Mouth Ulcers (Open Sores in the Mouth)

What are mouth ulcers?

Mouth ulcers are open sores that occur inside the oral cavity (mouth). The two most common types of mouth ulcers include sores following localized trauma to the oral cavity and aphthous ulcers. The ulcers may be solitary  or in groups known as “crops”. Although it is often not a serious problem, recurrent ulcers or ulcers that do not heal easily may be a sign of some underlying disease.

Usually mouth ulcers usually heal over time but can recur several times on the same site or on different parts of the oral cavity. It should not be confused with cold sores. Sometimes longstanding mouth ulcers are resistant to any treatment and may be oral cancer. Mouth ulcers may be associated with some medical conditions like anemia, chickenpox and vitamin deficiency.

Symptoms of Mouth Ulcers

Most mouth ulcers are round to oval in shape with a white or yellow center and a red margin. The ulcers are typically located on the tongue or underneath it, on the inner side of the cheek or lips, on the gum or base of the soft palate (roof of the mouth). The ulcers may be painless or painful especially with consumption of spicy food.

Recurrent aphthous ulcers are mainly of three different types – minor, major and herpetiform. Minor and major canker sores usually occur singly whereas herpetiform ulcers occur in clusters. Both the minor and herpetiform ulcers are shallow, smaller in size and usually heal without any scarring whereas major ulcers are deeper, larger with irregular border and usually heal with scarring.

Causes and Risk Factors

There are number of causes of mouth ulcers, however, the two most common causes are injury to the oral cavity and recurrent aphthous ulcers.
The mucous membrane lining the oral cavity is much thinner in comparison to the skin an is therefore easily damaged by mechanical, chemical, thermal, electrical or radiation injury. The main causative factors include :

  • Sharp edges of the tooth and dental fillings.
  • Ill-fitting artificial dentures and braces.
  • Accidental biting.
  • Unintentional burning of the oral mucous membrane following intake of hot drinks or food.
  • Accidental injury during dental treatment.
  • Sucking on drugs like aspirin that are meant to be swallowed.

The exact cause of aphthous ulcers is not always identifiable but the most commonly affecting factors include an allergic response to bacteria present in the mouth, a diet lacking in vitamin B12, zinc or folic acid, emotional stress and hormonal changes during menstruation.

Mouth ulcers are also a feature of certain systemic diseases like celiac disease, inflammatory bowel disease like Crohn’s disease and ulcerative colitis, Bechet’s disease, HIV/AIDS, anemia and chickenpox. The intake of certain drugs like anti-cancer drugs and antithyroid drugs may also lead to mouth ulceration. Rarely oral cancer may present as non-healing large ulcers with a tendency to bleed.

Women are at a higher risk of developing mouth ulcers. Other risk factors include a family history, intake of alcohol, betel nuts and tobacco chewing.

Treatment of Mouth Ulcers

The treatment of mouth ulcers depend on the underlying cause where identifiable. Most of the mouth ulcers heal without any treatment but drugs are prescribed for large painful ulcers. Commonly prescribed drugs include :

  • Mouth rinses and topical pastes to relieve pain and inflammation of the ulcers.
  • Nutritional supplements containing vitamins, iron, zinc and folic acid.
  • Oral corticosteroids in severe cases.
  • Cauterization of the ulcer may be done mechanically or chemically to facilitate healing.

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