Overview

Mouth ulcers, also known as canker sores or aphthous ulcers, are small, painful lesions that develop inside the mouth. They commonly appear on the inner cheeks, lips, tongue, floor of the mouth, or soft palate. Mouth ulcers are generally benign and self-limiting, meaning they heal on their own within one to two weeks. They are not contagious, unlike cold sores caused by the herpes virus. While most mouth ulcers are harmless, frequent or unusually large ulcers can indicate an underlying health condition. Understanding their causes, symptoms, and treatment options can help manage discomfort and prevent recurrences.

Causes

There are multiple factors that can trigger the development of mouth ulcers. Common causes include:

• Minor Trauma: Accidental bites, sharp teeth, ill-fitting dentures, or brushing too hard can injure the mouth lining and cause ulcers.
• Stress: Emotional stress is a known trigger for recurrent mouth ulcers in many individuals.
• Nutritional Deficiencies: Lack of essential nutrients such as vitamin B12, iron, folic acid, or zinc can contribute to ulcer formation.
• Hormonal Changes: Some women experience mouth ulcers during menstruation due to hormonal fluctuations.
• Food Sensitivities: Certain foods like spicy foods, acidic fruits, nuts, and chocolate can provoke mouth ulcers in sensitive individuals.
• Medical Conditions: Mouth ulcers can be a symptom of systemic diseases such as celiac disease, inflammatory bowel disease (IBD), or Behçet’s disease.
• Medications: Some medications, including non-steroidal anti-inflammatory drugs (NSAIDs), beta-blockers, and certain chemotherapy drugs, can cause mouth ulcers as a side effect.
• Autoimmune Factors: The immune system may attack the mucosal lining, leading to recurrent aphthous stomatitis.
• Smoking Cessation: Some people develop mouth ulcers after quitting smoking, though this is usually temporary.

Symptoms

The primary symptom of a mouth ulcer is a painful sore inside the mouth, but additional signs can include:

• Appearance: Ulcers typically appear as round or oval white or yellowish sores with a red, inflamed border.
• Pain: Localized pain or tenderness, especially when eating, drinking, or speaking.
• Size and Number:
  • Minor Ulcers: Small (less than 1 cm), heal within 7-10 days.
  • Major Ulcers: Larger (greater than 1 cm), may take several weeks to heal and can leave scars.
  • Herpetiform Ulcers: Multiple pinpoint ulcers that can merge into larger, painful lesions.
• Associated Symptoms: In some cases, fever, swollen lymph nodes, and general malaise may accompany mouth ulcers, especially in severe cases.

Diagnosis

Most mouth ulcers are diagnosed based on clinical examination and medical history. Additional investigations may be needed if ulcers are persistent or recurrent:

• Physical Examination: A healthcare provider inspects the mouth for characteristic ulcer features and checks for other oral or systemic signs.
• Medical History: Information about recent stress, diet, medications, and underlying health conditions is reviewed.
• Blood Tests: Used to check for nutritional deficiencies (B12, iron, folic acid), infections, or autoimmune conditions.
• Biopsy: Rarely, a small tissue sample may be taken to rule out more serious causes like oral cancer, especially in non-healing or suspicious ulcers.

Treatment

Most mouth ulcers heal without treatment, but several options can help reduce pain, speed up healing, and prevent recurrence:

• Topical Treatments:
  • Over-the-counter gels, creams, or mouth rinses containing benzocaine, lidocaine, or corticosteroids to reduce pain and inflammation.
  • Antiseptic mouthwashes to prevent secondary infection.
• Pain Relief: Non-prescription painkillers like paracetamol or ibuprofen can help relieve discomfort.
• Nutritional Supplements: If a deficiency is identified, supplements for vitamin B12, folic acid, or iron may be recommended.
• Avoiding Triggers: Identifying and avoiding foods or activities that provoke ulcers, such as spicy foods or stress, is beneficial.
• Oral Hygiene: Maintaining good oral hygiene with a soft toothbrush and avoiding harsh mouthwashes can prevent worsening of symptoms.
• Prescription Medications: In severe or recurrent cases, doctors may prescribe stronger treatments like corticosteroid tablets, immunosuppressants, or colchicine.

Prognosis

The prognosis for mouth ulcers is generally very good:

• Self-Limiting Condition: Most minor ulcers heal on their own within 1-2 weeks without scarring.
• Recurrent Ulcers: Some individuals experience frequent recurrences, but episodes can often be managed with preventive strategies.
• Chronic Conditions: When associated with systemic diseases, mouth ulcers may persist but can be controlled with proper treatment of the underlying condition.
• Good Quality of Life: With appropriate care, most people with mouth ulcers can maintain a good quality of life with minimal discomfort.
• Warning Signs: Ulcers that last more than three weeks, increase in size, or are associated with other worrying symptoms should be evaluated to rule out serious conditions like oral cancer.

In summary, mouth ulcers are common and generally harmless, with effective treatments available to relieve pain and accelerate healing. Regular oral care and attention to health triggers can minimize their impact.