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Mouth ulcers are open sores that can give rise to a great deal of pain and discomfort in your oral cavity.
These lesions usually have a white or yellow center surrounded by an inflamed, red border. They often appear on the inside of the cheeks, on the lips, under the tongue, on the floor of the mouth or gums. (1)
Although they are relatively harmless, they can be an extremely irritating and discomforting nuisance.
Causes and Types of Mouth Ulcers
Mouth ulcers are broadly categorized as traumatic or aphthous.
Traumatic Mouth Ulcers
As the name suggests, traumatic mouth ulcers result from trauma that causes erosion of a part of the mucous membrane – the delicate tissue lining the inside of your mouth.
Ulcers caused by trauma or injury, usually appear as singular and painful sores next to the source of damage and often resolve by themselves once the cause is removed.
Many factors can give rise to traumatic mouth ulcers, such as:
- Biting the inside of the cheek or the tongue by accident
- Poor-fitting dentures and braces or rough fillings that rub against the mouth, gums, or tongue
- The constant friction of the mouth or tongue against crooked or sharp teeth
- Damaging your gums with a toothbrush through rigorous brushing or accidental scraping of the oral soft tissues while brushing
- Burning your mouth by consuming hot food or beverages
- Cutting your gums or the insides of your cheek by eating hard, rough, or crunchy foods such as toast, chips, pizza, and bread crust
- Irritating the lining of your mouth by using strong antiseptics such as a mouthwash or toothpaste and frequently rinsing with hydrogen peroxide or as an allergic reaction to some toothpaste ingredients
Other factors that can trigger or aggravate a case of mouth ulcers include:
- Oral thrush infection
- Running low on certain nutrients, most notably an iron or vitamin B12 deficiency
- Certain underlying gastrointestinal ailments such as inflammatory bowel disease (IBD), celiac disease, Crohn’s disease, and ulcerative colitis
- Hormonal changes during puberty, pregnancy, and menopause
- Reaction to certain medications, including beta-blockers and painkillers
- Genetic predisposition to mouth ulcers
- Viral infections such as herpes simplex
- Blood disorders such as anemia
- Skin conditions such as lichen planus, which causes rashes in the mouth
- Inadequate oral hygiene
- Elevated levels of stress and anxiety
- Quitting smoking (ulcers can appear in the mouth when you first stop smoking)
- Eating a lot of acidic foods such as citrus fruits and spicy foods
- Inhalers that contain steroids such as those for asthma or COPD
- Diuretic medications that cause reduced saliva production and oral dryness
- Many anxiety, sleep, and psychiatric medications, which can reduce saliva production due to their anticholinergic effects
- Herpangina condition, which is a viral condition with a sudden onset
Aphthous Mouth Ulcers
Aphthous mouth ulcers are recurring episodes of mouth ulcers in otherwise healthy individuals.
This condition remains largely idiopathic with no known cause but is considered to be neither infectious nor inherited.
Aphthous ulcers afflict around 20% to 30% of the entire population and are classified into three different types:
a. Minor Aphthous Ulcers
- Minor aphthous ulcers are characteristically round or oval in shape and small in size, usually no larger than 10 mm in diameter, which is roughly the size of the top of a pencil.
- Minor ulcers account for 8 out of every 10 cases and are the most common of all types of mouth ulcers.
- They usually develop on the inside of the cheeks, tongue, gums, and lips but rarely on the roof of the mouth.
- Minor aphthous ulcers are usually pale yellow in color with visible swelling and redness in the area around them.
- They commonly occur as a single lesion, but these minor ulcers can sometimes develop in a cluster of up to five at the same time.
- It can take anywhere between 7 and 10 days for these minor ulcers to resolve and heal completely.
- As the name suggests, minor aphthous ulcers are associated with relatively minimal pain and virtually no signs of scarring.
- Ulcers such as these are commonly referred to as canker sores.
However, it would be wrong to assume that all mouth ulcers are canker sores.
Mouth ulcers, in general, can develop due to multiple reasons ranging from a viral infection to injury.
Canker sores, on the other hand, specifically result from a condition called aphthous stomatitis.
Just like any other mouth ulcer, a canker sore is fairly non-contagious and can be addressed with virtually the same treatment methods.
b. Major Aphthous Ulcers
- Major aphthous ulcers are relatively severe and take a long time to heal.
Each major ulcer is likely to take anywhere between 2 weeks and several months to resolve.
- About 1 in 10 cases of mouth ulcers fall in this category, making the incidence of major aphthous ulcers quite rare.
- These ulcers tend to be relatively larger than the minor ones, extending to 10 mm or larger across.
- Major mouth ulcers are irregularly shaped and slightly raised.
- Major ulcers generally do not appear in a cluster, and only one or two may appear at a time.
- As they penetrate deeper into the tissue, major ulcers tend to leave behind a scar.
- Large ulcers can give rise to a lot of pain and discomfort, which can make eating difficult.
Sometimes, the ulcer may appear near the tonsils, which can make swallowing quite difficult.
c. Herpetiform Ulcers
- Herpetiform ulcers are so named due to their uncanny resemblance to the sores associated with herpes.
Although they look alike, herpetiform ulcers do not share any characteristics with those caused by the herpes virus.
For instance, unlike herpes, mouth ulcers of any kind are not contagious and cannot be contracted through kissing or sharing of utensils.
- These ulcers occur in about 1 in 10 cases.
- Herpetiform ulcers are the size of a pinhead and generally not more than 1–2 mm in diameter.
- Multiple ulcers of this kind usually occur together in clusters and can sometimes join together to form large, irregular-shaped ulcers.
- These ulcers have a tendency to recur very quickly, so the condition may seem quite chronic.
Usually, an ulcer of this kind takes anywhere between two weeks and two months to heal.
- These lesions are more prevalent among women than among men, and there is greater incidence reported in older adults.
Signs and Symptoms of Mouth Ulcers
The signs and symptoms of mouth ulcers tend to vary depending upon the cause, but most cases of mouth ulceration are usually accompanied by:
- The development of one or multiple open sores in the mouth
- Pain or discomfort in the mouth
Typical mouth ulcers share some easily identifiable physical characteristics:
- A mouth ulcer is usually round or oval in shape.
- Mouth ulceration can manifest in the form of a single lesion or multiple sores on the soft sensitive lining of the mouth.
- The lesion can be white, yellow, or gray in the center and is usually surrounded by red, swollen edges.
- The pain in the affected area tends to get aggravated by spicy, hot, salty, sour, or acidic foods.
- The soft lining of the mouth around the wound tends to be extremely tender, which can make chewing and brushing extremely painful.
In extreme cases, the patient may also experience the following symptoms:
- Loss of Appetite
- Swollen glands
Most mouth ulcers can occur anywhere on the lining of the mouth:
- The inside of the cheeks
- The inside of the lips
- The floor of the mouth
- The undersurface of the tongue
In rare cases, the ulcer may also develop on the roof of your mouth.
Diagnosing Mouth Ulcers
Because mouth ulcers are completely benign, mild cases generally do not require you to pay a visit to the doctor for a proper diagnosis.
Proper self-care usually suffices to resolve a typical case of mouth ulceration. (1)
However, if the lesion persists for longer than 3 weeks, worsens with time, or frequently recurs, getting a formal diagnosis is necessary to rule out any underlying medical condition, an infection, or other complications.
To that end, your doctor may conduct a close examination of your oral cavity and order a few tests if necessary.
Some of these routine tests are conducted with the aim of assessing your gastrointestinal functioning as well as overall health, particularly if your ulcers happen to be recurrent, unusually large, or persistent. These include:
- Swab tests to rule out the risk of infection
- Test to evaluate your complete blood count
- Test to evaluate your iron, folate, and B12 levels
- Test to determine the celiac antibody count
If the preliminary test results are inconclusive or if your condition continues to persist despite the recommended treatment, your doctor will have to conduct a more in-depth examination of the lesion itself.
This typically involves extracting a small portion of the ulcer and the adjoining skin tissue, which is then tested to identify probable causes.
In rare cases, an endoscopy may even be performed to rule out the risk of inflammatory bowel disease.
Standard Treatment for Mouth Ulcers
The standard treatment for mouth ulcers involves the following steps:
a. Treatment of the Cause
If your doctor is able to identify a specific cause of the mouth ulcer, he/she will start your treatment by first addressing the causative agent(s) or factor(s).
For instance, if the ulcer is caused by a bacterial infection, the doctor may prescribe a course of antibiotics to treat the underlying problem.
Similarly, if the ulcer has resulted from constant friction against a misaligned or sharp tooth, your dentist will file down the jagged edges.
Ill-fitting dentures and braces can also be properly affixed by your dentist if they are found to be the source of trouble.
b. Avoidance of Irritating Foods and Substances
The doctor will also stipulate certain guidelines to manage the pain and discomfort so that they do not worsen.
This involves avoiding any food, medication, or irritating substance that may be causing or aggravating the mouth sores in the first place.
People with mouth ulcers are often advised to cut back or completely avoid excessively acidic or salty foods to help reduce the pain until the ulcer(s) heal.
Moreover, optimum and appropriate oral hygiene is a must to keep the wound from getting infected.
Use a soft-bristled toothbrush and fluoridated toothpaste and do gentle strokes while brushing to clean your already sensitive oral cavity.
Commit yourself to this morning and bedtime ritual on a daily basis, without fail. Moreover, rinsing your mouth with warm saline solution can help give your oral cavity an additional clean sweep to avoid the risk of infection. (2)
c. Topical Treatments
Your doctor may suggest certain ointments, creams, or other substances be applied topically on the ulcerated skin.
These include anesthetics, corticosteroids, and protective coatings to promote fast healing and to ease the discomfort.
Topical treatment may also involve burning the ulcer with a laser or chemicals, which is only to be done under the doctor’s supervision.
Home Remedies to Get Rid of Mouth Ulcers
Here is what you can do at home to get rid of mouth ulcers
1. Self-Care Tips to Help Healing
Mouth ulcers cannot always be prevented, but there are certain things you can do to minimize your risk.
These self-care tips can also benefit those already suffering from a mouth sore by accelerating the healing process, reducing the discomfort to a manageable degree, and decreasing the risk of recurrence.
- You can consider using cold therapy to ease ulcer-induced pain.
Take a paper towel and wrap an ice cube with it to make a cold compress. Hold this ice wrap over the lesion, but try not to exert too much pressure.
The application of cold temperature helps desensitize the affected site and numb the burning pain for a temporary period.
However, one must never apply the ice directly to the skin, which can only worsen the damage.
- You may register some relief from the pain and inflammation associated with a mouth ulcer by placing a wet tea bag over the affected site.
This therapeutic effect can be attributed to the tannins present in black tea.
- Keep your mouth clean and healthy by practicing regular oral hygiene.
This includes using a high-quality toothbrush with soft bristles and a toothpaste that does not contain sodium lauryl laureth sulfate.
- Use gentle strokes when brushing your teeth to avoid damaging the inner lining of your mouth or gums.
- Cut back on foods that are excessively acidic, sour, spicy, sweet, or salty as they can further irritate your mouth lining.
- Avoid chewing gum until your ulcer heals.
- Avoid eating foods that have a hard, solid, or crunchy texture, and consume a soft diet instead.
Eating foods that are easy to chew and swallow will keep things comfortable inside your mouth.
- Apply an antiseptic gel on the oral lesion to reduce the risk of further contamination.
- To keep your oral cavity in the best of condition, use an alcohol-free mouthwash that preferably contains chlorhexidine gluconate.
Ask your doctor to recommend a good-quality medicated brand that is most appropriate for you.
- You can also ask your dentist or physician to prescribe a topical steroid mouthwash or ointment or an over-the-counter analgesic such as acetaminophen or paracetamol if the discomfort is particularly bad.
- Eat a healthy, well-balanced diet to avoid any nutritional deficiencies that are often at the root of such ulcers.
Be sure to include a whole variety of fresh fruits and vegetables that supply you with enough antioxidants such as vitamins A, E, and C as well as a good dose of B12.
- Refrain from consuming hot beverages until the ulcer heals completely.
Stick to cool liquids instead and drink them through a straw to avoid irritating the lesion.
- If you suffer from mouth ulcers frequently, it is important to identify possible triggers and be wary of them.
You can avoid the flare-up of this condition by avoiding these culprits.
- A mouth rinse containing sodium bicarbonate, commonly referred to as baking soda, may be beneficial for relieving oral ulcers caused by acidic foods or beverages.
This alkalizing agent can help neutralize the pH of your oral cavity and aid recovery, provided it is used with the required precaution. (6)
- The findings of one double-blind, case-control clinical trial conducted on 40 patients with oral minor aphthous ulcers suggested that the topical application of aloe vera gel or juice on the affected mucosa may help reduce the pain associated with this condition and speed up the healing process.
Aloe vera is popularly recognized as a natural skin salve that exhibits potent antiseptic, antibacterial, antifungal, and antiviral properties. (9)(10)
2. Rinse Your Mouth with a Water Solution
Saltwater solution can be used as a mild disinfectant to reduce the bacteria responsible for the development of some mouth ulcers and other oral problems.
Using a regular astringent-type mouthwash to rinse your oral cavity can further irritate the ulcerated lining of your mouth.
A saline solution, on the other hand, can help sanitize your mouth without the stinging sensation at the affected site.
While the saline solution may taste unpleasant, this gentle antiseptic may help curtail the spread of infection and promote fast healing of the oral lesion.
You can make your own saline mouthwash by mixing 1 teaspoon of salt into one cup of water. Rinse your mouth with it several times a day.
Although a saline mouth rinse is routinely recommended by oral health experts as a supplementary tool to your regular oral hygiene regimen, the efficacy of this method is supported by minimal research.
Needless to say, the promising results of this preliminary in vitro study do not hold much significance by themselves and require further validation by more large-scale human studies.
Conclusion: A saline rinse may work as a gentler alternative to regular variety mouthwashes for people with mouth ulcers.
This simple intervention serves as supportive home care for healing mouth ulcers and will only yield favorable results if performed in conjunction with routine oral care rather than as a standalone treatment.
Because there isn’t enough research to scientifically confirm the effectiveness of this remedy, further studies on the topic are needed.
3. Dab a Bit of Honey
Honey is recognized as a natural humectant, which essentially means that this viscous substance locks in moisture and keeps it from escaping. It is this moisture-retaining property that can be utilized to soothe mouth ulcers.
Honey can help keep your mouth hydrated and speed the healing process. What makes it even more effective is that it also exhibits significant antioxidant and antimicrobial activities. (7)
In a randomized controlled trial conducted on 94 patients, honey was found to be a safe and effective topical treatment for minor oral lesions as it could adhere to the oral lining and yield quick, long-standing positive results without any of the adverse side effects typically associated with conventional antibiotics. (8)
Conclusion: Scientific evidence suggests that topical application of honey can help heal your mouth ulcer fast and may even reduce the risk of recurrence.
Plus, the fact that honey is inexpensive, easily available, and far less toxic than standard antibiotics makes it a worthy remedy for oral blisters.
4. Rinse with a Licorice Root Mouthwash for Quick Healing
Licorice root is a therapeutic herb that may provide some degree of symptomatic relief from mouth ulcers. It has a high mucilage content that is responsible for its demulcent properties.
Licorice root may help lubricate and soothe the irritated mucous membranes by forming a protective film over the open lesions.
Incorporating this healing agent in your regular oral care may help reduce the inflammation and pain associated with mouth ulcers.
You can take a deglycyrrhizinated licorice (DGL) extract in the form of chewable tablets or gargle with a DGL-containing mouthwash.
One 2008 randomized, double-blind clinical trial found licorice root to be helpful in reducing the size of the mouth ulcer and promoting the overall healing process. (4)
This was further supported by a 2012 review that highlighted the promising potential of licorice root against oral diseases in general. (5)
While some of the studies included in the review found licorice to be beneficial in reducing the pain, size and healing time of aphthous ulcers, others produced inconclusive results.
Conclusion: Because the research concerning the use of licorice root for treating recurrent aphthous ulcers have yielded mixed results, further studies are needed to establish its efficacy.
Distinguishing Between Mouth Ulcers and Cold Sores
Unlike mouth ulcers that develop on the inner lining of the mouth, a cold sore usually form on the lip or around the mouth.
Mouth ulcers can stem from a number of underlying factors, but cold sores tend to have a specific cause, which is the herpes simplex virus (HSV).
Mouth ulcers generally clear up within a matter of 2 weeks, but in some rare cases where the ulceration is severe and extensive, the wound may give way to a secondary bacterial infection.
The doctor may prescribe an antibiotic mouthwash and/or toothpaste to combat and contain the underlying infection.
If the infection is particularly aggressive, the doctor may even provide a prescription for an oral antibiotic in pill form.
When to See a Doctor
Most cases of mouth ulcers generally resolve on their own without any medical intervention.
That said, it is essential that you consult a dentist, an oral medicine specialist, or an ear, nose, and throat specialist (otolaryngologist) if:
- The condition becomes so painful that it starts to hamper your daily life, rendering even the most basic tasks such as eating, drinking, swallowing, and brushing extremely difficult.
- The mouth ulcer does not clear even after 3 weeks.
- Your gums begin to bleed.
- You develop white patches on your tongue or anywhere inside the oral cavity.
- The pain and redness in and around the ulcer worsen, which may indicate that the wound may have become infected.
- You constantly run a fever higher than 100.5° F (taken by mouth).
- You notice new or unusual symptoms as the condition progresses.
- The ulcer shows no sign of subsiding despite adequate self-care.
- The mouth ulcers keep coming back.
Expert Answers (Q&A)
Answered by Dr. Mugdha Motani, BDS (Dentist)
What can be the possible causes of recurrent episodes of mouth ulcers?
There could be multiple causes of mouth ulcers.
Some of the local causes are:
– Mechanical trauma (such as a slip of a toothbrush or braces).
– Chance biting of lip/cheek.
– Repeated abrasion due to a faulty denture, sharp tooth or a filling.
– Poor oral hygiene.
– Nutritional deficiencies (such as Vitamin B12 or Iron).
– Low immunity/autoimmune diseases.
– Hormonal fluctuations during puberty, pregnancy or menopause.
– Irritation from strong chemicals or flavors, food allergies, and sensitivities.
– Hot or spicy foods
– Side effects of some drugs.
Some medical causes could include:
– Bacterial or viral infection.
– Cancer of oral region.
– Radiotherapy/chemotherapy involving oral regions.
– Celiac/inflammatory bowel disease.
Is it advisable to pop a mouth ulcer?
No. If you touch or try to rub an ulcer, it will cause irritation and become more painful.
Are mouth ulcers a symptom of oral cancer?
Not all oral ulcers mean cancer. Typically a mouth ulcer heals within 2 weeks with no scar formation.
If an ulcer that is present in the mouth is a mix of red and white areas with ragged, uneven edges and for more than 2 weeks, it needs to be checked by a dental professional.
Can applying toothpaste on mouth ulcer help them shrink?
No. Rather, sometimes agents like mint present in the toothpastes can irritate it more.
Are ulcers more common in children?
Teens and pre-teens are more susceptible to ulcers, especially females. Children with low immunity and nutritional deficiencies are also at more risk.
Please provide some care tips for people suffering from mouth ulcers.
Most of the oral ulcers, although painful, usually heal on their own within 2 weeks time.
The first thing to do is to visit a dental professional to figure out the cause and correct any underlying irritant such as a sharp tooth or a faulty filling.
Few things which can be kept in mind to alleviate the pain are:
– If it is stress-related, then try reducing stress with the help of meditation or guided imagery.
– Avoid touching or rubbing the ulcer and surrounding area.
– Avoid consuming hot, spicy, or acidic food.
– Stay hydrated.
– A balanced diet including more of greens, legumes, and poultry.
– Maintain proper oral hygiene.
– Pain killers, such as paracetamol.
– Over-the-counter/prescription gels or ointments for topical application on the ulcers.
– Anti-virals, if prescribed by the professional.
Some home remedies:
– Apply cold milk/milk of magnesia a few times a day on ulcers.
– Apply ice on ulcers.
– Brush your teeth gently with a super soft toothbrush.
– Keep your oral cavity clean.
About Dr. Mugdha Motani, BDS: Dr. Motani has over 10 years of experience in the Dental Surgery department. She has also worked in some of the most reputed medical institutes like AIIMS, India and NHS, UK.