Mouth Ulcers

Mouth ulcers are painful sores that develop inside the mouth, affecting millions of people. While most are harmless canker sores that heal within two weeks, some mouth ulcers can signal serious conditions including infections, autoimmune diseases, or oral cancer. Understanding the different types and knowing when to seek medical care is essential for proper treatment.

Quick Facts

  • Affect 20% of population
  • Usually heal in 1-2 weeks
  • Can be very painful
  • Multiple types exist
  • Some need urgent care

⚠️ Seek Immediate Medical Care If Mouth Ulcers Occur With:

  • Ulcer lasting more than 3 weeks
  • Ulcers that are painless (may indicate cancer)
  • High fever with mouth sores
  • Difficulty swallowing or breathing
  • Severe dehydration from inability to eat or drink
  • Spreading rash or blisters on body
  • Eye pain or vision problems with mouth ulcers
  • Genital ulcers along with mouth ulcers
  • White patches that don't wipe off (possible thrush or leukoplakia)
  • Bleeding that won't stop
  • Rapidly spreading or worsening ulcers
  • Signs of severe infection (pus, red streaks)

These symptoms may indicate oral cancer, severe infections, or systemic diseases requiring urgent evaluation.

Understanding Mouth Ulcers

Mouth ulcers are breaks in the mucous membrane lining of the mouth that expose the underlying tissue. They can appear as round or oval sores with a white, yellow, or gray center and a red border. These painful lesions can occur anywhere in the mouth, including the lips, cheeks, gums, tongue, floor of the mouth, and soft palate.

The most common type is the aphthous ulcer (canker sore), which affects up to 20% of the population. These are not contagious and typically heal without scarring. However, it's crucial to distinguish benign canker sores from other types of mouth sores that may be contagious (like cold sores) or indicate serious conditions (like oral cancer).

The pain from mouth ulcers can range from mild discomfort to severe pain that interferes with eating, drinking, and speaking. While most ulcers are isolated incidents, some people experience recurrent ulcers that significantly impact their quality of life. Understanding triggers and underlying causes is key to prevention and appropriate treatment.

Types of Mouth Ulcers

Canker Sores (Aphthous)

  • Most common type
  • Not contagious
  • White/yellow center
  • Red border
  • Minor: <1cm, heal in 7-14 days
  • Major: >1cm, heal in weeks
  • Herpetiform: Multiple tiny ulcers

Cold Sores (Herpes)

  • Caused by HSV-1 virus
  • Highly contagious
  • Start as blisters
  • Usually on lips
  • Tingling before appearing
  • Crust over when healing
  • Recur in same spot

Traumatic Ulcers

  • From injury
  • Dental work
  • Accidental biting
  • Sharp foods
  • Ill-fitting dentures
  • Usually single ulcer
  • Heal when cause removed

Disease-Related

  • Behcet's disease
  • Lupus ulcers
  • Crohn's disease
  • HIV/AIDS related
  • Cancer (painless)
  • Often recurrent
  • May have other symptoms

Common Causes

Local Factors

  • Trauma: Accidental biting, dental work, sharp foods
  • Burns: Hot food or drinks
  • Irritation: Braces, dentures, rough teeth
  • Chemical burns: Aspirin held against gums
  • Toothpaste: Sodium lauryl sulfate sensitivity
  • Mouthwash: Alcohol-containing products
  • Tobacco: Smoking or chewing

Infections

  • Viral: Herpes simplex, varicella-zoster, coxsackie
  • Bacterial: Streptococcus, tuberculosis, syphilis
  • Fungal: Candida (thrush), histoplasmosis
  • HIV/AIDS: Multiple opportunistic infections

Systemic Conditions

  • Nutritional deficiencies: B12, folate, iron, zinc
  • Autoimmune diseases: Lupus, Behcet's, pemphigus
  • Inflammatory bowel disease: Crohn's, ulcerative colitis
  • Celiac disease: Gluten sensitivity
  • Blood disorders: Anemia, neutropenia
  • Hormonal changes: Menstruation, pregnancy
  • Stress: Physical or emotional

Medications and Treatments

  • Chemotherapy: Mucositis common side effect
  • Radiation therapy: To head and neck
  • Medications: NSAIDs, beta-blockers, some antibiotics
  • Immunosuppressants: Increase infection risk

Symptoms and Characteristics

Appearance

  • Round or oval shape
  • White, yellow, or gray center
  • Red, inflamed border
  • Size from 2mm to several cm
  • Single or multiple lesions
  • Shallow or deep crater

Associated Symptoms

  • Pain: Often severe, worse with eating/drinking
  • Burning sensation: Before ulcer appears
  • Difficulty eating: Especially acidic or spicy foods
  • Difficulty speaking: If on tongue
  • Drooling: In children
  • Bad breath: From bacterial overgrowth
  • Swollen lymph nodes: With infection
  • Fever: Suggests systemic cause
  • Fatigue: With chronic ulcers

Warning Signs

  • Painless ulcers (cancer risk)
  • Non-healing after 3 weeks
  • Irregular, raised edges
  • Bleeding easily
  • Hard or indurated base
  • Multiple systemic symptoms

Diagnosis and Evaluation

Medical History

  • Duration and frequency
  • Location and number
  • Pain level
  • Triggering factors
  • Previous episodes
  • Associated symptoms
  • Medications
  • Family history

Physical Examination

  • Visual inspection
  • Palpation of ulcers
  • Lymph node examination
  • Complete oral exam
  • Skin examination
  • Genital examination if indicated

Diagnostic Tests

  • Blood tests: CBC, vitamins, inflammatory markers
  • Cultures: Bacterial, viral, fungal
  • Biopsy: For persistent or suspicious ulcers
  • Allergy testing: Food or contact allergies
  • Autoimmune panels: If systemic disease suspected
  • HIV testing: For recurrent severe ulcers
  • Celiac testing: If gluten sensitivity suspected

Treatment Options

Topical Treatments

  • Numbing gels (benzocaine)
  • Corticosteroid paste
  • Antimicrobial rinses
  • Magic mouthwash
  • Silver nitrate sticks
  • Amlexanox paste
  • Honey application

Oral Medications

  • Prednisone for severe cases
  • Colchicine
  • Dapsone
  • Vitamin supplements
  • Antiviral medications
  • Antibiotics if infected
  • Immunosuppressants

Home Remedies

  • Salt water rinses
  • Baking soda paste
  • Ice chips
  • Milk of magnesia
  • Aloe vera gel
  • Chamomile tea rinse
  • Coconut oil

Lifestyle Changes

  • Avoid trigger foods
  • Use soft toothbrush
  • SLS-free toothpaste
  • Stress management
  • Adequate sleep
  • Good oral hygiene
  • Nutritious diet

Diet and Nutrition Tips

Foods to Avoid

  • Acidic foods: citrus, tomatoes, vinegar
  • Spicy foods
  • Salty snacks
  • Rough or crunchy foods
  • Hot beverages
  • Alcohol
  • Carbonated drinks

Healing Foods

  • Yogurt with active cultures
  • Soft, bland foods
  • Cool liquids
  • Smoothies
  • Mashed vegetables
  • Protein shakes
  • Foods rich in B vitamins

Prevention Strategies

  • Maintain oral hygiene: Brush gently, floss daily
  • Avoid triggers: Keep food diary to identify
  • Manage stress: Relaxation techniques
  • Protect mouth: Wax on braces, proper denture fit
  • Nutritional support: B-complex, zinc, iron
  • Stay hydrated: Prevents dry mouth
  • Quit smoking: Reduces irritation
  • Regular dental visits: Fix sharp teeth
  • Gentle products: SLS-free toothpaste
  • Boost immunity: Healthy lifestyle
  • Treat underlying conditions: Manage chronic diseases
  • Careful eating: Avoid mouth trauma

When to See a Doctor

Schedule an Appointment For:

  • Ulcers lasting more than 2 weeks
  • Unusually large ulcers
  • Recurring ulcers
  • Ulcers spreading
  • Severe pain despite treatment
  • Difficulty eating or drinking
  • Signs of infection

Seek Immediate Care For:

  • Non-healing ulcer after 3 weeks
  • Painless ulcers
  • High fever
  • Difficulty swallowing
  • Dehydration
  • Eye involvement
  • Genital ulcers
  • Spreading rash

Related Conditions

Sore Throat

Often occurs with mouth ulcers in viral infections.

Fever

May accompany mouth ulcers in systemic infections.

Swollen Lymph Nodes

Common with infectious causes of mouth ulcers.

Skin Rash

May indicate systemic conditions causing mouth ulcers.