Mouth Ulcer

Mouth ulcers are a common oral health issue that affects many people at some point in their lives. These small, painful sores can cause discomfort and make eating, drinking, and talking difficult. While most mouth ulcers are harmless and heal on their own, understanding their causes, symptoms, and treatment options can help manage and prevent them effectively.

What are Mouth Ulcers?

Mouth ulcers, also known as canker sores, are small lesions that develop within the mouth. They can appear on various soft tissue surfaces, such as the gums, tongue, inner cheeks, inner lips, or the roof of the mouth. These sores are typically round or oval-shaped and have a white or yellowish centre with a red border. Mouth ulcers can be caused by factors like minor mouth injuries from dental work, hard brushing, or accidental cheek bites, as well as certain health conditions like coeliac disease, inflammatory bowel disease (IBD), diabetes, HIV, and some autoimmune diseases.

Mouth ulcers can be categorised into several types:

1. Canker Sores (Aphthous Ulcers)

Canker sores are the most prevalent type of mouth ulcer. Their exact cause remains unclear, but they may be triggered by factors such as minor injuries (like biting the inside of the cheek), acidic foods, or stress. These ulcers typically appear as white or yellow lesions surrounded by a red halo and can be quite painful. They usually heal on their own within one to two weeks.

2. Oral Lichen Planus

This chronic inflammatory condition leads to the formation of itchy, lace-like white patches and sores inside the mouth. It is primarily an immune response and is more common in women and individuals assigned female at birth (AFAB) aged 50 or older. Symptoms can include burning sensations and discomfort while eating.

3. Leukoplakia

Leukoplakia manifests as white or gray patches on the mucous membranes of the mouth due to excessive cell growth. It often results from chronic irritation, such as smoking or chewing tobacco, although it can occur without any obvious cause. While leukoplakia lesions are generally non-cancerous, they warrant monitoring due to potential precancerous changes.

4. Erythroplakia

Similar to leukoplakia, erythroplakia presents as red patches in the mouth, often found beneath the tongue or behind the lower front teeth. This condition is frequently associated with tobacco use and is considered more serious than leukoplakia, as it can indicate precancerous or cancerous changes.

5. Oral Thrush

Oral thrush is a fungal infection caused by an overgrowth of Candida albicans, often occurring after antibiotic use or in individuals with weakened immune systems. It results in creamy white or red patches in the mouth and can cause discomfort during eating.

6. Mouth Cancer

Oral cancer can present as persistent red or white sores that do not heal. If a mouth ulcer lasts longer than three weeks without improvement, it is crucial to consult a doctor for further evaluation.

Here are the common symptoms of mouth ulcers:

1. Visible Sores

The most prominent symptom of mouth ulcers is the formation of sores on various parts of the mouth, including the gums, tongue, inner cheeks, inner lips, and the roof of the mouth. These sores typically appear in shades of red, yellow, or white.

2. Pain and Discomfort

Individuals often experience significant pain associated with these sores, which can make routine activities such as eating, drinking, and speaking quite uncomfortable. The pain may intensify when consuming spicy, salty, or acidic foods.

3. Difficulty Swallowing

In more severe cases, mouth ulcers can lead to difficulties in swallowing. This symptom may arise if the ulcers are particularly large or numerous.

4. Swelling

There may be noticeable swelling around the ulcerated areas, contributing to discomfort and sensitivity in the mouth.

5. Fever

In some instances, individuals with mouth ulcers might also experience fever, especially if there is an underlying infection.

The intensity and combination of these symptoms can differ from person to person. Additionally, mouth ulcers may recur over time if the underlying causes are not properly addressed.

The healing process of mouth ulcers can be divided into four stages: hemostasis, inflammation, proliferation, and maturation.

1. Haemostasis

If a mouth ulcer causes bleeding, the body will first attempt to reduce blood loss through haemostasis. However, most canker sores do not bleed unless they are irritated or infected.

2. Inflammation

During this stage, a swollen, red bump may form, accompanied by pain, roughness, or a burning sensation. A fully developed canker sore typically appears as a white or yellow round bump with a raised, red, inflamed border.

3. Proliferation

In the proliferation stage, new skin growth begins from the outside of the ulcer and works its way toward the center. As the ulcer heals, the surrounding redness will diminish, the central white part will take on a grayish tinge, and sensations like pain and burning will subside.

4. Maturation

In the final stage, as new skin tissue continues to form, the bump will decrease in size, and the tissue will start to regain its regular appearance. The healing process can be influenced by diet, and it is advisable to avoid irritating foods and products like alcohol-containing mouthwash and sodium-based toothpaste.

Mouth ulcers can develop due to a variety of factors, ranging from minor mouth injuries to underlying health conditions. Some common causes include accidentally biting your cheek, brushing too hard, or dental work like braces that irritates the soft tissues in your mouth.

Emotional stress has also been linked to the development of mouth ulcers, as it can weaken the immune system and make the body more susceptible to ulcers.

Certain health conditions, particularly autoimmune diseases, can also contribute to the formation of mouth ulcers.

Additionally, sensitivity to spicy or acidic foods, use of toothpastes containing sodium lauryl sulfate, hormonal shifts, and nutritional deficiencies in vitamin B12, iron, zinc, or folic acid can all play a role in the development of mouth ulcers.

Here are some of the risk factors to look out for:

• Stress: High levels of emotional stress can trigger the development of mouth ulcers.

• Nutritional Deficiencies: Low levels of vitamin B12, iron, zinc, or folic acid can increase the risk.

• Dietary Factors: Consuming spicy, acidic, or sharp-edged foods.

• Oral Care: Using toothpaste containing sodium lauryl sulfate, being hard with oral care, and accidental sores due to braces

• Autoimmune Diseases: Conditions like Crohn's disease or ulcerative colitis.

• Hormonal Changes: Hormonal shifts, particularly in women.

• Genetic Predisposition: Some people may have a genetic tendency to develop mouth ulcers.

While mouth ulcers are usually harmless, they can sometimes lead to complications or indicate underlying health issues. Larger ulcers may leave scars after healing, and if an ulcer becomes infected, it can cause increased pain, redness, and bleeding, potentially requiring medical attention. Recurrent or persistent mouth ulcers can be a symptom of various systemic diseases, such as Crohn's disease, ulcerative colitis, Behçet disease, celiac disease, and immunodeficiencies like HIV/AIDS.

In rare cases, a mouth ulcer that does not heal within three weeks could be a sign of oral cancer, particularly if it appears on or under the tongue. Severe cases of mouth ulcers may also cause swelling of the lymph nodes, fever, and physical fatigue or lethargy, although these symptoms are uncommon.

Preventing the development of mouth ulcers involves making several lifestyle and dietary adjustments.

• Maintaining a balanced diet rich in essential vitamins and minerals, particularly vitamins B, iron, and folic acid, can help reduce the risk of developing mouth ulcers.

• Avoiding irritants, such as toothpaste containing sodium lauryl sulfate, can also prevent ulcers from forming.

• Since stress is a common trigger for mouth ulcers, managing stress through relaxation techniques or counseling can be beneficial.

• Identifying and avoiding trigger foods, such as chocolate, peanuts, coffee, and gluten, can help prevent ulcers in sensitive individuals.

• Lastly, ensuring proper dental care, including well-fitting dental appliances and using a soft-bristled toothbrush, can help avoid mouth injuries that may lead to ulcers.

Diagnosing mouth ulcers typically begins with a visual examination by a doctor.

• They will look for the characteristic white or yellow sores surrounded by a red border.

• If the cause of the ulcers is unclear or if they are persistent or severe, additional diagnostic steps may be necessary. These can include taking a biopsy of the ulcer for laboratory analysis, performing blood tests to check for nutritional deficiencies or underlying health conditions, and exploring the patient's medical history to identify any contributing factors or triggers.

• In some cases, a referral to a specialist, such as a dermatologist or an oral surgeon, may be necessary for further evaluation and treatment.

Mouth ulcers can often heal on their own, but various treatments are available to help manage discomfort and promote faster healing.

• Topical medications (gels and sprays) containing benzocaine can numb the area and reduce pain.

• For more severe cases, prescription medications like triamcinolone acetonide, sucralfate, colchicine, or clobetasol may be used to alleviate inflammation and pain. Steroids can be given as mouth sprays, dissolvable tablets, or tablets that can be dissolved in water to reduce inflammation and pain. Remember, do not start medical treatment without advice from your doctor.

• For particularly severe cases or those associated with an underlying medical condition, immunosuppressant medication may be necessary.

• Rinsing the mouth with a warm salt water or baking soda solution can also help reduce pain and aid healing.

• Some natural remedies, including applying milk of magnesia, using a damp tea bag, or placing ice on the ulcer, may provide relief as well.

• If nutrient deficiencies are contributing to the development of mouth ulcers, supplements like vitamin B9 (folate), vitamin B12, zinc, and iron may be recommended.

While mouth ulcers often resolve on their own, it is important to seek medical advice if certain symptoms persist or worsen. If a mouth ulcer lasts longer than 3 weeks or fails to heal after 2 weeks, it is advisable to consult a doctor. Additionally, if the ulcer is larger than usual, extremely painful, bleeds, or becomes more red and swollen, which could indicate an infection, medical attention should be sought. Experiencing difficulty eating, drinking, or swallowing due to the presence of mouth ulcers also warrants a visit to a doctor.

• Mouth ulcers are a common condition that can cause discomfort and pain, but they often heal on their own within a few days to a couple of weeks.

• Various factors can contribute to the development of mouth ulcers, including minor injuries, nutrient deficiencies, hormonal changes, and certain medications.

• Treatment options for mouth ulcers include topical medications, mouth rinses, home remedies, and nutritional supplements.

• In more severe or persistent cases, prescription medications such as steroids, painkilling gels and sprays, oral medications, and immunosuppressants may be necessary.

• If mouth ulcers persist for more than 3 weeks, fail to heal after 2 weeks, or are accompanied by unusual symptoms, it is important to seek medical advice.