Mouth Ulcers: Causes, Types, Diagnoses, Treatment and Prevention

 Mouth ulcers, also known as canker sores or aphthous ulcers or benign oral ulcers, or recurrent aphthous stomatitis, are common and painful lesions of the oral cavity. A lesion is an abnormal area of tissue inside or outside your body that may get bigger or change appearance, and may or may not be cancerous. 

Mouth ulcers generally develop inside your mouth or at the base of your mouth and are painful. They are mostly seen in women and adolescents (individuals between ages 10 and 24 years).

Mouth ulcers usually go away within one to two weeks. If you have a mouth ulcer that is extremely painful, you should seek advice from your ENT specialist.

Causes of Mouth Ulcers

Although mouth ulcers have been known for a long time, the exact cause of a simple aphthous ulcer has never been determined. However, certain triggers and factors that can cause mouth ulcers include:

1. Stomach disorder/digestion problems. Crohn's disease is a chronic inflammatory disease of the digestive tract. Crohn's disease can lead to redness, swelling, or sores anywhere in your digestive system, including your mouth. 

2. Vitamin deficiency. A lack of essential vitamins, especially iron, folic acid, zinc, and vitamin B 12 can cause an ulcer. 

3. Stress. Too much stress can cause problems with your mouth, teeth, and gums. Stress likely raises your chances of getting them.

4. Auto-immune disorder. Although there is no strong evidence to prove this as a cause; theories suggest that your body's immune system tries to destroy its own cells thus creating these mouth ulcers. This could be aided by genetic, emotional, nutritional, or hormonal factors.

5. Other factors. A number of other factors that can cause mouth ulcers include:

• Acidic foods. Sensitivity to acidic foods like strawberries, citrus, and pineapples, and other trigger foods like chocolate and coffee.

• Oral thrush. This is a yeast infection that develops in your mouth. It causes white or yellowish bumps to form on the inner cheeks and tongue and increases your risk of mouth ulcers.

• Diabetes mellitus. It is a condition in which there is too much sugar (glucose) present in your blood. Diabetes is associated with an increased risk for thrush. Additionally, people with diabetes are likely to have a dry mouth, which has been associated with an increased risk for mouth ulcers.

• Dental braces. These are used to align and straighten your teeth. In the early weeks of wearing dental braces, you will notice mouth sores. This happens because your lips and cheeks are not yet used to rubbing against your braces. 

Types of Mouth Ulcers

Depending upon the size and causation of the ulcer, these are divided into: 

1. Minor aphthous ulcers. They are small, about 2-8 mm in size. Minor aphthous ulcers account for 85% of cases. They occur on the floor of your mouth, lateral and ventral tongue. These are usually not serious and heal without scarring in 7-10 days.

2. Major aphthous ulcers. These ulcers are larger, more than 10 mm in size. They involve deeper ulceration and are thus, very painful. Major aphthous ulcers usually appear on the anterior (inside) pillar of your tonsil (two oval-shaped pads of tissue on either side at the back of the throat). They may also be more likely to scar with healing.

3. Herpetiform ulcers. Herpetiform ulcers are small (1-2 mm in size ), multiple ulcers (5-100 in number) present on the lateral margins and ventral surface of the tongue and also can occur on the floor of the mouth. They are painful and can cause difficulty in eating and speaking. 

Contrary to the name “herpetiform ulcers”, these ulcers are not caused by HSV (herpes simplex virus) but constitute a part of a recurrent disease called aphthous stomatitis (a disease in which ulcers are present on the oral mucosa). They are rare and can heal within 1 to 2 weeks. 

Symptoms of Mouth Ulcers

• Redness and pain, especially when eating and drinking

• Frequent outbreaks of mouth sores

• Rashes

• Joint pain

• Fever

• Diarrhea (a condition characterized by loose, watery stools or a frequent need to have a bowel movement)

Diagnosis of Mouth Ulcers

Mouth ulcers are usually easy to diagnose, through a visual examination. They're usually white or yellow and surrounded by red, inflamed soft tissues. If you’re having frequent mouth ulcers, then your doctor might perform a biopsy of the area to test for the presence of cancer or other health issues.

Treatment and Management of Mouth Ulcers

Mouth ulcers don’t need treatment in most cases. The treatment is usually symptomatic if you get mouth ulcers often or if they’re extremely painful. There is no role of antibiotics (medications used to treat bacterial infections) in the treatment of this condition. Various treatment options include:

• Pain-relieving gels and medications to provide instant relief from pain. Consult your doctor before self-medicating. 

• Warm salt water gargles will help prevent the growth of bacteria in your mouth and decrease the bacteria on your gums, relieving pain and sore ulcers.

• Mouth rinse that contains a steroid to reduce pain and swelling.

• Nutritional supplements to treat deficiencies of iron, folic acid, zinc, and vitamin B 12.

Mouth ulcers can be prevented with certain steps such as:

• Avoiding very hot foods and drinks. Quite often patients confuse oral ulcers with pharyngitis (pain or irritation in your throat) and try to consume warm or hot things, whereas the exact opposite is true- cold food items will be more soothing. 

• Avoiding acidic foods. Choose whole grains and alkaline (non-acidic) fruits and vegetables like beans, lentils, soybeans, tofu, herbal teas, potatoes, unsweetened yogurt, and milk.

• Chewing food slowly. When you chew your food slowly and consciously, you can avoid accidental biting of your lips or tongue that can help prevent mouth ulcers.

• Maintaining good oral hygiene and a sound digestive system is an easy way to stay away from ulcers in the mouth. Brush your teeth at least twice a day with an appropriate toothbrush and toothpaste. Floss regularly for healthy gums.

If your mouth ulcers are recurrent or if the symptoms do not go away for more than 10 days, consult your doctor immediately.