Why you get mouth ulcers
From time to time many of us will get painful ulcers inside our mouths. Although these aren’t usually dangerous or lifethreatening, they can be annoying and often worrying enough to prompt a visit to the doctor.
So why do we get them, and what, if anything, do we need to do about them?
Mouth ulcers are basically painful sores that can occur anywhere inside the mouth.
Although there are certain types of mouth ulcers that can be potentially more serious, and indeed some that can indicate the possible presence of other underlying health issues, the majority are called aphthous ulcers and aren’t worrying at all.
Aphthous ulcers develop from around 10 years of age, and are most common in the under-40s. Women are affected more often than men. They tend to recur, so once you have had one you may well get more over the following years, until eventually they abate. They are not the same as cold sores, and are not related to any sort of virus or bacterial infection.
They usually first appear as a round or ovalshaped, raised yellow patch inside the mouth, surrounded by a red ‘‘halo’’.
The surface of this then breaks down, leaving a typical ulcer, or shallow indentation in the tissue.
The ulcerated area can be covered by a thin greyish, yellow or white membrane. They can be painful, especially when eating spicy or acidic foods, but aren’t always so.
Over the following 10-14 days, most ulcers will heal on their own, without leaving any scar behind.
Aphthous ulcers can vary in size – most will be under 1cm in diameter but occasionally they can be much larger, or multiple ulcers can occur at the same time, leading to a lot more pain and distress.
We don’t really know why some people get this type of ulcer, and others don’t, but it is thought to be due to something related to our immune system.
Genes also play a role as aphthous ulcers tend to run in families. Sometimes they are triggered or exacerbated by other factors, including those listed below, but this isn’t always the case and they often occur totally ‘‘out of the blue’.
Factors that can trigger the development of aphthous ulcers:
❚ Trauma, for example injuring the inside surface of your mouth while brushing your teeth, or biting on something; ill-fitting dentures can also lead to ulcers.
❚ Nutritional deficiencies – if you lack iron, B12 or folic acid you are more likely to get ulcers.
❚ Hormones – for women, ulcers are more likely to occur around the time of their period.
❚ Stress.
❚ Certain medications, including antiinflammatories (such as ibuprofen), oral nicotine replacement therapy, and alendronate (a drug used to treat osteoporosis).
❚ Recreational drugs, especially cocaine.
Nearly all aphthous ulcers will go away on their own, so treatment isn’t essential, but it can help lessen the symptoms so if you get an ulcer you may want to consider the following:
❚ Avoid spicy or acidic foods and hot drinks as these may irritate the ulcer.
❚ Ensure you get regular dental checks, especially if you have dentures.
❚ Be careful to use a soft toothbrush and ensure your brushing technique isn’t overvigorous.
❚ Try doing regular mouth washes to ease the pain and help the ulcer heal faster. You can do this simply by dissolving some salt in a glass of water and swishing it round your mouth, or buy a mouthwash containing a substance know as chlorhexidine which will help to prevent any secondary infection in the ulcer.
❚ Protective pastes – these can be bought over the counter, and provide a ‘‘cover’’ over the ulcer, preventing food and drink from aggravating it and enabling it to heal. One brand used here is Orabase, but you can ask your pharmacist for any effective alternative.
❚ Pain-relieving sprays and gels – these can be effective for some people, but are short-lived and can be quite expensive. They include things like Bonjela gel and Difflam spray. They simply reduce the pain from the ulcer, but won’t affect healing time.
If you have tried all of the above and your mouth ulcer persists beyond two weeks, or your
Mouth ulcers tend to recur, so once you have had one you may well get more over the following years, until eventually they abate.
symptoms get worse over that time rather than better, you should book an appointment with your doctor.
They will be able to check out your mouth thoroughly, arrange any necessary tests, and make sure this is actually an aphthous ulcer and nothing more serious, as well as prescribing you something stronger if needed to help settle your symptoms down.
Very rarely, mouth cancers and unusual types of infection can present as ulcers in the mouth, so do get proper advice if yours isn’t healing as expected, or you have other unusual symptoms.