Mouth ulcers

Mouth ulcers are among the most common problems that can occur in the mouth. They are small, painful sores that form inside the mouth. Stress, minor injuries inside the mouth, acidic fruits and vegetables, as well as spicy and hot foods can all be risk factors for the development of mouth ulcers. Here is everything you need to know about mouth ulcers.

Most mouth ulcers heal on their own within two weeks at the latest. In the case of unusually large and very painful mouth ulcers that show no signs of healing, a visit to the dentist is essential.

There are three types of mouth ulcers:

• minor mouth ulcers;
• major mouth ulcers;
• herpetiform mouth ulcers.

Minor mouth ulcers

These are the most common mouth ulcers; they occur three or four times a year and generally affect people aged between 10 and 20. They are oval-shaped with red edges, do not exceed one centimetre in size and heal in about a week without leaving scars.
 

Major mouth ulcers

These are less common, larger and more painful. They are round in shape with defined edges, but may also have irregular edges when very large. They can take up to a month to heal and often leave scars. They are more common among people who have previously had a form of mouth ulcer. Their cause may be another health problem. A weakened immune system, Crohn’s disease or a vitamin deficiency are among the risk factors.
 

Herpetiform mouth ulcers

This type of mouth ulcer is very rare and appears as a cluster of tiny ulcers with irregular edges. They usually heal within a week and do not leave scars. Older people are more prone to developing this form of mouth ulcer.

These include:

• emotional stress;
• minor injury to the mouth caused by an invasive dental procedure, excessive brushing or an accidental bite;
• injured tissue from a sharp tooth or poorly maintained dental braces;
• toothpaste and mouthwash containing sodium lauryl sulphate;
• food sensitivities, particularly to chocolate, coffee, strawberries, eggs, peanuts, nuts and spicy or acidic foods (lemons, oranges, apples);
• a food allergy;
• a diet lacking in vitamin B-12, zinc, folic acid or iron;
• hormonal changes during menstruation;
• a viral infection;
• non-steroidal anti-inflammatory drugs, such as ibuprofen;
• Helicobacter pylori, the bacterium that also causes peptic ulcers.
   

Canker sores can also occur due to certain health conditions:

• Coeliac disease, an intestinal condition caused by a sensitivity to gluten;
• Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis;
• Behçet’s disease, a rare condition that causes inflammation throughout the body, including in the mouth;
• A weakened immune system, which attacks healthy cells in the mouth instead of pathogens (viruses, bacteria);
• HIV infection, which suppresses the immune system.
• In some cases, the factors leading to the development of mouth ulcers cannot be identified.

In most cases, mouth ulcers cause localised pain and irritation. Signs that can help you recognise mouth ulcers include:

• shape: round, well-defined, less than one centimetre in size;
• colour: white or yellow in the centre, surrounded by a red border;
• location: inside the mouth (inside the lip, inside the cheeks); mouth ulcers can also appear on or under the tongue;
• a tingling sensation, up to 24 hours before they appear;
• sometimes, they affect the gums and, relatively rarely, the area at the back of the mouth;
• usually heals within a maximum of two weeks.

In more severe cases or if left untreated, mouth ulcers may have the following symptoms:

• apathy;
• fever;
• fatigue;
• swollen lymph nodes;
• lesions spreading outside the mouth;
• discomfort or pain when brushing, speaking or chewing.

Pay close attention to your diet – avoid foods that may irritate the mouth (nuts, crisps, pretzels, certain spices, salty foods and acidic fruits) or that cause sensitivity or allergies.

A balanced diet – to prevent nutritional deficiencies, fruit, vegetables and whole grains are recommended.

Good oral hygiene – regular brushing of the teeth after every meal with a soft-bristled toothbrush (to avoid irritating delicate tissues), avoiding toothpaste and mouthwash containing sodium lauryl sulphate, and flossing once a day all help to maintain oral health.

Less stress – if the appearance of mouth ulcers is linked to stress levels, it is advisable to use relaxation techniques, such as meditation, to reduce stress.

Most common mouth ulcers heal within a maximum of two weeks without the need for medical treatment. However, more severe or recurrent cases can only be treated following a medical examination at a dental clinic. These include lesions that are:

• large in size;
• that spread rapidly;
• that appear immediately after others have healed;
• that are slow to heal, even though risk factors (food, medication, stress, etc.) have been removed;
• that cause difficulty in drinking fluids;
• which cause a fever.

The dentist will make a diagnosis following a clinical examination or based on your medical history. Therefore, as a general rule, mouth ulcers should be checked by a specialist if they do not heal after two weeks; they worsen, even if natural remedies are used; they occur more than three or four times a year or are frequent or severe; they occur alongside other symptoms (fever, headaches, skin irritation, diarrhoea) or are considered part of another condition.

When it comes to treating mouth ulcers, there are two main approaches: medical and natural.
 

Medical treatment

The pain associated with common mouth ulcers tends to subside a few days after they appear. In the case of complex ulcers, which do not heal quickly or are recurrent, the dentist may offer several solutions: 

• Mouthwash containing steroids or painkillers;
• Topical medications containing steroids, such as dexamethasone – for inflammation – and painkillers, such as lidocaine – for pain relief;
• Oral medications, including hydrocortisone tablets;
• Nutritional supplements – where nutritional deficiencies cause mouth ulcers;
• Cauterisation – disinfecting and treating wounds. 

Natural remedies

There are also a few remedies that can be tried at home to speed up the healing of mouth ulcers and relieve discomfort and pain.

• Applying small amounts of ice, milk or honey to the sores helps to relieve pain and aids the healing process.
• Rinsing the mouth with a mixture of warm water and bicarbonate of soda can also relieve the pain.

In conclusion, mouth ulcers are not contagious, but they can be extremely painful in severe cases. Although they can heal on their own, it is advisable to consult a dentist, especially in cases where they are recurrent or occur alongside other symptoms. Although the causes of these lesions in the oral cavity have not been scientifically proven, there are several risk factors that play an important role in the development of mouth ulcers.

References:

1. Medical News Today. (n.d.). Canker sores vs. cold sores: How to tell the difference
2. Healthline. (n.d.). Canker sores
3. WebMD – Canker sores
4. Cleveland Clinic. (n.d.). Canker sores
5. Mayo Clinic Staff. (n.d.). Canker sore: Symptoms and causes
6. Belenguer-Guallar, I., Jiménez-Soriano, Y., & Claramunt-Lozano, A. (2014). Treatment of recurrent aphthous stomatitis: A literature review. Journal of Clinical and Experimental Dentistry, 6(2), e168–e174