Affected Sites: Ulcers Affecting Oral Cavity (Mouth)

Ulcers affecting oral cavity (mouth)
One of the most common lesions that humans have suffered from at one point of time or another in
their lifetime are mouth ulcers. Ulcers in simple terms mean- the damaged internal linings (mucous
membrane) of an organ or break in skin usually resulting in discomfort of the affected organ thus
causing limited function or hindrance in our day to day work. They are painful sores, red or yellow in
colour, mostly rounded in shape and the size may range from 2 mm – 1 or 2 cm.
Affected sites
Most common: inside cheeks, lips, tongue, gums. Rarely on roof of mouth, on the under surface of
tongue, floor of mouth, the palatine folds (in throat) only during throat infection, ulcers on any other
body part apart from mouth is a point of concern. In a few conditions like cold sores (Herpes Labialis)
they appear outside of mouth around the lips, chin or under the nose.
Causes of ulcers
 Aphthae
 Systemic disease (inflammatory/ infectious disorders, cutaneous, gastrointestinal and
haematological disease)
 Malignancy
 Local causes
 Drugs
Each of these causative factors have their own sets of different presentations indicative of their
diagnosis.
 Aphthous Stomatitis (non-infectious) Oral Ulcers can be categorised into 3 main types depending
upon size, shape and number. They are:
1. Herpetiform ulceration- (Herpes like ulceration) not caused by Herpes Virus. Non
contagious. Extremely painful. These are small pin point shaped, red in colour.
2. Minor ulcers- round to ovoid, yellow based ulcers with red border
3. Major ulcers- similar to minor ulcers but larger in diameter exceeding 1cm.
These canker sores can be recurrent due to genetic predilection or sometimes due to unknown
cause.
 Systemic disease
1. Viral Infections: EBV, HPV, HSV, HIV, Chicken pox (varicella zoster)
2. Bacterial infection: syphilis, tuberculosis,
3. Fungal infection: mostly associated with weakened immune system
4. Behçet’s disease- poorly understood disease associated with swelling of blood vessels
5. Weakened immune system- for example, due to HIV, leukaemia or lupus
6. Vitamin B12 and Iron deficiency in body
 Malignancy
1. Mouth cancer, in rare cases.
 Local causes
1. Mechanical trauma- sharp edges of teeth, fillings, crown, false teeth, braces, cheek biting,
even due to some accidental trauma during dental treatment
2. Thermal injury- due to hot food and drinks ingested at a temperature causes serious burns
leading to ulcer formation in later stages of healing. The optimal temperature that our
mouth withstand is 57.8 deg C (136 deg F) to 60 deg C (140 deg F)
3. Chemical injury:
 Medications:
1. Painkillers like Non-Steroidal Anti-inflammatory Drugs (NSAIDS) - e.g. ibuprofen.
2. Beta-blockers- used in angina, high blood pressure and abnormal heart rhythms.
3. Side effect of chemotherapy or radiotherapy (aka mucositis)
Aggravating factors
 Stress
 Genetics
 Triggering foods and/or chemicals
 hormonal changes – some women develop mouth ulcers during their monthly period
 stopping smoking
Treatment
Is not usually required in mouth ulcers/ non contagious aphthae but a visit to your General
Practitioner or Dentist may be necessary when the ulcers do not heal within the usual self-limiting
time period of 1-2 weeks. This usually involves self-care and pharmacy medicines to reduce the
swelling and discomfort during eating and drinking.
Self-care:
 Covering the affected area with a soothing, protective paste recommended by pharmacist
 Avoiding hard, salty, spicy, acidic or hot foods
 Frequent intake of cool drinks with help of straw
 Using a sodium lauryl sulphate free toothpaste, if it is an aggravating factor
Medicines:
 Temporary acting painkillers or local anaesthetics available as mouthwash, topical gels, lozenges,
or spray and diluting mouthwash with water before use.
 Antimicrobial mouthwashes e.g. chlorhexidine gluconate for no more than 7 days, may cause
slight staining but this reduces once treatment is stopped, are helpful in fast recovery and
preventing infections.
 Corticosteroid lozenges reduces pain and inflammation and also helps in speed up healing.
 Vitamin B12 or Iron supplements in your diet.
For ulcers with systemic diseases, proper treatment with antibiotics or antivirals is required as per
the case.
When to see a doctor

If the ulcers last for more than 2 weeks or may be associated with any other symptoms that may
seem concerning except for the usual pain, burning sensation or inflammation. It is important that
one should let the attending GP or Dentist know about ulcers affecting any other body part apart
from mouth and throat.
Prevention
Prevention here would mean to reduce the risk of developing ulcers by eliminating certain causative
factors as they are often caused by factors which are not under our control (e.g. Stress, genetics, and
other unknown reason)
 Avoiding foods like chocolates, strawberries, cheese, etc. that causes ulcer
 Using soft toothbrush and sodium lauryl sulphate free toothpaste
 Reducing stress and anxiety
 Eating a healthy and balanced diet

Affected Sites: Ulcers Affecting Oral Cavity (Mouth)

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When to see a doctor

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