the bottle nipple during feeding. A diagnosis is directly linked to the infant's palatal trauma, and subsequent examination reveals these ulcers specific at these locations.

What Are the Other Causes of Bednar’s Ulcer?

Physicians' lack of awareness about these ulcers may complicate issues. These ulcers spontaneously regress without causing any form of a sequel, usually within a month, and no intervention is needed (as per retrospective case analysis studies and research). Bednar’s ulcers may not even be diagnosed at times because of a lack of concern. More often, however, it may be a source of stress during sucking to the infant causing discomfiture. The recent development of orthodontic bottles and nipples has positively impacted the reduced incidence reports of these ulcerative lesions in Newborn infants.

Amongst the causes, especially in developing and developed countries, the uneven temperatures of formula-based milk or even microwaving formula milk would be considered a possible source of thermal burns to the infant. Hence one of the preventive modalities for preventing oral ulcerations and burns, especially in an infant upto three months of age, would be to avoid uneven mixing, consistency, and temperatures, or microwaving formula milk as it can lead to burns in the oral mucosa.

What Is the Pathogenesis of Bednar’s Ulcer?

Though the pathophysiologic cause of these ulcers is unclear, research attributes the formation of these shallow-edged ulcers on the palate to two types of reasons - traumatic and immunologic. Mechanical pressure caused by bottle nipples during feeding or only in a horizontal position has triggered the hypothesis for traumatic origin Bednar’s aphthae. Also, as these lesions seldom have any exudate or rough borders, this hypothesis linked to bottle feeding and feeding intolerance is thought of as a primary reason.

However, another immunologic hypothesis states that infants born through standard or spontaneous vaginal delivery are exposed to the vaginal flora (that may evidentially show why infants born through normal vaginal delivery have more incidence of ulcers than infants delivered through cesarean section). This hypothesis may lack evidence given that the mode of delivery may not be as impactful for causing ulcers compared to the local trauma and discomfort caused to the infant's mouth while bottle or nipple sucking.

What Is the Differential Diagnosis of Bednar’s Ulcers?

The differential diagnosis for Bednar’s ulcers depends on the cause rather than the physical presentation of neonatal ulcers. Bohn’s nodules, Epstein pearls, and recurrent aphthous stomatitis (RAS) are other commonly occurring whitish-yellow opaque nodules also occurring at the junction of the hard palate or soft palate. However, the physician needs to confer with the dental surgeon to get an accurate diagnosis to differentiate it from the more severe conditions that involve an underlying infective etiology like herpetic stomatitis, coxsackievirus, and hand, foot, and mouth disease.

The differentiating factor always remains, however, that an infective etiology will also clinically present with fever, and the lesions do not always occur at the posterior palate region. The dentist or physician should also note that Bednar’s ulcers are relatively smooth and rounded with a shallow presentation specifically in the palate region while establishing a differential diagnosis for oral lesions. Also, as it is essential to wait and watch whether these lesions are self-limiting and will heal obviously within 6 to 8 weeks, neonatal ulcers should not be interfered with unless an infectious entity is involved in the infant. Hence establishing the cause of ulcers becomes essential.

The differential diagnosis conditions for Bednar’s ulcers are mainly being:

How Is Bednar’s Ulcer Managed?

  • Management mainly depends on treating the underlying cause of discomfort to the child either due to bottle or nipple feeding. A change in the feeding habits by the mother proved a source of faster healing of these self-healing ulcers. Usually, the time taken is 6 to 8 weeks for the ulcer to heal spontaneously.

  • The physician or dentist should cross-check any duration after eight weeks to establish a differential diagnosis and investigate any infectious cause of concern to the baby.

  • Physicians usually advise infant mothers to enlarge the orifice of the nipple (if the narrow nipple hole is creating an issue), and the position for nursing also should be corrected (horizontal position to be avoided then).

  • The possibility of light scars on the palate may exist and is not a cause of concern if the ulcers heal within a month on their own.

Conclusion:

To conclude, the physician should not intervene with Bednar's ulcers discovered routinely during check-ups. Instead, the underlying cause and changes in feeding habits adopted to address the oral discomfort of the newborn should be investigated.

Frequently Asked Questions

1.

What Are the Causes of Aphthous Ulcers?

The exact cause of aphthous ulcers is unknown. However, according to studies, it shows that external triggers are one of the causative factors that may cause aphthous ulcers; these include:
- Emotional stress.
- Genetic.
- Minor mouth injuries are caused by cuts, burns, or bites when eating, hard brushing, or poorly fitted dentures.
- Vitamin deficiencies include zinc, B-12, folate, iron, and other vitamins and minerals.
- Various foods and beverages include spicy or acidic foods, coffee, chocolate, eggs, and cheese.
- Hormonal changes in pregnancy.
- Weak immune system.

2.

Is Aphthous Ulcer a Serious Condition?

Aphthous ulcers are not a serious condition. It usually goes away within a few weeks without any specific treatment. However, aphthous ulcers are sometimes very painful and uncomfortable if they are recurrent ulcers. There are no signs of any non-infectious diseases or oral cancers. If aphthous ulcers remain for more than three weeks, the affected person should consult immediately with any doctors.

3.

Is Aphthous Ulcer Painful?

Aphthous ulcer ulcers are tiny, shallow, painful lesions that appear on the mouth's soft tissues or gum lines, making it difficult to speak, drink and eat. The pain may get worse when the affected area gets more irritated. Mouth ulcers can cause more pain in the initial days, but once the healing process has started, the discomfort should start to subside.

4.

How to Treat Aphthous Ulcers?

There is no appropriate treatment for aphthous ulcers or canker sores; however, there are methods to minimize the symptoms. In most cases, ulcers heal independently and control the pain by avoiding irritating foods like pineapples, applying cold items, or numbing medicines like topical lidocaine or benzocaine to the affected area.

5.

What Is the Quickest Way to Heal an Aphthous Ulcer?

The quickest way to speed up the recovery, prevent infection, or reduce the discomfort of aphthous ulcers includes:
- Corticosteroid lozenges.
- Antibacterial mouthwash. 
- Mouthwash, gel, pain-killing tablets, or spray.
- A mouthwash with salt (saline).  

6.

Which Virus Results in Aphthous Ulcers?

Viruses do not cause aphthous mouth ulcers. Herpes Simplex Virus Types 1 or 2 are associated with herpes labialis, also known as cold sores.

7.

Can a Mouth Ulcer Be Cancerous?

An average period of a mouth ulcer is 10-14 days. However, some ulcers may persist more than their period. It may be a sign of oral cancer. In such cases, the affected person should consult a doctor immediately.

8.

Is Aphthous Ulcer Fungal?

Bacterial, fungal, and viral infections may also cause oral ulceration. For example, numerous studies have suggested that fungal infections like oral thrush associated with Candida albicans can cause an oral aphthous ulcer. These lesions are painful and discomfort, marginally elevated, pale in color, and make the mouth dry.

9.

How Long Does Aphthous Ulcer Last?

Aphthous ulcers are normal mouth ulcers that may heal within 10-14 days without any treatment. However, some ulcers may not clear up and persist for more than three weeks; such ulcers may be a sign of oral cancer. These ulcers make the affected person very painful and uncomfortable while eating or communicating. For such cases, It is recommended to consult with any physicians immediately.

10.

Is Salt Good for Aphthous Ulcers?

Yes, salt is good for aphthous ulcers. Frequent saltwater rinse helps accelerate the healing process by drying out the ulcers. One teaspoon of table salt should be dissolved in half a cup of warm water; then, the mixture should be swirled around the mouth for 15 to 30 seconds and spit out.

11.

What Is the Best Antibiotic for Mouth Ulcers?

A cortisone-like medication called dexamethasone is used to relieve inflamed areas. According to the studies, tetracycline mouthwash may help to reduce pain and speed up the healing process within 24 hours. Antibiotic or corticosteroid mouthwash can be taken with any doctor's prescription.

12.

What Is the Best Medicine for Aphthous Ulcers?

Over-the-counter and prescription medications (pastes, creams, gels, or liquids) may help reduce discomfort and promote healing. These include:
- Benzocaine.
- Fluocinonide.
- Hydrogen peroxide.

13.

Is Aphthous Ulcer an Autoimmune Disease?

According to studies, it shows that there is a connection between autoimmune diseases and recurrent aphthous mouth ulcers. In addition, some autoimmune diseases, including Crohn's disease, pemphigus, and Behcet's, are associated with complex and recurrent aphthous mouth ulcers.

14.

Can Stress Cause Aphthous ulcers?

Aphthous mouth ulcers may develop as a result of stress. Although stress does not directly cause mouth ulcers, it does increase the probability of them occurring and can influence how quickly they heal. Mouth ulcers can also bring on stress since they limit what and how a person can eat and drink.

15.

How to Get Rid of Mouth Ulcers Overnight?

Mouth ulcers may last a minimum of 10 to 14 days. Using the following guidelines can minimize the discomfort and pain and also may accelerate the healing process of mouth ulcers:
- Use a toothbrush with gentle bristles.
- Consume soft meals.
- Avoid the consumption of hot spicy food.
- Use a straw for drinking beverages.
- Consume a balanced, healthful diet.
- Regular dental examinations.
Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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