Mouth ulcers are one of the most common conditions affecting the oral mucosa, with statistics indicating that they affect up to 20-50% of the population. They are more common among young people and tend to decrease with age.

Mouth ulcers are not contagious, and factors that lead to their appearance include stress, low immunity, injuries to the oral mucosa, vitamin deficiency, and spicy or hot foods.

In contrast, oral herpes is an extremely contagious lesion. This condition occurs as a result of infection with the herpes simplex virus type 1 (HSV-1), and figures show a prevalence of over 67% in the population under 50 years of age. Contamination occurs during childhood (6 months to 5 years).

Although mouth ulcers and herpes can be confused, these conditions have distinct causes, symptoms and treatments.

Mouth ulcers (aphthous ulcers or aphthous stomatitis) appear as small reddish areas accompanied by a burning sensation. After a few hours, an ulcer covered with yellowish-white fibrin deposits appears at that site. Mouth ulcers can vary in size (2-10 mm), are painful (the patient has difficulty eating or speaking), but do not bleed and are not accompanied by fever.

"Mouth ulcers most commonly appear on the inside of the cheeks and lips, on the tongue, at the base of the gums, and on the floor of the mouth. They can also appear on the tonsils. Canker sores do not appear on the fixed gums and the outer surface of the lips (lip red), which is an element that differentiates them from oral herpes," explains Dr. Irina Popa, resident periodontist.

After 1-2 weeks, the ulcers disappear without leaving any scars.

Causes of mouth ulcers

Although the exact cause is unknown, there are a number of factors that favour the appearance of mouth ulcers:

• stress
• low immunity
• sensitivity or allergies to various foods (nuts, peanuts, citrus fruits, spices, strawberries, chocolate)
• nutritional deficiencies (folic acid, iron, vitamin B6, B12)
• local trauma
• hormonal changes during menstruation
• smoking
• gastrointestinal disorders (e.g. Crohn's disease, coeliac disease, ulcerative colitis)

Mouth ulcers in children (aphthous stomatitis in children)

In children, mouth ulcers are often associated with dehydration. Due to the painful sensation, children refuse to eat and drink. In addition, they avoid brushing their teeth, and the ulcerative lesions can become infected.

In adolescents, mouth ulcers may occur due to hormonal imbalances during this period (puberty, menstruation). Young people usually describe a burning or stinging sensation in the oral mucosa 1-2 days before the appearance of ulcers.

Most mouth ulcers heal within 1-2 weeks without any treatment. However, in more severe cases or recurrent episodes of aphthous stomatitis, your dentist may recommend a series of treatments to reduce discomfort and speed up healing:

• Local application of creams, gels with anaesthetics (lidocaine, benzocaine) and corticosteroids (dexamethasone)
• Rinsing with bicarbonate water, mouthwashes with antiseptics (chlorhexidine), steroids, analgesics
• Nutritional supplements (folic acid, zinc, vitamins B6 and B12)
• Avoiding foods that promote the development of mouth ulcers
• Cauterisation of mouth ulcers
• Antibiotics – used only in severe cases (when there are associated general conditions that lower immunity and can lead to superinfection of the ulcers).

What to eat when you have mouth ulcers?

When it comes to diet, we should avoid foods that irritate the oral mucosa (citrus fruits, crunchy, hard, spicy, salty foods) or those with allergenic potential (nuts, peanuts).

Foods recommended for consumption when you have mouth ulcers are:

• Dairy products
• Cooked vegetables
• Soft fruits (bananas, ripe apples)
• Foods rich in zinc, iron, vitamin B12 (meat, fish, eggs, whole grains)
• Rice, pasta

Treatment of aphthous stomatitis in children

The treatment of aphthous stomatitis in children varies depending on the severity of the lesions, the age of the child and their general state of health.

In most cases, treatment for mouth ulcers in children consists of:

• Painkillers, such as acetaminophen (paracetamol) to reduce discomfort
• Avoiding irritating foods (spicy, salty, acidic)
• Using soft or very soft toothbrushes for oral hygiene
• For older children who can spit – rinsing with bicarbonate water or local application of gels, creams, ointments

"If the mouth ulcers are severe, last more than two weeks or interfere with the child's eating, it is necessary to consult a paediatrician," says Dr Irina Popa, resident periodontist.

Oral herpes is a highly contagious viral infection caused by the herpes simplex virus type 1 (HSV-1), and infection occurs during childhood, between 6 months and 5 years of age. Transmission occurs predominantly through saliva or direct contact.

"Herpes appears as small, clustered blisters filled with fluid on and around the lips, but can also appear on the fixed mucosa (gums, palate). After the blisters burst, ulcers appear, covered with reddish scabs. Healing is slow, usually taking 2-3 weeks, without leaving scars," explains Dr Irina Popa.

The onset of oral herpes is almost always accompanied by general symptoms: fever, headache, general malaise, sore throat and swollen lymph nodes.

Cold sores can recur in approximately 20-40% of people who have already had a primary infection. Once it enters the body, the virus remains dormant in the nerve cells and can be reactivated by a number of factors, such as:

• Exposure to UV light
• Common colds
• Viral infections or immunosuppression (HIV, chemotherapy)
• Minor trauma, cracked lips
• Intense physical exertion
• Emotional stress
• Hormonal fluctuations (puberty, menstrual cycle)
   

The treatment of oral herpes varies depending on the type of infection (primary or secondary) and the severity of clinical manifestations, with the aim of alleviating symptoms and speeding up healing. Currently, there is no cure for the virus, which remains dormant in the body and can reactivate when immunity declines.

Medication treatment - antiviral drugs in the form of:

• Tablets: Acyclovir, Valacyclovir, Penciclovir, Famciclovir
• Creams, ointments: based on Acyclovir or Penciclovir

Natural remedies - local application of substances with antiseptic and anti-inflammatory properties on herpes lesions helps to reduce pain:

• Tea tree oil
• Aloe vera
• Vitamin E
• Propolis

Other recommendations:

• Good oral hygiene
• Local application of cold compresses or ice (relieves discomfort)
• Avoid irritating foods (acidic, spicy)
• If necessary, an anti-inflammatory medication may be taken to reduce pain

• Stress reduction - stress is a major trigger for many conditions, so it is very important to manage stress in our daily lives
• Eat a balanced diet (rich in vitamins and nutrients), avoiding or moderating your consumption of foods that are known to cause mouth ulcers and herpes (spicy foods, acidic foods, citrus fruits, strawberries, nuts, peanuts, chocolate).
• Avoid trauma to the mouth/lips (if you wear braces, ask your orthodontist about orthodontic wax to cover the edges that irritate your gums or mucous membrane).
• Maintain good oral hygiene – both at home and through regular professional cleaning by your dentist.

When should you see a doctor?

In most cases, mouth ulcers and herpes can be treated at home. However, there are certain situations that require specialist consultation:

• The lesions are very large and painful
• They show no signs of healing or heal very slowly
• Recurrence is frequent (several times a year)
• There are signs of bacterial infection (pus, pain, high fever)
• You have a weakened immune system (due to conditions such as diabetes, cancer, HIV)
• You are pregnant.