An ulcer occurs when the tissue is damaged by an infection, inflammation, or injury. If left untreated, ulcers can cause pain, discomfort, and sometimes even serious complications. They can affect the skin, the stomach, the mouth, and the genitals. Here are a few ways in which ulcers can cause pain, discomfort, and sometimes serious complications.
You can get mouth ulcers on your tongue, gums, cheeks, or lips, which are small, painful sores inside your mouth. Mouth ulcers can also be known as canker sores or aphthous ulcers. They are not contagious and usually go away by themselves within one to two weeks. However, some mouth ulcers may be a sign of a more serious condition requiring medical attention.
There is no definitive cause of mouth ulcers, but some factors that may trigger or worsen them include:
Minor injuries to the mouth, such as from biting your cheek, brushing too hard, dental work, or wearing braces.
Allergic reactions to oral bacteria, toothpaste, mouthwash, or food.
Infections by bacteria, viruses, or fungi, such as oral thrush, hand-foot-and-mouth disease, or herpes simplex virus.
Sensitivities to acidic or spicy foods and drinks, such as citrus fruits, tomatoes, chocolate, or coffee.
Nutritional deficiencies, especially of vitamin B9 (folate), vitamin B12, zinc, and iron.
Hormonal changes, such as during menstruation, pregnancy, or menopause.
Emotional stress, anxiety, or lack of sleep.
Underlying medical conditions, such as celiac disease, inflammatory bowel disease, diabetes, HIV, or autoimmune diseases like lupus, oral lichen planus, or Behçet’s disease.
An ulcer in the mouth is characterized by a painful sore that may be yellow, white, or red. There may also be an area of redness and inflammation around the sore. The pain may worsen when you eat, drink, or talk. Before the ulcer appears, you may also experience burning or tingling.
You may have one or more mouth ulcers at the same time. They can vary in size and shape, depending on the type of ulcer. There are three main types of mouth ulcers:
Minor ulcers: These are the most common type of mouth ulcers. They are small (less than 5 millimeters in diameter) and oval or round in shape. They heal within one to two weeks and do not leave scars.
Major ulcers: These are larger (more than 10 millimeters in diameter) and irregular in shape. They may take several weeks to heal and may leave scars.
Herpetiform ulcers: These are clusters of tiny (1 to 2 millimeters in diameter) ulcers that form a large ulcerated area. They heal within one to two weeks and do not leave scars.
Because mouth ulcers are easily recognizable and self-limiting, they do not require a diagnosis. A mouth ulcer that is large, persistent, recurrent, or accompanied by other symptoms, such as fever, swollen glands, or weight loss, should be evaluated by your dentist or doctor.
In addition to examining your mouth, your doctor or dentist may also ask about your medical history, medications, and lifestyle habits. Tests may also be conducted to rule out or confirm an infection, nutritional deficiency, or underlying condition.
A swab or a biopsy of the ulcer to check for bacteria, viruses, or fungi.
A blood test to check for anemia, vitamin levels, or signs of inflammation.
A skin patch test to check for allergies to oral products or foods.
An endoscopy or a colonoscopy to check for celiac disease or inflammatory bowel disease.
There are several general measures that can help relieve the pain and discomfort associated with mouth ulcers, depending on the cause, severity, and frequency of the ulcers.
Applying ice or cold water to the ulcer.
Rinsing the mouth with warm salt water or an antiseptic mouthwash.
Avoiding sour, hot, and spicy foods and drinks that may irritate the ulcer.
Using a soft toothbrush and a toothpaste that does not contain sodium lauryl sulfate (SLS).
Taking over-the-counter painkillers, such as ibuprofen or acetaminophen, as needed.
Applying a topical gel, cream, or ointment that contains an anesthetic, an antiseptic, a steroid, or a protective agent, such as benzocaine, chlorhexidine, triamcinolone, or carmellose sodium.
Your doctor or dentist may prescribe stronger medications to treat the underlying cause or to prevent future outbreaks of mouth ulcers. These medications may include:
Antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, for mouth ulcers caused by herpes simplex virus.
Antifungal drugs, such as fluconazole, itraconazole, or nystatin, for mouth ulcers caused by oral thrush.
Antibiotics, such as tetracycline, doxycycline, or amoxicillin, for mouth ulcers caused by bacterial infections.
Immunosuppressants, such as azathioprine, cyclosporine, or methotrexate, for mouth ulcers caused by autoimmune diseases.
Nutritional supplements, such as iron, zinc, vitamin B9, or vitamin B12, for mouth ulcers caused by nutritional deficiencies.
It may not be possible to prevent all mouth ulcers, but you can reduce your risk by following some simple steps, such as:
Practicing good oral hygiene by brushing your teeth twice a day, flossing daily, and using a mouthwash as needed.
Eating a well-balanced and nutritious diet that includes plenty of fruits, vegetables, whole grains, lean proteins, and dairy products.
Getting enough vitamin B9, vitamin B12, zinc, and iron from your diet or from supplements, if recommended by your doctor.
Avoiding foods and drinks that may trigger or worsen mouth ulcers, such as citrus fruits, tomatoes, chocolate, coffee, or alcohol.
Quitting smoking and chewing tobacco, as these habits can damage your oral tissues and increase the risk of mouth ulcers and oral cancer.
Managing your stress levels by practicing relaxation techniques, such as meditation, yoga, breathing exercises, or hobbies.
Getting enough sleep and rest to help your body heal and recover.
Seeing your doctor or dentist regularly for check-ups and screenings, especially if you have a chronic condition that may affect your oral health.
