
Wounds taking weeks to heal on skin disappear in a week inside the mouth (2013) - bookofjoe
http://www.nytimes.com/2013/03/26/health/the-mouths-guard.html?ref=health
======
giardini
From the article: _" “It is a known observation among the vulgar that the
saliva is efficacious in cleansing foul wounds, and cicatrizing recent ones,”
wrote the 18th-century physician Herman Boerhaave. He was correct. Wounds that
would take several weeks to heal on one’s skin disappear in a week inside the
mouth."_

But the author of the article (not Boerhaave) seems to be missing several
points:

1) a wound inside the mouth is protected by tissue all about, and body
temperature is maintained as well. An external wound is ~half open to the
world and has no temperature maintenance on the open surface. Temperature is
important for the immune system to perform.

b) concerning the phrase "saliva is efficacious in cleansing foul wounds":
what Boerhaave is saying is that _licking_ one's wounds is efficacious. He's
not merely speaking of saliva floating about a wound inside a closed mouth.
The common phrase "to lick one's wounds" is not a false euphemism and is not
limited to animals other than humans. Licking a wound can help heal it,
sucking a wound can remove material that has been inserted into a wound and
can quickly route fresh blood to a wound site, aiding healing and flushing out
foreign material.

[https://www.quora.com/Does-licking-your-own-wound-help-
heal-...](https://www.quora.com/Does-licking-your-own-wound-help-heal-it)

[https://www.sciencedaily.com/releases/2008/07/080723094841.h...](https://www.sciencedaily.com/releases/2008/07/080723094841.htm)

[http://www.science20.com/news_releases/histatin_why_licking_...](http://www.science20.com/news_releases/histatin_why_licking_your_wounds_actually_works)

~~~
IncRnd
Placing an Activ Flex by Band-Aid on a skin cut seems to act as a true
temporary replacement "second skin", and the cut heals far more rapidly then a
regular band-aid. It heals in a similar time-scale as this article says is
regular for the mouth.

I'm sure there are other brands or technologies that act similarly, but once I
found this particular type of bandage I never had the thought of using
anything else.

~~~
refurb
While true, the reason covered skin wounds heal faster is often due to the
cover stops the drying out of the wound which slows healing.

~~~
IncRnd
Thank you. Though, I wasn't implying these bandages have spit in them.

------
goda90
As someone who occasionally suffers from canker sores, I wish it were true
that they'd heal faster than say a paper cut.

~~~
neolefty
Consider food allergies -- I used to suffer from canker sores and then
accidentally stopped drinking milk for 6 months (moved to a place where it
wasn't available) and voila they disappeared!

(I didn't actually notice that they had disappeared until I returned to milk-
land, and they came back. Took another month or so to establish the link
clearly, since there was 3-4 day delay between drinking milk and appearance of
canker sores. Then it took another couple of years to alter my habits ...)

~~~
derefr
It's not so much that you were drinking milk, as that you were drinking milk
_to answer thirst_ —i.e., you were drinking milk when dehydrated. When you're
dehydrated, the mucous membranes of your mouth and throat and sinuses become
highly absorbent to any fluid that passes by. If there are things dissolved in
solution in that fluid, they'll get absorbed into your mucous membranes too,
and stick around for quite a while (either until you drink something else;
until you exercise or take in a sauna, and sort of "sweat internally", purging
said membranes; or until your lymphatic system slowly flushes the contents of
your interstitial fluid out to your liver.)

To talk about canker sores, I first have to talk about dental plaque. Plaque
appears when both of these conditions are true:

1\. your mucous membranes are saturated with nutrients (such as those in milk,
or juice, or soda, or "saucy" foods) amenable to the growth of bacterial
biofilms; and

2\. you are dehydrated enough—or under the chronic effects of diuretics such
as caffeine—such that you don't consistently produce enough saliva to reach
the mucous membrane and battle the nascent bacterial colony.

(That's right: plaque may live on your teeth, but the food those bacteria
consume mostly isn't food stuck to/between your teeth; it's food "in" the
mucous membranes of your lips. This is why the regrowth speed of plaque seems
to have no correlation to how well you've brushed your teeth—the factor is how
much food they have access to, and brushing your teeth has no effect on the
nutritive content of your mucous membranes.)

Canker sores, then, happen when an established plaque (bacterial biofilm)
colony is pressed into a dehydrated mucous membrane, further isolating it from
the reach of saliva, for an extended period. Picture, say, a dirty tooth
pressed against your lower/upper lip as you sleep, with your face laying to
squeeze that part of your lip around the tooth, such that saliva can't get in.

So, ways to avoid the problem:

1\. brush your teeth at night (i.e. after you stop eating food.) It's more
important than brushing in the morning, if you want to prevent canker sores.

2\. If you're dehydrated, _drink water_ or another substance that contains few
bacteria-promoting nutrients (like unsweetened flavoured carbonated water, or
even hard liquor.) If you can't—if only milk/juice/soda/beer/coolers are being
served—then try to "chase" your drink with water as soon as possible. When you
do, swish some of the water in your mouth as if it was a mouthwash. Ensure
your mucous membranes themselves are getting hydrated.

3\. Get enough vitamin C. Subclinical hypovitaminosis C ("pre-scurvy") causes
the linings of your mucous membranes to weaken, making it easier for rough
spots on your teeth to cause micro-abrasions in them, which is where bacterial
biofilms get in. But make sure you're not "getting enough vitamin C" by
drinking orange juice when you're dehydrated!

~~~
darkerside
This was incredible! Thanks for sharing. I wish they taught more of this kind
of thing in grade school. Do you work in the dental field?

I've been reading about xylitol lately, a sweetener found in sugar free gum.
From what I can tell, it could potentially help with cavities because it can
help regenerate dentin. Not to mention gum seems to be generally helpful for
removing waste from teeth. Is this something you've heard about?

~~~
derefr
Xylitol is great! I can't stop eating these -- [https://www.amazon.ca/Xyla-
Brand-Xylitol-Raspberry-Candies/d...](https://www.amazon.ca/Xyla-Brand-
Xylitol-Raspberry-Candies/dp/B007PT82KO). And, indeed, they help, rather than
harm, your teeth, and discourage bacterial sinus infections.

Which reminds me of a rant:

You know what _doesn 't_ do either of those things? Any mouthwash you can buy
in the mouthwash aisle.

Ask a dentist about mouthwash. They'll recommend it—but only because the
alcohol temporarily shrinks your gums, which allows a toothbrush and/or floss
to scrape plaque out that was embedded deeper between the gum and the tooth.
Mouthwash _doesn 't_ kill bacteria. (Or, it does, but only for the 30 seconds
it's in your mouth—meaning that you'll have just created a power-vacuum that
other, worse bacteria from e.g. the back of your throat can intrude into. And
now the alcohol has also _dried out_ your mucous membranes!)

If a dentist needs to _prescribe_ you a mouthwash, on the other hand—for
example, to keep a wound inside your mouth clean post-surgery—they'll
prescribe something with ingredients completely unlike that in "regular"
mouthwash. Here's ([https://www.amazon.ca/Chlorhexidine-Gluconate-Antiseptic-
Pep...](https://www.amazon.ca/Chlorhexidine-Gluconate-Antiseptic-Peppermint-
Ecolab/dp/B01HNCQIYE/ref=sr_1_1?ie=UTF8&qid=1519799776&sr=8-1&keywords=chlorhexidine+gluconate))
an example of one.

The primary ingredient of "mouthwash that actually works" is _chlorhexidine_
—that's a chemical more commonly used as a surgical antiseptic (i.e. a "scrub"
doctors will sanitize their hands with before putting them inside your body.)
Conveniently, the fact that it's safe to touch your internal organs with, also
means that it's safe to touch your mucous membranes with. (Though it's not
entirely safe; it says stringently on such mouthwashes not to swallow any—but
not because it'd harm _you_ per se, just that it'd likely kill your intestinal
flora in much the same way an antibiotic would.)

Interestingly, chlorhexidine and xylitol work in similar ways—they're both
things bacteria intentionally take up into themselves, that then destroy the
bacteria from the inside. Xylitol just stalls the bacteria's metabolism,
starving it to death; while, IIRC, chlorhexidine throws off the bacteria's
osmotic regulation until it pops, much like highly-saline environments do—but
without doing the same to animal cells. Unlike xylitol, though, chlorhexidine
will stick around in the mucous membranes (until you do any of the stuff I
mentioned in the previous post) for _eight hours_ , protecting you all the
while. It's great. Everyone should use it, at least at night.

It's kind of weird, given all this, that it's not well-known, and not used in
regular mouthwashes, no? Well, much like you just can't convince some people
that a HWRNG-seeded CSPRNG is a valid source of OS entropy, you just can't
convince some people that long-term chlorhexidine use wouldn't result in
bacterial resistance—even though, in both cases, if there was any potential
for it to fail in "normal" use (OS entropy; mouth-washing), it would have
failed a long time ago in the "heavy-duty" use-case where it's already being
used (cryptography; surgery.)

Or, to put that another way: if doctors will put chlorhexidine on their hands
every day without worrying about growing MRSA under their fingernails, you can
put it in your mouth every day without worrying about growing MRSA in your
throat.

(Bonus pleasant fact: most prepared chlorhexidine mouthwash solutions are
sweetened _with xylitol_. So you're getting a double-effect from that.)

On the other hand, prepared chlorhexidine mouthwash isn't very cheap (the one
I linked above was $15 for a bottle that'll last less than a month), and
preparing such a mouthwash yourself from concentrate is really a hassle (pure
2-4% chlorhexidine gluconate is much cheaper, but just diluting it with
water/alcohol would create a solution that only retains potency for ~1 day;
you'd need to add other chemicals to make it shelf-stable.)

But, if you can't (or just don't want to) get chlorhexidine mouthwash, I still
wouldn't recommend using alcohol-based mouthwash. For battling gingivitis or a
canker sore or whatever else, Xylitol actually works pretty well as a "quick-
fix" alternative. That is, it works well _if_ you exploit the very property I
mentioned before—increased mucous-membrane absorption and retention under
dehydration. So, here's a "life hack":

• Go buy a box of xylitol sweetener packets (the kind you'd pour into coffee.
You can probably find them sorted into the "nutrition products for diabetics"
area of a drug store.)

• Before you sleep, brush your teeth, floss, swish with water, spit. And
then...

• Dump one of those xylitol sweetener packets _directly into your mouth_ , not
dissolved in liquid or anything. Spread it around; get it onto the insides of
your lips, onto your teeth, etc.

• Let it absorb. Don't swallow it; just let it sit.

• Go to sleep, just like that.

 _That_ will protect your mouth, at least a little. Far more than Listerine
ever would.

\---

Oh, and as a separate thought: if you have recurring canker sores, oral
thrush, throat/sinus infections, ear infections, etc., despite good oral
hygiene—there's likely a "hidden fortress" of bacterial biofilm somewhere out
of reach, probably your maxillary sinuses or adenoids or Eustachian tubes.
These areas are "safe" for bacteria because they're damp from breathing, but
few actual fluids reach them.

Want a permanent solution? Flush them out. For the nose, I see people trying
nasal lavage ("neti pots" et al), and for the ears, I see people going to an
ENT to get microsuction. Neither of these are really needed. The biofilms
aren't invincible; they're just _dry_ —too dry for your body's natural
defences to loosen them. Drip a few drops of mineral oil down your nose/into
your ears, once per day. After two days, you should start to feel the need to
clear your sinus passages by snorting, inwards. Just keep doing that. And
voila, the hidden fortress has been destroyed.

------
dempseye
I wonder if the instinct to lick wounds is related to this.

~~~
Clubber
It is. As is mothers kissing their children's boo-boos.

------
delibes
And yet we still can't heal damaged gums easily. When somebody figures that
out, they'll be rich.

~~~
klipt
You mean periodontics? I think the main problem there is horizontal bone loss.
Periodontists can laser off unhealthy gum tissue, but once the jawbone has
retreated, there's less scaffolding for healthy gum to regrow on, so it won't
grow back to the same level you originally had.

Figure out how to reverse horizontal bone loss though, and you'll be rich!

~~~
criddell
I recently had a post for a dental implant installed and the doctor used
ground cadaver (or maybe bovine) bone to help grow new bone around the post
area. Is that related to what you are talking about?

~~~
klipt
According to the periodontist I spoke to, bone tissue grafts work for vertical
bone loss (a dent in your bone in a small area) not horizontal bone loss (bone
has been lost uniformly over a wide area).

------
euler_
That had disappointingly little content. Mouth wounds heal faster because of
background saliva, but why?

~~~
bookofjoe
Histatins: antimicrobial peptides with therapeutic potential

ABSTRACT

Histatins are a group of antimicrobial peptides, found in the saliva of man
and some higher primates, which possess antifungal properties. Histatins bind
to a receptor on the fungal cell membrane and enter the cytoplasm where they
target the mitochondrion. They induce the non-lytic loss of ATP from actively
respiring cells, which can induce cell death. In addition, they have been
shown to disrupt the cell cycle and lead to the generation of reactive oxygen
species. Their mode of action is distinct from those exhibited by the
conventional azole and polyene drugs, hence histatins may have applications in
controlling drug-resistant fungal infections. The possibility of utilising
histatins for the control of fungal infections of the oral cavity is being
actively pursued with the antifungal properties of topical histatin
preparations and histatin-impregnated denture acrylic being evaluated. Initial
clinical studies are encouraging, having demonstrated the safety and efficacy
of histatin preparations in blocking the adherence of the yeast Candida
albicans to denture acrylic, retarding plaque formation and reducing the
severity of gingivitis. Histatins may represent a new generation of
antimicrobial compounds for the treatment of oral fungal infections and have
the advantage, compared with conventional antifungal agents, of being a normal
component of human saliva with no apparent adverse effects on host tissues and
having a mode of action distinct to azole and polyene antifungals.

Kavanagh, Kevin and Dowd, Susan (2004) Histatins: antimicrobial peptides with
therapeutic potential. Journal of Pharmacy and Pharmacology, 56.

[http://eprints.maynoothuniversity.ie/354/1/R03014.pdf](http://eprints.maynoothuniversity.ie/354/1/R03014.pdf)

~~~
bookofjoe
Histatins are the major wound-closure stimulating factors in human saliva as
identified in a cell culture assay

ABSTRACT

Wounds in the oral cavity heal much faster than skin lesions. Among other
factors, saliva is generally assumed to be of relevance to this feature.
Rodent saliva contains large amounts of growth factors such as epidermal
growth factor (EGF) and nerve growth factor (NGF). In humans, however, the
identity of the involved compounds has remained elusive, especially since EGF
and NGF concentrations are ∼100,000 times lower than those in rodent saliva.
Using an in vitro model for wound closure, we examined the properties of human
saliva and the fractions that were obtained from saliva by high-performance
liquid chromotography (HPLC) separation. We identified histatin 1 (Hst1) and
histatin 2 (Hst2) as major wound-closing factors in human saliva. In contrast,
the d-enantiomer of Hst2 did not induce wound closure, indicating
stereospecific activation. Furthermore, histatins were actively internalized
by epithelial cells and specifically used the extracellular signal-regulated
kinases 1/2 (ERK1/2) pathway, thereby enhancing epithelial migration. This
study demonstrates that members of the histatin family, which up to now were
implicated in the antifungal weaponry of saliva, exert a novel function that
likely is relevant for oral wound healing.

Oudhoff, M. J., Bolscher, J. G. M., Nazmi, K., Kalay, H., van 't Hof, W.,
Nieuw Amerongen, A. V., Veerman, E. C. I.

[http://www.fasebj.org/doi/pdf/10.1096/fj.08-112003](http://www.fasebj.org/doi/pdf/10.1096/fj.08-112003)

~~~
euler_
Thanks for the information! After reading the abstracts, I still have two
question.

1\. It sounds like the mechanism for killing cells is very general. Why do
histatins not attack somatic cells?

2\. Do mouth wounds simply heal faster because the mouth is cleaner?

~~~
IntronExon
The cells lining the entire upper GI are exposed to digestive enzymes, and are
perforce replaced rapidly and constantly. Until bicarbonate rich bile is added
to the mixture in the duodenum, those enzymes (and acids) eat your own cells
too. Chemotherapy plays havoc with your GI tract because it selectively kills
cells which rapidly divide.

As for histamines, mast cells are designed to respond to them and rupture as
part of your inflammatory cycle. They release more cytokines, recruiting
neutrophils and in general telling your immune system to attack.

~~~
classichasclass
Histatins, not histamines.

~~~
IntronExon
Oops, thanks for the correction!

------
chapill
[https://en.wikipedia.org/wiki/Stratified_squamous_epithelium](https://en.wikipedia.org/wiki/Stratified_squamous_epithelium)

Mouths heal faster because of the type of cells in there. Licking your wounds
is a good way to get them infected. Use antibiotic creme and a bandage.

~~~
bookofjoe
As a physician, I demur: avoid anything but copious irrigation with water ±
bandage.

~~~
Bartweiss
If I'm reading that correctly, you're arguing against antibiotic or
sterilizing agents in favor of extensive rinsing without only water.

It certainly wouldn't surprise me to hear that Neosporin et al are usually
unnecessary, but are they actually bad? And if they're bad because antibiotic
resistance, are things like hydrogen peroxide and rubbing alcohol also bad?

~~~
logfromblammo
I think doc is saying, "Please don't make your wound worse with dubious
remedies before you come in to show it to me."

Your mouth is full of bacteria, some of which could be harmful when introduced
into an open wound. Your home first-aid kit is unlikely to be perfectly
sterile, or as versatile as an entire medical clinic. If you are in the
wilderness, and licking is the only means you have at your disposal to clean a
wound, go for it. Your mouth is less dirty than actual dirt. Otherwise, use
filtered, boiled water to wash, and a clean, sterile bandage to dress. [A
single application of] antibiotic ointment is unlikely to hurt, but painting
the surrounding skin with iodine would be better, and that kind of
antimicrobial power isn't typically found at home, unless you have livestock
and didn't care for the magnitude of your vet bills.

~~~
bookofjoe
Published August 2017

Povidone iodine in wound healing: A review of current concepts and practices

Abstract

BACKGROUND: Of the many antimicrobial agents available, iodophore-based
formulations such as povidone iodine have remained popular after decades of
use for antisepsis and wound healing applications due to their favorable
efficacy and tolerability. Povidone iodine's broad spectrum of activity,
ability to penetrate biofilms, lack of associated resistance, anti-
inflammatory properties, low cytotoxicity and good tolerability have been
cited as important factors, and no negative effect on wound healing has been
observed in clinical practice. Over the past few decades, numerous reports on
the use of povidone iodine have been published, however, many of these studies
are of differing design, endpoints, and quality. More recent data clearly
supports its use in wound healing.

METHODS: Based on data collected through PubMed using specified search
criteria based on above topics and clinical experience of the authors, this
article will review preclinical and clinical safety and efficacy data on the
use of povidone iodine in wound healing and its implications for the control
of infection and inflammation, together with the authors' advice for the
successful treatment of acute and chronic wounds.

RESULTS AND CONCLUSION: Povidone iodine has many characteristics that position
it extraordinarily well for wound healing, including its broad antimicrobial
spectrum, lack of resistance, efficacy against biofilms, good tolerability and
its effect on excessive inflammation. Due to its rapid, potent, broad-spectrum
antimicrobial properties, and favorable risk/benefit profile, povidone iodine
is expected to remain a highly effective treatment for acute and chronic
wounds in the foreseeable future.

Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA.

Int J Surg. 2017 Aug;44:260-268. doi: 10.1016/j.ijsu.2017.06.073. Epub June 23
2017.

[http://www.journal-
surgery.net/article/S1743-9191(17)30536-8...](http://www.journal-
surgery.net/article/S1743-9191\(17\)30536-8/fulltext)

~~~
logfromblammo
[citation appreciated]

------
yogrish
[https://www.reddit.com/r/explainlikeimfive/comments/7yux9i/e...](https://www.reddit.com/r/explainlikeimfive/comments/7yux9i/eli5_how_do_cuts_on_the_inside_of_your_mouth_on/)

------
everyone
Thats an example of good writing imo. Short and concise.

------
smdz
Weird to know that this is not common knowledge. I have known since I was a
kid that applying saliva on a fresh wound helps recover it faster

------
overcast
I always assumed it was because the environment is kept moist. Which is why
you bandage wounds, and not let them scab over.

~~~
tjpaudio
You bandage wounds to keep out bacteria, and it is your skin having to fight
off less infections that make it heal faster. Consider that Neosporin,aka
generic triple antibiotic ointment, does increase the speed of external wound
healing. It does this because of its antibiotic properties. Nothing to do with
moisture far as I know, where did you get that notion?

~~~
overcast
The proof that moist wounds heal faster than dry wounds came back in 1962,
thanks to Dr. George D. Winter and his landmark paper, "Formation Of The Scab
And The Rate Of Epithelialization Of Superficial Wounds In The Skin Of The
Young Domestic Pig"1\. His research showed that, contrary to the conventional
wisdom at the time that wounds should be allowed to dry out and form scabs to
promote healing, wounds instead heal faster if kept moist. Winter's work began
the evolution of modern wound dressings that promote moist wound
healing.Specifically, cell growth needs moisture and the main goal of moist
wound therapy is to create and maintain these optimal moist conditions. Cells
can grow, divide and migrate at an increased rate to enhance the formation of
new tissue. During this phase of wound healing, an aqueous medium with several
nutrients and vitamins is essential for cell metabolism and growth.

A study published in the Annals of Plastic Surgery aimed to determine the
effects of moist wound care. Researchers used a porcine wound model, to
compare wet conditions using saline, moist conditions using hydrocolloid
dressings and dry conditions using sterile gauze. The scientists found an
increase in the presence of liquids led to faster healing (wet wounds healed
after six days, while moist ones took seven days and dry wounds took eight).
Additionally, moist and wet wound care led to less necrosis and inflammation
as well as higher quality in the newly regenerated epidermis.

[http://www.woundsource.com/blog/clearing-air-about-moist-
vs-...](http://www.woundsource.com/blog/clearing-air-about-moist-vs-dry-wound-
healing)

[https://www.sunoven.com/how-to-heal-open-wounds-
faster/](https://www.sunoven.com/how-to-heal-open-wounds-faster/)

[https://int.hansaplast.com/advisor/health-and-
protection/moi...](https://int.hansaplast.com/advisor/health-and-
protection/moist-wound-healing)

[https://www.advancedtissue.com/debunking-wound-cares-
biggest...](https://www.advancedtissue.com/debunking-wound-cares-biggest-
myth/)

~~~
meric
Are dry wounds are less likely to be infected than wet wounds? A wet wound
that gets infected can take more time to heal than dry wounds that doesn't?

------
devsafrun
try a dip of "Policresulen"

your body will 'straighten out' due to pain, but wounds usually takes 2~3 days
to heal

------
kayall
Mary Roach. Her books are quite fun to read.

The titles are good too.

Stiff: The Curious Lives of Human Cadavers

Bonk: The Curious Coupling of Science and Sex

------
jwilk
(2013)

~~~
sctb
Thanks! Updated.

