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
While the exact cause of mouth ulcers is still not yet known and may vary from person-to-person, the most common cause of mouth ulcers world over is accidentally biting your inner cheek. This causes injury and trauma to the mucous membrane. Some common causes or other factors that may aggravate mouth ulcers are as follows:
- Citrus fruits and other foods high in acidity or spice (Consuming hot spicy foods or hot soups may burn the delicate mucous membrane leading to ulcers)
- A deficient filling of tooth
- Poor-fitting dentures, braces including other apparatus that may rub against the gums and mouth
- While brushing, the toothbrush may slip accidentally causing a traumatic ulcer
- Stress or anxiety
- Medications, such as pain killers and beta-blockers
- Hormonal changes during menopause, puberty and pregnancy
- A common fungal infection called oral thrush can also lead to ulcers in the mouth.
- Genetic factors
A skin condition called pemphigus (common in India in age group forty to sixty years characterized by a bright red mouth ulcer which can get infected later by bacteria) and a fungal infection called histoplasmosis may also be the likely cause
Some individuals may develop ulcers due to a nutritional deficiency. Conditions like Crohn’s disease or Celiac, or iron or vitamin B12 deficiency, may also trigger ulcers to form.
Cancers, such as squamous cell cancer may cause ulcers. Tobacco chewing predisposes to oral cancer.
In people with a weakened immune system, for example, people suffering from tuberculosis or AIDS, mouth ulcers are common.
A variety of ulcers, ‘Apthous Ulcers’ occur inside the mouth due to no apparent reason but have been linked to stress and hormones. These ulcers usually respond to anti-inflammatory oral medication.
Symptoms and Signs of Mouth Ulcers
- Pain and sores in the mouth.
- Ulcers may bleed.
- Tenderness of the surrounding areas is also seen.
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.
Antiseptic gels or steroid gels can be applied to promote healing.
A mouthwash may be helpful to keep the mouth clean. Over the counter anti-inflammatory drugs (NSAID’s) should be taken to relieve pain. Paracetamol is another option for pain relief in case there is severe pain.
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.
Mouth ulcers do not have known cure. They typically recur in the mouth throughout an individual’s life.
Although the occurrence of an ulcer is unavoidable, there are few things we can do to reduce the severity of or lessen the number of times we suffer from it. A few prevention methods include:
- Cutting down or totally avoiding foods that can either trigger or worsen the symptoms
- Speaking to a doctor about changing medicines that are known to cause ulcers
- Brushing and flossing teeth twice a day
- Avoiding triggers known to cause mouth ulcer in the past