Mouth ulcers – should you worry?

What are mouth ulcers?

Mouth ulcers, also called oral ulcers, or aphthous ulcers, are painful round-to-oval shaped sores appearing in mouth. These are usually located on inner side of mouth over tongue, lips, gums or mucosa of cheeks. They appear white, red or yellow and swollen. There can be a single or multiple number of ulcers at a time.

Mouth ulcers are harmless, usually subside in a week or two without any treatment. But these are painful and make you uncomfortable while eating, drinking and brushing.

Up to 1 in 5 people get recurrent mouth ulcers.

Why do I get mouth ulcer?

The exact cause of mouth ulcer is not known. Some external factors are identified as triggers of mouth ulcer. There can also be some underlying immune disorder or nutritional deficiencies causing mouth ulcers.

Known Triggers of mouth ulcers:

• Stress and anxiety is supposed to one of the most common cause of mouth ulcer
• Tissue injury by sharp tooth or dental appliances as ill fitting dentures or braces may also trigger mouth ulcers
• Spicy and acidic food (citrus fruits as lemons, oranges, pineapples, apples, figs, tomatoes and strawberries etc) may trigger mouth ulcer or make it worse
• Hormonal changes can trigger mouth ulcers during monthly periods
• Smoking withdrawal is known to cause mouth ulcers in first few weeks of withdrawal
• Some medications can also trigger mouth ulcer as some pain killers, beta blockers and some chest pain medications. mouth ulcers can also occur during cancer chemotherapy

Medical conditions associated with mouth ulcers:

• Underlying immune disorder including HIV
• Nutritional deficiency as vitamin B 12, zinc, folic acid and iron deficiency
• Chronic gastrointestinal disorders
• Viral infections including the cold sore virus, chickenpox, and hand, foot and mouth disease

Why do I keep on getting mouth ulcers?

In some patients, there can be repetitive episodes of mouth ulcers. Approximately 40% of people who keep on getting mouth ulcers have a family history of the same. Current hypothesis indicates that some immune defect is triggered by some external factors that reacts abnormally against proteins in mouth mucosa.

How to deal with mouth ulcers?

Normally, an mouth ulcer subsides on its own without medication within 10-15 days. To alleviate discomfort, over-the-counter gels are available that have local anesthetic effect and provide a protective coating over ulcer surface that speeds up healing. Antimicrobial Mouthwashes may help in healing and prevent infection. In case of deficiencies, vitamin supplements are advocated.

Things that I can do to help healing of my mouth ulcer

• Use soft bristled brush for brushing teeth
• Use medicated toothpaste without irritant sodium laureth sulfate
• Avoid spicy, salty, acidic or hot food and drink until ulcer heals
• Use straw to drink cold drink

When to visit a doctor

• If mouth ulcers do not respond to over the counter treatment and there is intense pain that causes difficulty in eating and taking fluids in sufficient quantity
• If your mouth ulcer does not subside within 3 weeks
• If your mouth ulcers are unusually large and are spreading
• If there is fever along with mouth ulcers

Can mouth ulcers be cancerous?

If the ulcer does not subside on its own in 2-3 weeks or it spreads keeps on spreading and bleeding, you should urgently visit a surgeon.

Cancerous ulcers caused usually appear on or under the tongue, although you can get them in other areas of the mouth.

Risk factors that can cause mouth cancer include:

• Smoking or chewing tobacco
• Drinking alcohol
• Infection by papilloma virus.
• Smokers who are also heavy drinkers are at much risk as compared to general population.