Mouth ulcers

Symptoms Of Mouth Ulcers

Mouth ulcers are easy to recognise. They usually begin as a round yellowish spot or bump with a red border or halo. This later on breaks down into a punched out ulcer which is covered with a white,yellowish or greyish membrane. Surrounding area usually appears unaffected and healthy. The following symptoms are generally experienced with mouth ulcers:

• A tingling or a burning sensation.

• Pain and difficulty while chewing food, drinking or swallowing.

• Increase in pain if irritated by movement while speaking, brushing teeth or consuming certain food like citrus fruits.

• Severe mouth ulcers may also cause fever and swollen lymph nodes.

Types Of Mouth Ulcers

Mouth ulcers are a common occurrence, with an estimate of about 1 in 10 individuals being affected with mouth ulcers. Depending on the severity, mouth ulcers can be classified into the following types:

Minor mouth ulcers: These are the most common type of ulcers and account for 85% of the cases. They are usually small, rounded, or oval-shaped, have a well-defined edge, and heal within a week or two, without any scarring.

Major mouth ulcers: These ulcers are less common and account for about 10% of the cases. They are bigger, deeper, very painful, and may or may not have a well-defined edge. These types of ulcers take a long time to heal and may cause extensive scarring.

Herpetiform mouth ulcers: These are pinpoint lesions with irregular edges that occur in clusters and heal within a month without scarring. These ulcers occur rarely and usually appear on the tongue.

Causes Of Mouth Ulcers

The exact cause of mouth ulcers is not known. However, multiple reasons are associated with ulceration in the mouth, such as:

Physical factors

• Accidental biting of the cheek or tongue

• Ill-fitting dental braces or dentures 

• Site of a local anesthetic injection and dental treatment

• Impacted or misaligned wisdom teeth that continually irritate the inner cheek

• External trauma to the cheeks or the tongue

• Hard pressure while brushing teeth or use of brush with hard bristles

Lifestyle factors

• Excessive consumption of citrus,sour and spicy foods

• Stress or lack of sleep

• Excess alcohol intake

• Smoking and cessation of smoking

• Chewing of Tobacco 

• Using toothpaste or mouthwashes that contain Sodium Lauryl Sulphate

Health conditions

• A weakened immune system occurring with conditions such as HIV-AIDs, post-chemotherapy, viral infections etc.

• Nutritional deficiency of Vitamin B1, B2, B6, B12, folic acid, zinc, etc. 

• Helicobacter pylori infection

• Hormonal changes during menstruation

• Gastrointestinal diseases like celiac disease, Crohn’s disease, ulcerative colitis, etc.

• Oral malignancies

• Certain medications like Sodium hypochlorite, Piroxicam, Phenobarbital , Phenindione, Niflumic acid and Captopril

Risk Factors Of Mouth Ulcers

There is a higher risk of getting mouth ulcers if you:

• Are a woman

• Have a family history of mouth ulcers

• Follow poor oral hygiene

• Are immunocompromised or have weak immunity

• Have a stressful lifestyle

Diagnosis Of Mouth Ulcers

Minor mouth ulcers usually do not require any investigations and can be managed at home by the patients themselves. If you see a doctor, he/she will evaluate the site and type of lesion, along with a detailed history. Occasionally, for ulcers with repeated recurrence,severe symptoms and multiple lesions, doctors may ask for lab investigations, such as:

• Complete Blood Count (CBC) to check for the overall health status.

• Erythrocyte Sedimentation Rate (ESR), C - Reactive Protein Quantitative can give an idea about any ongoing infection, inflammation, etc., in the body. These infections may occur in certain health conditions which can further cause mouth ulcers.

• Vitamin B12 and Vitamin B9 to check for nutritional deficiencies.

• Any other tests which may be needed to evaluate further based on the initial laboratory testing.

Prevention Of Mouth Ulcers

Mouth ulcers cannot be prevented completely. However, it is possible to reduce the frequency of occurrence or troublesome symptoms by following the tips given below:

• Reduce the intake of foods that irritate your mouth. Different people may react differently to various foodstuffs. You may be able to identify the items that cause your symptoms when you get frequent ulceration after consuming certain foods.

• Restrict alcohol consumption

• Do not smoke.If you are a smoker and trying to quit, there is an increased possibility of getting mouth ulcers during the cessation period.

• Reduce emotional stress and engage in activities that boost mental health.

• Try to get adequate and sound sleep.

• Maintain good oral hygiene. Brush your teeth gently with a soft bristled toothbrush after every meal. Do not use toothpaste or mouthwashes with Sodium Lauryl Sulphate.

• Take a balanced diet rich in vitamins and minerals to prevent nutritional deficiencies.

• Consult your dentist for ill fitting or fractured dentures or fillings or for dental wax application over the sharp edges of your braces.

Specialist To Visit 

Most mouth ulcers usually heal on their own within a week or two without any medical intervention. However, Over-the-counter products can help in relieving pain and discomfort associated with them.To diagnose and treat mouth ulcers, you can go to:

• General physician

• Dentist

You must seek medical attention if your mouth ulcers fail to heal within a week or two and if you have symptoms such as: 

• Recurrent mouth ulcers

• Multiple or large-sized ulcers

• Severe pain and difficulty while chewing, talking, or swallowing

• Fever along with ulcers

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Treatment Of Mouth Ulcers

The treatment for mouth ulcers is broadly divided into two categories:

Symptomatic relief

Various OTC and prescription formulations are available for topical application to provide relief and promote faster healing of the mouth ulcers:

• Topical gels containing anesthetics like benzocaine and lidocaine are used to give relief from pain.

• Antiseptics can be used to prevent and treat infections associated with mouth ulcers.

• Use of chlorhexidine gluconate mouthwash can decrease the duration of the ulcer.

• Antibiotic Mouthwash containing Tetracycline helps in reducing the size of the ulcer and the pain associated with it.

• Oral painkillers like diclofenac are used to relieve pain.

• Oral Steroids and Mouthwashes containing dexamethasone are prescribed in cases of severe ulceration.

• Drugs used in the treatment of gastrointestinal ulcers such as sucralfate may also provide some relief in mouth ulcers.

• Dental lasers can be used to perform cautery, a kind of mini-surgery on mouth ulcers to promote healing.

Supportive care

• Multivitamins or vitamin supplements are used to treat Vitamin B complex deficiencies.

• Antipyretics such as paracetamol may be used to treat fever occurring along with the ulcers.

• Antibiotics can be advised to treat any concurrent infections.

Home-Care For Mouth Ulcers

If you have mouth ulcers, you can do the following at home to help relieve symptoms and promote faster healing:

• Follow good oral hygiene. Brush your teeth gently with a toothbrush with soft bristles after meals. Rinse your mouth well, preferably with an OTC mouthwash.

• Avoid eating citrus fruits, acidic vegetables, spicy or hot foods that may further irritate the ulcer. 

• Avoid chewing foods on the ulcer side of the mouth if possible.

• Warm saline gargles may also help in relieving symptoms.

• You can suck on ice chips or apply an ice pack externally at the site of the mouth ulcer. Ice helps reduce inflammation and provides pain relief.

• Take a balanced diet full of essential vitamins and minerals to ensure good nutrition.

Complications Of Mouth Ulcers

Most mouth ulcers heal within one to two weeks. Rarely, a person may suffer from major mouth ulcers that take longer to heal and may cause complications like:

• Nutritional deficiencies due to the inability to chew or swallow food properly

• Increased risk of oral malignancies

• Secondary infections of the mouth may lead to cellulitis

• Tooth abscess due to secondary dental infections

• Bleeding from the ulcer

Alternative Therapies Of Mouth Ulcers

Diet: People who get recurrent mouth ulcers may be at a higher risk of nutritional deficiencies due to the difficulty in chewing or swallowing foods. And nutritional deficiencies, in turn, are a cause for recurrent mouth ulcers. This becomes a vicious circle. A diet rich in essential vitamins and minerals and low on irritant foods like oily or spicy foods is recommended for people with mouth ulcers. Include a lot of fresh leafy greens, whole-grain cereals, legumes, and pulses in your diet.

Homeopathy: Homeopathy preparations like Borax, Arsenicum album, Sulphuricum acidum, Mercurius solibis, Kali muitacum, etc., are used to treat mouth ulcers. Homeopathy treatment is ideally individualized to the patient and must be taken under the guidance of a homeopathy doctor only.

Ayurveda: Mouth ulcers are known as “Mukhpak’ or ‘Sarvasar Rog’ in Ayurveda. Topical usage of herbal remedies like aloe vera gel, licorice, and chamomile has been found useful in treating recurrent mouth ulcers. Oral Ayurvedic formulations prepared from Amla, Draksha, Hareetaki, Chandan, Triphala, etc., are also used in treating oral ulcers.

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Living With Mouth Ulcers

Chronic or recurrent mouth ulcers can be a cause of severe frustration and pain. The person may not be able to enjoy their favorite foods and is at an increased risk of malnutrition. People with mouth ulcers often have poor oral hygiene and may also suffer from social embarrassment due to a bad mouth odor. Chronic pain, coupled with a lack of enjoyment of preferred meals, may become a source of anxiety for the patient. 

Following good oral hygiene techniques, such as regular flossing, gentle brushing, and rinsing the mouth, must be followed by all those who suffer from mouth ulcers. Most mouth ulcers heal on their own if one follows good oral hygiene. If the ulcers are recurrent or do not heal within one to two weeks, or are accompanied by unbearable pain and fever, immediate medical care is essential.