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Mouth ulcers are most common painful mucosal oral conditions affecting 20% of the general population. In terms of age, mouth ulcers are most frequent with teens around 16 to 25 years old. They rarely happen to adults over 55 years of age.
What are mouth ulcers?
Mouth ulcer, also known as apthous ulcers, are painful, clearly defined, round or oval sores that appear in the mouth, often on the inside of the cheeks. They are usually red or yellow. They are different from cold sores, which appear on the outer lips and are due to a virus.
Mouth ulcers cannot be caught from someone else.For example, you cannot get an ulcer from kissing someone or from sharing drinking glasses.
What causes mouth ulcers?
Mouth ulcer is an idiopathic condition (unknown cause) in most patients.
Some of the factors that may trigger recurrent mouth ulcers include:
Stress and anxiety: A stressed, adrenaline fueled lifestyle with school exam periods and staying up all hours which includes lack of sleep and emotional pressure can lead to recurring mouth ulcers. Persistent mouth ulcer is a reaction by your body’s immune system to stress and/or anxiety.
Tissue injury: Such as sharp teeth, excessive tooth brushing or a habit of accidentally biting the inside of your cheek. A mouth injury sustained as a result of playing sports or an accident can also cause mouth ulcers.
Hormonal changes: Women and girls are more prone to have mouth ulcers than men, largely due to hormones.Some women develop mouth ulcers during their menses. This is due to changes in the hormone levels in their body during the menstrual cycle.
Unhealthy diet and certain types of foods: A diet in which not enough essential vitamins are absorbed, e.g. Vitamin B12, or is lacking in folic acid and iron can cause mouth ulcers. An adequate supply of iron, vitamin B12 and folic acid are needed for the healthy maintenance of the lining of the mouth. Certain foods, including citrus or acidic fruits and vegetables (such as lemons, oranges, pineapples, apples, figs, tomatoes and strawberries), chocolate, coffee, peanuts, almonds and wheat flour can trigger a mouth ulcer or make the problem worse.A junk food diet, which includes excessive amounts of fat and sugar might also trigger mouth ulcers.
Medical conditions: In some cases, recurrent mouth ulcers may be caused by an underlying medical condition, such as an impaired immune system and gastrointestinal tract disease, such as Coeliac disease and Crohn’s disease. Any condition that attacks or suppresses the body’s immune system (the body’s natural defense against infection and illness)for example, HIV or lupus, might also cause mouth ulcers.
Medications: Some medications, including common pain killers (e.g. ibuprofen and aspirin), beta-blockers and some chest pain medicines (e.g. Nicorandil) may cause a reaction that leads to mouth ulcers.
Smoking cessation: When you first quit smoking, you may develop more mouth ulcers than normal, but this is temporary. Actually, this is a normal reaction. Your body is dealing with the change in chemicals in your body.The long-term health benefits of not smoking are far greater than the short-term discomfort of mouth ulcers.
Genetics: Mouth ulcers run in some families.If your parents are prone to persistent mouth ulcers then you will have inherited this tendency.
Types of mouth ulcers:
- Minor ulcers are the most common.They are small, round, or oval, and are less than 10 mm in diameterand usually heal naturally, within 10-14 days without leaving a scar. They look pale yellow, but the area around them may look swollen and red. Only one ulcer may develop, but up to five may appear at the same time.
- Major ulcers are deeper and larger than minor ulcers, and usually have a raised or irregular border.They tend to be 1 cm or larger in diameter. Usually only one or two appear at a time.This type of ulcer can take several weeks to heal and can cause scarring.They can be very painful and eating may become difficult.
- Herpetiform ulcer is characterized by recurrent crops of multiple and pinhead-sized sores, about 2-3 mm in diameter. The number of ulcers can range up to 100. These tiny ulcers are often fuse together to form larger, irregular shaped sores, which are very painful.Each ulcer lasts one week to 2 months. Herpetiform ulcers are not related to the herpes virus.
Treating mouth ulcers:
The treatment depends on the cause of the ulcers. Pain from a mouth ulcer generally lessens in a few days and the sores usually heal without treatment in about a week or two.
In the case of minor ulcers, you can treat these using over the counter medications such as ‘Bonjela’ or with a home-made rinse made from a small amount of salt and warm water. Another option is an ice pack which can be applied to the area of the mouth which contains the mouth ulcers.
If sores are large, painful or persistent, your dentist may prescribe a chlorhexidine mouth rinse, a corticosteroid ointment, or painkilling oral rinse, gel or mouth spray.
Although there is no cure for mouth ulcers and they often reoccur, you can take few precautions to reduce further risk by:
- Avoiding foods that irritate your mouth, including acidic, salty or spicy foods
- Reducing your stress levels
- Using a very soft toothbrush
Golden rules if you have mouth ulcers:
Always see your dentist or doctor if you have:
- Sores which refuses to heal for more than three weeks without sign of healing, or is different in any way.
- A high fever with the appearance of the mouth ulcer(s)
- The ulcers keep coming back
Dr. Marini Ismail is a dental officer currently working in Selangor.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References:
- Scully C, Porter S. Oral mucosal disease: Recurrent aphthous stomatitis. Br J Oral Maxillofacial Surg 2008; 198-206
- Cawson RA, Odell EW. Cawson’s Essentials of Oral Pathology and Oral Medicine. 8th ed. Philadelphia: Elseivier; 2008
- http://acofs.weebly.com/uploads/2/3/6/9/23692028/acofs009.pdf
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227248/
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784439/