Oral Ulcers: Causes and Treatment

Dr. Dhanashree A Iyengar, Junior Consultant ENT, SUT Hospital, Pattom

Oral ulcers are small, painful, round to oval sores inside the mouth. They may be white, yellow or grey in the centre and have a red border. They are commonly located on the insides of the cheek (buccal mucosa), tongue, lips, gums (gingival) or roof of the mouth (hard and soft palate). They are generally benign and harmless, lasting foe about 1-2 weeks and heal by themselves.

Oral ulcers occur as a result of damage to the oral epithelium and its underlying layer (lamina propria). The damage could be due to trauma, irritation, chemo radiation, infections, certain drugs, inflammatory systemic disorders and many
other causes.

The causes can be broadly classified into:

1. Avoidable
2. Non-avoidable

Avoidable causes

1. Biting the insides of the cheeks.
2. Sharp tooth, braces, rough fillings, ill fitting dentures.
3. Food allergies / intolerance.
4. Cuts or burns while eating / drinking.
5. Stress and anxiety.
6. Trauma by tooth brush.

Non-avoidable causes

1. Genetics / familial predisposition.
2. Nutrient deficiencies – Iron, Zinc, Follic acid, Vitamin B & D.
3. Medications – Eg: NSAIDs, Beta-Blockers.
4. Hormonal changes, Eg: Pregnancy.
5. Stopping smoking – tendency to develop mouth ulcers in the initial few days after quitting smoking.

A few conditions cause multiple mouth ulcers:

1. Hand, foot and mouth disease.
2. Oral Lichen Planus.
3. Crohn’s disease / Celiac disease.
4. Immunodeficiency – HIV, Lupus.

You need to consult a doctor if:

1. The ulcer lasts for more than 3 weeks.
2. Bleeds / is more painful / red – different than ulcers you have had before.
3. Ulcers anywhere else on your body – skin, genitals.
4. Associated with painful, red, swollen joints.
5. Keeps recurring.
6. Interferes significantly with food intake.
7. Associated with fever, tiredness, weight loss.
8. Associated with history of heavy use of alcohol / tobacco.

Few do’s and don’ts to consider:

Do’s

• Maintain oral hygiene – use soft bristled tooth brush, floss regularly.
• Drink cool drinks through a straw.
• Eat softer foods.
• Get regular dental check-ups. Seek immediate care in case of sharp edges of orthodontic appliances (braces) or ill fitting dentures.
• Eat healthy, balanced diet.
• Minimize stress, get adequate sleep.
• Regular check-ups and appropriate treatment of underlying comorbidities (Diabetes, Hypertension, dysliipidemia, liver and renal conditions, etc).

Don’ts

• Avoid very salty / spicy / acidic foods.
• Avoid rough / crunchy food.
• Avoid excess intake of very hot / acidic drinks / tea / coffee / excess alcohol.

Mouth ulcer care at home

• Allow ice chips to melt over the ulcers.
• Rinse your mouth with salt water or antiseptic mouth rinses.
• Tonsil ulcer gels containing antiseptic and anti-inflammatory agents.