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Mouth ulcers
A mouth ulcer is the loss or erosion of part of the delicate tissue
that lines the inside of the mouth (mucous membrane). Some of the causes
include certain drugs, chemicals and infectious diseases such as herpes or
thrush. The most common cause is mechanical injury, such as accidentally
biting your cheek. In most cases, mouth ulcers are harmless and resolve by
themselves in a few days without the need for medical treatment. Aphthous
ulcers are recurring ulcers with no known cause that affect around 20 per
cent of the population. See your doctor if your mouth ulcers don't clear up
within a few days, or if you are troubled by frequent attacks.
Symptoms
The symptoms of a mouth ulcer depend on the cause but may include:
· A round sore or sores inside the mouth
· Swollen skin around the sores
· Tenderness
· Problems with chewing or toothbrushing because of the
tenderness
· Irritation of the sores by salty, spicy or sour foods
· Loss of appetite.
A range of causes
Mouth ulcers can be caused by a wide range of factors including:
· Accidental biting of the cheek.
· Injury from a toothbrush (such as slipping while brushing).
· Constant rubbing against misaligned or sharp teeth.
· Constant rubbing against dentures or braces.
· Poor oral hygiene.
· Burns from eating hot food.
· Irritation from strong antiseptics, such as a mouthwash.
· Oral thrush infection.
· Herpes simplex viral infection (cold sore).
· Reaction to certain drugs, such as chemotherapeutic agents.
· Autoimmune diseases (for example, lichen planus).
· Syphilis infection.
· A range of other infections including hand-foot-mouth
syndrome.
· Certain diseases including tuberculosis, AIDS, diabetes
mellitus and inflammatory bowel disease.
· Cancer of the lip.
The cause of aphthous ulcers isn't known
Around one in five adults suffer from recurring bouts of aphthous
ulcers, which are mouth ulcers with no known cause. The tongue, gums or
mouth lining can be affected. Crops of these tiny off-white ulcers tend to
sprout during times of emotional stress or the menstrual period. This has
led some researchers to suggest that aphthous ulcers may be caused by an
immune system reaction, since the immune system is affected by stress and
hormones. The underlying trigger may be a virus or an allergic reaction.
Another name for aphthous ulcer is canker sore.
Possible complications
Untreated, mouth ulcers can occasionally lead to complications
including:
· Bacterial infection
· Inflammation of the mouth (cellulitis)
· Tooth abscess.
Diagnosis methods
It is important to establish the cause of the mouth ulcers. Some of
the investigations may include:
· Physical examination - mouth ulcers look different depending
on their cause. For example, if the ulcer is large and yellow, it was most
likely caused by trauma. Cold sores inside the mouth tend to be very
numerous and spread around the gums, tongue, throat and inside of the
cheeks. A fever also suggests the ulcers may be caused by a herpes simplex
infection.
· Blood tests - to check for signs of infection.
· Skin biopsy - a small tag of tissue from the ulcer is taken
and examined in a laboratory.
Treatment options
Most mouth ulcers are harmless and resolve by themselves in a few
days. Other types of mouth ulcers, such as the aphthous variety or those
caused by herpes simplex infection, need medical treatment. It isn't
possible to speed the recovery of ulcers, but the symptoms can be managed
and the risk of complications reduced. The range of treatment options
includes:
· Avoid spicy and sour foods until the ulcers heal
· Drink plenty of fluids
· Regularly rinse your mouth out with warm, slightly salted
water
· Keep the mouth clean
· Take pain-killing medication, such as paracetamol
· Apply antiseptic gel to the ulcers
· Use a medicated mouthwash
· Use steroid gels or tablets
· Treat aphthous ulcers with anti-inflammatory drugs
· Treat ulcers caused by the herpes simplex virus with
anti-viral drugs
· Treat oral thrush with anti-fungal drugs.
Prevention tips
Suggestions on how to reduce the likelihood of mouth ulcers include:
· Brush your teeth at least twice every day.
· Floss regularly.
· Visit your dentist regularly.
· Brush your teeth very gently, taking care not to slip with
the brush.
· Eat a well balanced and nutritious diet.
· Make sure that underlying conditions, such as diabetes
mellitus and inflammatory bowel disease, are managed appropriately.
Where to get help
· Your doctor
· Dentist
· Chemist
Things to remember
· A mouth ulcer is the loss or erosion of the delicate lining
tissue of the mouth (mucus membrane).
· The most common cause is mechanical injury, such as
accidentally biting your cheek.
· In most cases, mouth ulcers are harmless and resolve by
themselves in a few days without the need for medical treatment.
· Aphthous ulcers are recurring ulcers with no known cause
that affect around 20 per cent of the population.
· If your mouth ulcers don't clear up within a few days, or if
you are troubled by frequent attacks, see your doctor.
Related articles:
Cold sores.
Gum disease.
This page has been sourced from the Better Health Channel and produced
in consultation with, and approved by the following sponsor. The sponsor
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Mouth Ulcers
Related Articles
. Gingivostomatitis
. Hand Foot Mouth Disease
. Dental Health Guide
Internet Links
. About Pediatrics
. About Hand Foot and Mouth Disease
. Management of Aphthous Ulcers
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Children's Oral Care
Canker and Cold Sore Refief
Younger children often get mouth ulcers as part of a viral infection,
like herpes gingivostomatitis or hand foot and mouth disease. In older
children, recurrent ulcers are often caused by canker sores or aphthous
stomatitis.
Your child's age, duration of symptoms (how long the ulcers have been
there), and other symptoms can help you and your Pediatrician figure out
what is causing your child's mouth ulcers.
a.. Herpes Gingivostomatitis - this is an infection caused by the
herpes virus, which is the same virus that cause fever blisters or cold
sores (herpes labialis). Although some people get cold sores over and over,
the first time you get this infection, instead of just getting a few
vesicles on your lips, you get the classic herpes gingivostomatitis
infection, with high fever, irritability and small, painful ulcers on the
child's gums and inside his mouth.
b.. Hand Foot and Mouth disease is another viral illness that causes
mouth ulcers. It is caused by the Coxsackie virus and children with this
infection usually get small red ulcers in their mouth and on their hands
(palms) and feet (soles). These children can also sometimes get a rash on
their legs and buttocks.
c.. Herpangina - is similar to hand foot and mouth disease, except
that the ulcers are just in the child's mouth. It is also caused by the
Coxsackie virus.
d.. Bacterial infections, like gingivitis.
e.. Geographic Tongue - also called benign migratory glossitis, can
look like a large ulcer, with a smooth pink or red area on the tongue with a
raised border. It is not usually painful though and no treatment is
necessary.
f.. Oral ulcers can also be caused by trauma, as a side effect of
chemotherapy, radiation and certain drugs, especially Stevens-Johnson
syndrome.
Recurrent Mouth Ulcers
Recurrent ulcers can be more difficult to diagnose, treat and prevent.
Referral to a specialist, a dentist or dermatologist, and perhaps a biopsy
of an ulcer is sometimes necessary.
a.. Trauma, like from a dental appliance, sharp tooth, habitual
cheek biting, are a common cause of recurrent mouth ulcers. In this
situation, you would expect the ulcers to keep coming back in the same area.
b.. Recurrent Aphthous Stomatitis is a common cause of recurrent
mouth ulcers in children and adults. They are also called canker sores and
although sometimes thought to be caused by smoking, food allergies, stress,
vitamin deficiencies and local trauma, no specific trigger is found in most
people.
c.. Recurrent HSV infections. Although most people with recurrent
herpes infections (herpes simplex labialis) get the ulcers on the outside of
their lips (cold sores or fever blisters), some get them inside too.
d.. Recurrent mouth ulcers can also accompany many systemic
disorders, such as:
a.. inflammatory bowel disease
b.. cyclic neutropenia - recurrent, cyclical episodes of mouth
ulcers, fever and neutropenia (low white blood counts)
c.. gluten-sensitive enteropathy
d.. periodic fever syndrome (PFAPA), in which children get
episodes of fever, aphthous stomatitis, pharyngitis, and cervical adenitis
every 2-8 weeks.
e.. vitamin deficiencies, including iron deficiency anemia, and
folate, zinc, or vitamin B12 deficiency
f.. Behcets syndrome, with aphthous stomatitis, recurrent genital
ulcers, and eye lesions.
g.. HIV
Treatment of Oral Ulcers
In most cases, symptomatic treatments are the main option. This might
include acetaminophen or ibuprofen containing pain medications.
Other symptomatic treatments include:
a.. Topical analgesics, such as 2% viscous lidocaine applied
directly to the ulcers, diphenhydramine (Benadryl) elixir mouthwash, and
benzocaine preparations, such as Anbesol or Orajel Mouth-Aid.
Medications to coat the ulcers can also be helpful, such as antacids
(Maalox or Milk of Magnesia), and dental pastes. A combination of Benadryl
and Maalox is often popular.
Antiseptics, such as chlorhexidine gluconate (Peridex) and
cetylpyridium chloride solution (Cepacol) might also be effective treatmeats
when used as a mouthwash twice a day.
Aphthasol (amlexanox) is an anti-inflammatory paste that can be
applied to ulcers 2-4 times a day to make them less painful and help them
heal faster.
Steroids are also sometimes used to treat oral ulcers. When needed,
0.1% triamcinolone acetonide (Kenalog) can be added to an emollient dental
paste, like Orabase, and applied to the ulcers several times a day. Topical
high-potency steroid gels are also sometimes used.
Prevention of Oral Ulcers
If a specific trigger for your child's oral ulcers are found, those
things should be avoided. A symptom diary, record when your child got his
ulcer and the things he ate and used in his mouth (toothpastes, mouthwashes,
etc.) just before and any medications he may have taken, may help you find
triggers.
When no trigger is found, a mouth rinse or toothpaste with triclosan
may be helpful. Colgate Total toothpastes contain tricolsan.
Sodium lauryl sulfate (SLS), which is an additive in many brands of
toothpaste and mouthwashes, is thought to be a possible trigger of ulcers in
some people with recurrent aphthous stomatitis, so it may be helpful to use
SLS free products. SLS free toothpastes include Biotene and Rembrandt's
Canker Sore toothpaste.
It may also be helpful to avoid letting your mouth get dry, avoid
sharp foods, like pretzels, and use a soft toothbrush.
