Mouth ulcers

Mouth ulcers are easy to recognize. They usually begin as a round yellowish spot or bump with a red border or halo. This later breaks down into a punched-out ulcer covered with a white, yellowish, or grayish membrane. The surrounding area usually appears unaffected and healthy. The following symptoms are generally experienced with mouth ulcers:

• A tingling or burning sensation.
• Pain and difficulty while chewing food, drinking, or swallowing.
• Increased pain if irritated by movement while speaking, brushing teeth, or consuming certain foods like citrus fruits.
• Severe mouth ulcers may also cause fever and swollen lymph nodes.

Causes of Mouth Ulcers

The exact cause of mouth ulcers is not known. However, multiple reasons are associated with ulceration in the mouth, such as:

Physical factors:

• Accidental biting of the cheek or tongue
• Ill-fitting dental braces or dentures
• Site of a local anesthetic injection and dental treatment
• Impacted or misaligned wisdom teeth that continually irritate the inner cheek
• External trauma to the cheeks or the tongue
• Hard pressure while brushing teeth or use of a brush with hard bristles

Lifestyle factors:

• Excessive consumption of citrus, sour, and spicy foods
• Stress or lack of sleep
• Excess alcohol intake
• Smoking and cessation of smoking
• Chewing of tobacco
• Using toothpaste or mouthwashes that contain Sodium Lauryl Sulphate

Health conditions:

• A weakened immune system occurring with conditions such as HIV/AIDS, post-chemotherapy, and viral infections
• Nutritional deficiency of Vitamin B1, B2, B6, B12, folic acid, zinc, etc.
• Helicobacter pylori infection
• Hormonal changes during menstruation
• Gastrointestinal diseases like celiac disease, Crohn’s disease, and ulcerative colitis
• Oral malignancies
• Certain medications like Sodium hypochlorite, Piroxicam, Phenobarbital, Phenindione, Niflumic acid, and Captopril

• Are a woman
• Have a family history of mouth ulcers
• Follow poor oral hygiene
• Are immunocompromised or have weak immunity
• Have a stressful lifestyle

Minor mouth ulcers usually do not require any investigations and can be managed at home by the patients themselves. If you see a doctor, he or she will evaluate the site and type of lesion, along with a detailed history. Occasionally, for ulcers with repeated recurrence, severe symptoms, and multiple lesions, doctors may ask for lab investigations, such as:

• Complete Blood Count (CBC) to check for overall health status.
• Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein Quantitative to assess any ongoing infection or inflammation in the body. These infections may occur in certain health conditions that can further cause mouth ulcers.
• Vitamin B12 and Vitamin B9 tests to check for nutritional deficiencies.
• Any other tests that may be needed to evaluate further based on the initial laboratory findings.

Mouth ulcers cannot be completely prevented. However, it is possible to reduce the frequency of occurrence or troublesome symptoms by following the tips given below:

• Reduce the intake of foods that irritate your mouth. Different people may react differently to various foodstuffs. You may be able to identify the items that cause your symptoms when you experience frequent ulceration after consuming certain foods.
• Restrict alcohol consumption.
• Do not smoke. If you are a smoker and trying to quit, there is an increased possibility of developing mouth ulcers during the cessation period.
• Reduce emotional stress and engage in activities that boost mental health.
• Try to get adequate and sound sleep.
• Maintain good oral hygiene. Brush your teeth gently with a soft-bristled toothbrush after every meal. Avoid toothpaste or mouthwashes containing Sodium Lauryl Sulphate.
• Take a balanced diet rich in vitamins and minerals to prevent nutritional deficiencies.
• Consult your dentist for ill-fitting or fractured dentures or fillings, or for dental wax application over the sharp edges of your braces.

The treatment for mouth ulcers is broadly divided into two categories:

Symptomatic Relief

• Various OTC and prescription formulations are available for topical application to provide relief and promote faster healing of mouth ulcers:
• Topical gels containing anesthetics like benzocaine and lidocaine are used to relieve pain.
• Antiseptics can be used to prevent and treat infections associated with mouth ulcers.
• The use of chlorhexidine gluconate mouthwash can decrease the duration of the ulcer.
• Antibiotic mouthwash containing tetracycline helps in reducing the size of the ulcer and the pain associated with it.
• Oral painkillers like diclofenac are used to relieve pain.
• Oral steroids and mouthwashes containing dexamethasone are prescribed in cases of severe ulceration.
• Drugs used in the treatment of gastrointestinal ulcers, such as sucralfate, may also provide some relief in mouth ulcers.
• Dental lasers can be used to perform cautery, a kind of mini-surgery on mouth ulcers to promote healing.

Supportive Care

• Multivitamins or vitamin supplements are used to treat Vitamin B complex deficiencies.
• Antipyretics such as paracetamol may be used to treat fever occurring along with the ulcers.
• Antibiotics can be advised to treat any concurrent infections.

If you have mouth ulcers, you can do the following at home to help relieve symptoms and promote faster healing:

• Follow good oral hygiene. Brush your teeth gently with a soft-bristled toothbrush after meals. Rinse your mouth well, preferably with an over-the-counter mouthwash.
• Avoid eating citrus fruits, acidic vegetables, and spicy or hot foods that may further irritate the ulcer.
• Avoid chewing foods on the ulcer side of the mouth if possible.
• Warm saline gargles may also help relieve symptoms.
• You can suck on ice chips or apply an ice pack externally at the site of the mouth ulcer. Ice helps reduce inflammation and provides pain relief.
• Take a balanced diet full of essential vitamins and minerals to ensure good nutrition.

• Nutritional deficiencies due to the inability to chew or swallow food properly
• Increased risk of oral malignancies
• Secondary infections of the mouth may lead to cellulitis
• Tooth abscess due to secondary dental infections
• Bleeding from the ulcer

Diet: People who experience recurrent mouth ulcers may be at a higher risk of nutritional deficiencies due to difficulty in chewing or swallowing foods. Nutritional deficiencies can, in turn, lead to recurrent mouth ulcers, creating a vicious cycle. A diet rich in essential vitamins and minerals and low in irritant foods, such as oily or spicy items, is recommended. It is advisable to include a variety of fresh leafy greens, whole-grain cereals, legumes, and pulses in your diet.

Homeopathy: Homeopathic preparations like Borax, Arsenicum album, Sulphuricum acidum, Mercurius solubilis, and Kali muriaticum are used to treat mouth ulcers. Homeopathic treatment should be individualized to the patient and taken under the guidance of a qualified homeopathy doctor.

Ayurveda: In Ayurveda, mouth ulcers are referred to as “Mukhpak” or “Sarvasar Rog.” The topical application of herbal remedies such as aloe vera gel, licorice, and chamomile has been found beneficial in treating recurrent mouth ulcers. Oral Ayurvedic formulations made from Amla, Draksha, Hareetaki, Chandan, and Triphala are also utilized in the treatment of oral ulcers.

There are several safe and simple home treatments to alleviate the pain of mouth ulcers. These home remedies can help reduce pain and speed up the healing process.

Chronic or recurrent mouth ulcers can cause severe frustration and pain. Individuals may struggle to enjoy their favorite foods and are at an increased risk of malnutrition. People with mouth ulcers often experience poor oral hygiene and may also suffer from social embarrassment due to bad breath. Chronic pain, combined with the inability to enjoy preferred meals, can lead to anxiety for the patient.

To manage mouth ulcers effectively, it is important to follow good oral hygiene techniques, which include:

• Regular flossing
• Gentle brushing
• Rinsing the mouth

Most mouth ulcers heal on their own with proper oral hygiene. However, if the ulcers are recurrent, do not heal within one to two weeks, or are accompanied by unbearable pain and fever, immediate medical care is essential.