The mouth is lined by what is called as mucous membrane. A mouth ulcer occurs when there is a break in this mucous membrane lining.
Causes of mouth ulcers
- The most common cause of mouth ulcers world over is accidentally biting your inner cheek. This causes injury and trauma to the mucous membrane.
- A common fungal infection called oral thrush can also lead to ulcers in the mouth.
- A tooth which is improperly placed or a sharp edge of braces or dentures can cause repeated injury to the same area inside the mouth leading to ulcers.
- While brushing, the toothbrush may slip accidentally causing a traumatic ulcer.
- Consuming hot spicy foods or hot soups may burn the delicate mucous membrane leading to ulcers.
- A skin condition called pemphigus (common in India in age group forty to sixty years characterised by a bright red mouth ulcer which can get infected later by bacteria) and a fungal infection called histoplasmosis may be the likely cause.
- Cancers such as squamous cell cancer may cause ulcers. Tobacco chewing predisposes to oral cancer.
- Apthous ulcers are a variety of ulcers that occur inside the mouth due to no apparent reason but have been linked to stress and hormones. These ulcers affect about 20% of the population and usually respond to anti-inflammatory oral medication.
- In people with a weakened immune system for e.g. people suffering from tuberculosis or AIDS, mouth ulcers are common.
Symptoms and signs of mouth ulcers
- Pain and sores in the mouth.
- Ulcers may bleed.
- Tenderness of the surrounding areas is also seen.
A single yellow round ulcer is most likely due to mechanical injury. In contrast, apthous ulcers are small multiple whitish or yellowish crater-like ulcers lasting for five to ten days. Mouth ulcers must be differentiated from ulcers due to cold sores caused by the herpes simplex virus. The latter has small boils filled with a colourless fluid and is accompanied by fever. Also, cold sores of herpes simplex are usually seen outside the mouth on the upper lip.
Diagnosis of mouth ulcers
A general physician or dentist can diagnose the likely cause of the ulcer by history and examination of the mouth. A history of repeated ulcer formation every few months is likely to be apthous ulcers, also known as canker sores. Ulcers occurring in old age and not healing in spite of treatment suggest cancer or a deficient immune system as in AIDS or tuberculosis.
Treatment of mouth ulcers
In general, when there is a mouth ulcer, sour and spicy food must be avoided. Food which is too hot should not be consumed as it will cause a burning sensation. Acidic foods like citrus fruits, pineapples, strawberries and apples should be avoided till the ulcer heals.
Over the counter anti-inflammatory drugs (NSAID’s) should be taken to relieve pain. Paracetamol is another option for pain relief.
Antiseptic gels or steroid gels can be applied to promote healing.
A mouthwash may be helpful to keep the mouth clean.
Oral hygiene is very important. Brush twice daily and floss at night daily.
If the cause is known, specific treatment is given. Anti-fungal drugs are given in case of oral thrush and anti-viral drugs if it is a herpes simplex infection.
A vitamin and mineral supplement can be given to boost immunity. This will help if the patient has a viral illness like AIDS or in case of tuberculosis.
Complication of mouth ulcers
- A tooth abscess may occur if the infection spreads to the teeth.
- Stomatitis is bacterial infection of the mouth.
- Oral cancer, if the ulcer does not heal or due to regular tobacco chewing.
Photograph via sxc.hu
Written by Dr Nisreen Nakhoda, General Physician
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