Mouth Ulcers: Causes, Symptoms and Treatments

Mouth ulcers, also referred to as canker sores or aphthous ulcers, are small, painful lesions that commonly develop within the mouth, including the gums and tongue.

Typically displaying a white or yellow centre surrounded by inflamed red tissues, leading to persistent discomfort.

They can significantly disrupt daily activities like eating, drinking, and speaking.

While generally benign and non-contagious, these ulcers may sometimes persist for a week or two, causing prolonged pain and inconvenience.

In such cases, seeking prompt dental and medical care becomes paramount.

Types of Mouth Ulcers

Mouth ulcers can be classified into several types based on their causes and characteristics:

Minor Aphthous Ulcers

These are the most common type of mouth ulcers, typically small (less than 1 cm) and shallow, appearing on the inside of the lips, cheeks, or under the tongue. Although painful, they usually heal within 1 to 2 weeks without scarring.

Major Aphthous Ulcers

Unlike minor ulcers, major aphthous ulcers are larger and deeper, often exceeding 1 cm in diameter. They can be extremely painful and may take several weeks to heal, with scarring being more likely.

Herpetiform Ulcers

Despite their name, herpetiform ulcers are not caused by the herpes virus. They are characterized by clusters of tiny ulcers that merge to form a larger sore. These ulcers are often very painful and tend to recur frequently.

Traumatic Ulcers

Resulting from physical injury or irritation to the mouth tissues, traumatic ulcers are usually shallow and heal relatively quickly once the source of trauma is removed. This can include accidental biting, sharp edges of dental appliances, or aggressive tooth brushing.

Drug-Induced Ulcers

Certain medications, such as NSAIDs, chemotherapy drugs, and some oral medications, can cause mouth ulcers as a side effect. These ulcers may resemble minor aphthous ulcers and typically resolve once the medication is discontinued.

Infectious Ulcers

Caused by viral infections like herpes simplex virus or bacterial infections like syphilis, infectious ulcers may be accompanied by other symptoms such as fever and swollen lymph nodes.

Systemic Disease-Related Ulcers

Some systemic conditions, including inflammatory bowel disease, Bechet's disease, and autoimmune disorders, can present with oral ulcers as one of their symptoms. Understanding the type of mouth ulcer a person is experiencing is crucial for determining the appropriate treatment and management. Seeking advice from a healthcare professional is essential for accurate diagnosis and individualised care.

Symptoms of Mouth Ulcers

Signs and symptoms of mouth ulcers vary depending on the type and cause of the ulcer.

However, the most common presentation of mouth ulcers is as follows:

• Presence of one or more painful sores inside the cheeks, roof of the mouth, tongue, gums, inside of the lips, and sometimes even on the floor of the mouth.
• Lesions are round or oval, with clean red, inflamed edges and yellowish-white centres.
• Pain and discomfort during eating, talking, and drinking.
• These lesions are often painful to the touch.
• Mouth ulcers can coincide with fever, causing lethargy and irritability.
• Swollen lymph nodes and oral glands in severe cases.

Symptoms Of Herpetiform Ulcers:

• Appearance of extremely painful multiple pinpoint ulcers in the mouth.
• High recurrence rate.
• Continuous formation of ulcers, with new ones appearing before the old ones heal.
• Ulcers start as tiny pinpoint sores and gradually increase in size as multiple ulcers merge.
• Can occur anywhere in the oral cavity.
• Healing may take more than a week.
• More common in females and older adults.

Causes and Risk Factors for Mouth Ulcers

• Minor trauma or repeated injury to the mouth due to faulty dentures, dental fillings, or sports injuries.
• Irritants like toothpaste and mouthwashes that contain sodium lauryl sulphate.
• Allergies to citrus foods.
• Hormonal changes during puberty, menstrual cycles, pregnancy, and menopause.
• Deficiency of vitamins such as Vitamin B12, folic acid, zinc, and iron.
• Poor nutrition.
• Infections which may be bacterial, fungal, or viral.
• Conditions like celiac disease, inflammatory bowel syndrome, diabetes, and HIV.
• Autoimmune diseases.
• Stressful environments.

All these factors can significantly contribute to the occurrence of mouth ulcers.

Identification of these risk factors and treatment of underlying causes remains the foundation of treating mouth ulcers.

Therefore, it is essential to consult a healthcare professional promptly for proper management.

Treatment for Mouth Ulcers

• In most cases, mouth ulcers can be managed with symptomatic treatment protocols and do not require specific medical intervention.
• For minor and major mouth ulcers, your healthcare professional may prescribe benzocaine oral gel to alleviate pain and discomfort.
• An antimicrobial mouthwash may be recommended for daily rinsing, sometimes in combination with antibiotic pills.
• Corticosteroid ointments and mouthwashes may be prescribed by our board-certified dentist for persistent ulcers to expedite healing.
• Supplementation with vitamins such as B12, zinc, folate, and iron may promote faster healing and prevent future outbreaks.
• Applying ice to the ulcer can help alleviate pain and reduce inflammation.
• Correcting issues with dentures and dental fillings may also be necessary for traumatic ulcers.
• Learning stress management techniques can help reduce the frequency of ulcers.
• Maintaining proper oral hygiene, including gentle brushing with a soft toothbrush, is essential.
• Avoiding foods and beverages that may trigger mouth ulcers can also be beneficial.

By following these recommendations and seeking guidance you can effectively manage mouth ulcers and promote oral health.

When to Seek Medical Attention

Mouth ulcers are typically not a cause for immediate concern and can often be managed at home.

However, there are certain situations where it may be advisable to seek medical or dental attention.

See a Dentist if:

• Your ulcers are interfering with your ability to eat, drink, or speak comfortably.
• You have sharp edges on dental appliances or restorations that may be causing trauma.
• You suspect your ulcers are caused by poor oral hygiene or dental issues.
• You need guidance on oral care practices to prevent future ulcers.
• You require prescription medication or mouthwash for managing the ulcers.

See a Doctor (General Practitioner or Primary Care Physician) if:

In severe cases where mouth ulcers become exceptionally large and painful, medical intervention may be necessary.

If your ulcer persists without improvement and the pain worsens, seek care to address any underlying issues.

• You have recurrent or persistent ulcers that do not heal within three weeks.
• Your ulcers are unusually large or painful.
• You experience additional symptoms such as fever, swollen lymph nodes, or unexplained weight loss.
• You have a weakened immune system due to a medical condition or medication.
• You suspect your ulcers are caused by a systemic condition like inflammatory bowel disease or celiac disease.

In general, if you are unsure whether to see a doctor or a dentist for your mouth ulcers, it is advisable to start by consulting with your dentist. They can assess your oral health and refer you to a physician for further management, if necessary.