Mouth ulcer

A mouth ulcer is a condition, which affects 20-30 per cent of the population. It is an erosion of the membrane that lines the mouth, known as the mucous membrane. They are not life-threatening, and there is a wide range of causes as well as treatment options available. Adults, as well as children, can suffer from oral ulcers and typically, these are painful. The sores may appear on the inside of the cheeks or lips and can last for two days to a week or more.

Based on the cause of the ulcer, mouth ulcers can be classified as follows:

• Traumatic ulcers
  These occur due to an injury. Based on the cause of the injury, these can be further classified as: 
  • Mechanical ulcers
    Ulcers that develop due to injury, dentures, accident, lip bite, blow to the lips or face.
  • Chemical ulcer
    Ulcers caused due to chemicals like aspirin, silver nitrate, hydrogen peroxide, and others.
  • Thermal ulcer
    Sores that occur due to sudden exposure to excessive heat from hot foods or drinks, a hot object that touches the lips accidentally, like a hot dental instrument, and others.
  • Radiation ulcers
    These occur as a side effect of radiation that is used for the treatment of cancer.
  • Factitious ulcers
    These are ulcers that occur due to stress and emotional problems.
• Ulcers due to infections 
  Such ulcers develop after or during a viral infection, measles, common cold, herpes, flu, and other such diseases.
• Ulcers due to immune system conditions
  Chronic granulomatous disease, Reiter's syndrome (a condition characterised by mouth ulcers along with swelling or inflammation of the joints or arthritis, conjunctivitis, and swelling or inflammation of the urethra or urethritis), drug reactions, Behcet's syndrome (a condition in which the blood vessels of the body get inflamed or swollen) are some of the conditions that are associated with the development of oral ulcers. 
• Ulcers of unknown cause or Idiopathic ulcers
  These ulcers do not have a clear underlying cause and hence are known as idiopathic ulcers. Since these are the ones that recur every once in a while, they are also known as recurrent aphthous ulcers. They are of the following types:
  • Minor ulcers 
    Minor ulcers range from about 2 mm up to 8 mm in size. They may take 1-2 weeks to clear up and could cause slight pain.
  • Major ulcers 
    Major ulcers are bigger and appear to be raised. They may seem irregular in shape and can cause pain while eating or even talking. They can take several weeks to heal and may leave behind a scar.
  • Herpetiform ulcers 
    These sores only resemble the herpes ulcers in shape but are not contagious and heal very quickly.

Mouth ulcers can appear on the inside of the cheeks, lips or even on the tongue. It is possible that an individual may have more than one mouth ulcer at a time. They usually appear as a swelling with redness surrounding them. The centre of the ulcer may seem yellowish or grey.

Most common symptoms of mouth ulcers include:

• Tender red erosions inside the mouth.
• Pain while talking and eating.
• Burning sensation.
• Irritation.
• Excessive saliva secretion or drooling.
• Temporary relief on taking cold food or drinks.
• Irritability (in case of children). 

Mouth ulcers usually heal within a few days. However, it is essential to see a doctor if one notices the following:

• The appearance of a sore that is not causing any pain.
• Spread of ulcers to new areas.
• Sores lasting for more than 2-3 weeks.
• Ulcers that are growing bigger.
• Sores accompanied with fever.
• Ulcers accompanied with bleeding, skin rash, or difficulty in swallowing.

When to see a doctor?

Mouth ulcers generally subside on its own within 3-4 days. However, If the mouth ulcer persists for more than 7 days you are advised to consult a dentist or a physician to ascertain the cause and type of mouth ulcer and also to get relief from pain caused due to the lesion. You are advised not to take any medication yourself, as some medicines do have certain harmful side effects which may aggravate your condition. 

Causes

Mouth ulcers can have several reasons, such as:

• Injury
  Most common cause of a single mouth ulcer is an injury. The layer of the sensitive tissue could be damaged by:
  • Accidental biting of the cheek.
  • Poorly fitted dentures.
  • Eating food which is hard to chew.
• Medical conditions
  Presence of certain medical conditions can also cause mouth ulcers, such as measles, diabetes, chicken pox, herpes, canker sores, and others.
• Nutritional deficiency
  The deficiency of vitamin B12 and iron also gives rise to mouth ulcers. Coeliac disease is a condition of the small intestines producing an adverse reaction to gluten that causes nutritional deficiencies resulting in mouth ulcers.
• Other causes
  Other common causes of mouth ulcers include:
  • Poor oral hygiene.
  • Burns from eating hot food.
  • Oral thrush (fungal infection).
  • Reaction to certain strong medications like methotrexate, beta-blockers, chemotherapy, and others.
  • Constant rubbing or friction against a sharp tooth.
  • Hormonal changes.
  • When a person is trying to quit smoking initially, mouth ulcers may occur.
  • Mouth ulcer could be the first symptom of oral cancer. The sores caused due to oral cancer stay for a long time and can persist without causing any pain. The risk of developing oral cancer increases significantly if one smokes, chews tobacco, uses certain tooth powders (“gul manjan”) and consumes alcohol in excessive quantities.

Risk factors

There are certain factors which predispose a person to develop mouth ulcers. These include:

• Stress.
• Hormonal changes in women (during menstruation or menopause).
• Excessive consumption of spicy food.
• Excessive smoking.
• Presence of other oral and systemic diseases.
• Dehydration.

The risk of developing mouth ulcers can be prevented by taking the following steps:

• Avoid having food which is too hot or spicy. Eating spicy food can irritate the inner lining of the mouth.
• Avoid chewing gum for a prolonged duration of time as it will also increase the risk of biting the cheek accidentally and causing an ulcer.
• Find ways to manage stress and anxiety. Stress is a known cause of mouth ulcers. 
• Maintaining proper oral hygiene is imperative. It involves brushing the teeth twice a day along with cleaning the tongue and flossing to get rid of the germs in the mouth. If you get mouth ulcers frequently, then avoid using harsh kinds of toothpaste and mouthwashes as they might irritate the inner lining of the mouth.
• Getting regular dental checkups can lower the risk of developing ulcers.
• Continued intake of alcohol, caffeine and constant smoking are important risk factors for developing mouth ulcers. One should limit or discontinue these things to prevent ulcers. 

The most common way of diagnosing mouth ulcers is a physical examination.

• A thorough oral and general physical examination by the doctor will help to identify the cause of a mouth ulcer in a vast majority of the cases. The doctor will also inquire about your medical history and everyday food habits. 
• Along with a complete physical or oral examination, specific blood tests can be done to rule out oral cancer as the underlying cause. The complete blood count test can be used to assess the overall health and to diagnose any infections or cancers like leukaemia.
• Blood tests to detect deficiency of iron and vitamin B12 tests may be done.
• A biopsy can also be done to rule out oral cancer, wherein a small part of the skin tissue will be used for medical analysis under a microscope. 

Mouth ulcers may or may not require medical intervention. They can usually be healed with the help of self-care and some minor home remedies. However, the doctor may also prescribe medication for faster relief. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) may be given to reduce the pain.
• Antimicrobial mouthwashes and pain-numbing ointments help to reduce inflammation (swelling) and pain. 
• Once the underlying cause of the ulcer is determined, a separate course of treatment may be followed specific to the disease. Oral antimicrobials for specific infections like antibiotics or antivirals.
• Vitamin B12 or B complex supplements for a deficiency of the same.
• Analgesic (pain-numbing) and/or anti-inflammatory local ointments for application on the ulcer to relieve pain and inflammation.
• Appropriate therapy for oral cancer based on its stage, which includes chemotherapy, radiation therapy or radiotherapy, or surgery.

Lifestyle management

There are a few steps which can be taken to deal with mouth ulcers effectively.

What to do?

• Use a soft-bristled, high-quality toothbrush while cleaning your teeth. Brush twice a day.
• Eat foods that are rich in antioxidants like vitamins A, C and E. e.g, citrus fruits, papaya, mangoes, carrots, lemon, guava, bell peppers, almonds, amla, among others.
• Eat soft foods that are easy to chew.
• Get regular dental checkups.
• Drink more water.

What not to do?

• Eating spicy or acidic food.
• Drinking soda.
• Using strong mouthwashes or toothpaste.
• Squeezing the ulcer to pop it.
• Touching the ulcer constantly.
• Drinking alcohol or smoking.
• Drinking very hot beverages.
• Eating a lot of chocolates and peanuts, and drinking coffee several times a day.

Prognosis

The prognosis of mouth ulcers is usually good. Mouth sores are rarely life-threatening or resulting in a complication. However, they can be uncomfortable and cause pain. Hence, preventing them from occurring in the first place is recommended and certainly possible.

Complications

Mouth ulcers are not life-threatening and complications are rare. However, constant touching and damage to the affected area can lead to bleeding and cause further inflammation. In case it has been caused due to a bacterial infection, the ulcer may spread and make one more uncomfortable. If the ulcer is caused due to a deficiency or underlying disease like cancer, then one may notice it recurring or even growing in size. 

Home remedies can prove to be very helpful to hasten the healing of mouth ulcers. Here is a list of home remedies, which can provide relief from mouth ulcers:

1. Baking soda to get rid of Mouth ulcers
2. Garlic for Mouth ulcers
3. Basil leaves for Mouth ulcers
4. Coconut oil is beneficial in Mouth ulcers
5. Ice to heal Mouth ulcers
6. Apple cider vinegar to treat Mouth ulcers at home
7. Honey for Mouth ulcers
8. Turmeric to get rid of Mouth ulcers