Health Tips

"What causes mouth ulcers? I seem to get them occasionally but don't know why." "My mouth ulcer is really swollen, what is the best option to reduce this?"

"Is there anything I can do to prevent getting mouth ulcers again?"

What is a mouth ulcer?

Mouth ulcers are common. They are normally small, painful lesions that develop in your mouth or at the base of your gums. A mouth ulcer is damaged epithelium and its underlying lamina propria (a thin layer of connective tissue that lines various tubes in the body).

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Mouth ulcers aren’t contagious and usually go away itself within 1 to 2 weeks. 

The symptoms of a mouth ulcer depend on the cause, but may include:

• one or more painful sores on part of the skin lining the mouth
• swollen skin around the sores
• problems with chewing or tooth brushing because of the tenderness
• irritation of the sores by salty, spicy or sour foods
• loss of appetite.

What causes mouth ulcer?

There is no definite cause behind mouth ulcers. However, certain factors and triggers have been identified. These include:

• accidental biting of the inside of your cheek
• constant rubbing against dentures or braces
• toothpastes and mouth rinses that contain sodium lauryl sulfate
• food sensitivities to acidic foods like strawberries, citrus, and pineapples, and other trigger foods like chocolate and coffee
• lack of essential vitamins, especially B-12, zinc, folate, and iron
• allergic response to mouth bacteria
• hormonal changes during menstruation
• emotional stress
• lack of sleep
• reaction to certain medications

If you have frequent, prolonged or large ulcers, or is unwell, the following tests may be done to assess general and gastrointestinal health.

• Bacterial and viral swabs from the ulcers
• Complete blood cell count
• Iron, B12 and folate
• Coeliac antibodies
• Faecal calprotectin (a test for inflammatory bowel disease)

Treatment for mouth ulcers

Most mouth ulcers are harmless and resolve by themselves within 10 days. Other types of mouth ulcers, such as the aphthous variety or those caused by herpes simplex infection, need topical treatment such as a mouthwash, ointment or gel. 

Treatment options for mouth ulcers include: 

• Apply antiseptic gel to the ulcers. Talk to your pharmacist to find out which product is best for you.
• Use an alcohol-free medicated mouthwash containing chlorhexidine gluconate.
• Take pain-relieving medication, such as paracetamol.
• Use a topical steroid mouthwash or ointment. This is usually prescribed by dentist or oral medicine specialist.

Lifestyles advice:

• Avoid spicy and sour foods until the ulcers heal.
• Drink plenty of fluids.
• Regularly rinse your mouth out with warm, slightly salted water.
• Keep your mouth clean.

Prevention of mouth ulcers

Suggestions on how to reduce the likelihood of mouth ulcers include: 

• Brush your teeth gently with a soft toothbrush, taking care not to slip with the brush.
• Eat a well-balanced and nutritious diet.
• Avoid foods and drink that are known to trigger or exacerbate ulcers such as chocolate, spicy foods, coffee, peanuts, almonds.
• Try to make sure that underlying medical conditions are well-controlled.
• Reduce stress by trying relaxation techniques and exercise might be helpful.

When to see a doctor:

• Ulcers more than 10mm in diameter
• Non-healing ulcers lasting longer than 3 weeks
• Painless, non-healing ulcers with raised borders
• Frequently recurring lesions
• Multiple ulcers (more than 5 or 6)
• Irregularly shaped ulcers
• Signs of systemic illness (fever, lymphadenopathy)
• Extreme difficulty in eating or drinking because of pain.

Reference:

1. https://www.healthline.com/health/mouth-ulcers#causes
2. https://www.dermnetnz.org/topics/mouth-ulcer/
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mouth-ulcers

Written by

Ms Caryn Lee