Mouth Ulcers

Mouth ulcers summary

• A mouth ulcer is the loss of part of the delicate tissue lining inside the mouth (mucous membrane)
• The most common cause is injury such as biting your cheek
• Other causes include certain drugs, chemicals and infectious diseases such as herpes or thrush
• In most cases, mouth ulcers are harmless and clear up in a few days
• Aphthous ulcers are recurring ulcers with no known cause that affect around 20 per cent of the population
• See your doctor if your mouth ulcers don’t clear up within a few days, or if you are troubled by frequent attacks

Mouth ulcer symptoms

• The symptoms of a mouth ulcer depend on the cause but may include:
  • A round sore or sores inside the mouth
  • Swollen skin around the sores
  • Tenderness
  • Problems with chewing or toothbrushing because of the tenderness
  • Irritation of the sores by salty, spicy or sour foods
  • Loss of appetite

Mouth ulcers causes

• Mouth ulcers can be caused by a wide range of factors including:
  • Accidental biting of the cheek
  • Injury from a toothbrush (such as slipping while brushing)
  • Constant rubbing against misaligned or sharp teeth
  • Constant rubbing against dentures or braces
  • Poor oral hygiene
  • Burns from eating hot food
  • Irritation from strong antiseptics, such as a mouthwash
  • Oral thrush infection
  • Herpes simplex viral infection (cold sore)
  • Reaction to certain drugs, such as chemotherapeutic agents
  • Autoimmune diseases (for example, lichen planus)
  • Syphilis infection
  • A range of other infections including hand-foot-mouth syndrome
  • Certain diseases including tuberculosis, AIDS, diabetes mellitus and inflammatory bowel disease
  • Cancer of the lip

The cause of aphthous ulcers isn’t known

• Around one in five adults suffer from recurring bouts of aphthous ulcers, which are mouth ulcers with no known cause
• The tongue, gums or mouth lining can be affected
• Crops of these tiny off-white ulcers tend to sprout during times of emotional stress or the menstrual period
• This has led some researchers to suggest that aphthous ulcers may be caused by an immune system reaction, since the immune system is affected by stress and hormones
• The underlying trigger may be a virus or an allergic reaction
• Another name for aphthous ulcer is canker sore

Possible complications of mouth ulcers

• Untreated, mouth ulcers can occasionally lead to complications including:
  • Bacterial infection
  • Inflammation of the mouth (cellulitis)
  • Tooth abscess

Medical examination for mouth ulcers

• It is important to establish the cause of the mouth ulcers
• Some of the investigations may include:
  • Physical examination – mouth ulcers look different depending on their cause
  • For example, if the ulcer is large and yellow, it was most likely caused by trauma
  • Cold sores inside the mouth tend to be very numerous and spread around the gums, tongue, throat and inside of the cheeks
  • A fever also suggests the ulcers may be caused by a herpes simplex infection
  • Blood tests – to check for signs of infection and iron and folate deficiency
  • Skin biopsy – a small tag of tissue from the ulcer is taken and examined in a laboratory

Mouth ulcer remedies and treatment options

• Most mouth ulcers are harmless and resolve by themselves in a few days
• Other types of mouth ulcers, such as the aphthous variety or those caused by herpes simplex infection, need medical treatment
• It isn’t possible to speed the recovery of ulcers, but the symptoms can be managed and the risk of complications reduced
• The range of treatment options includes:
  • Avoid spicy and sour foods until the ulcers heal
  • Drink plenty of fluids
  • Regularly rinse your mouth out with warm, slightly salted water
  • Keep the mouth clean
  • Take pain-killing medication, such as Panadol (paracetamol)
  • Apply antiseptic gel to the ulcers
  • Use a medicated mouthwash
  • Use steroid gels or tablets
  • Treat aphthous ulcers with anti-inflammatory drugs
  • Treat ulcers caused by the herpes simplex virus with anti-viral drugs
  • Treat oral thrush with anti-fungal drugs

Mouth ulcer prevention tips

• Suggestions on how to reduce the likelihood of mouth ulcers include:
  • Brush your teeth at least twice every day
  • Floss regularly
  • Visit your dentist or Ear Nose and Throat Specialist regularly
  • Brush your teeth very gently, taking care not to slip with the brush
  • Eat a well balanced and nutritious diet
  • Make sure that underlying conditions, such as diabetes mellitus and inflammatory bowel disease, are managed appropriately

Things to remember

• A mouth ulcer is the loss or erosion of the delicate lining tissue of the mouth (mucus membrane)
• The most common cause is mechanical injury, such as accidentally biting your cheek
• In most cases, mouth ulcers are harmless and resolve by themselves in a few days without the need for medical treatment
• Aphthous ulcers are recurring ulcers with no known cause that affect around 20 per cent of the population
• If your mouth ulcers don’t clear up within a few days, or if you are troubled by frequent attacks, see your doctor