Mouth Problems

Mouth Ulcers

What are the symptoms of this condition?

Mouth ulcers present with a tingling or burning sensation on the tongue, gum or inner cheek. A small whitish spot may be seen (usually one or two millimetres in diameter although they may be larger), possibly surrounded by a red halo. This may subsequently develop into an open, white or yellow ulcer. Pain and sensitivity in the ulcer can be very noticeable, and there may be more than one ulcer present at one time. In very bad cases, the pain may cause difficulties with eating or drinking.

Although mouth ulcers are common in most age groups and both sexes, they are not usually seen in those under ten.

What is the cause of the condition?

Generally, the ulcer is the result of damage to the outer surface of the skin covering the gums or tongue. The sensitive deeper layers are exposed causing the pain and sensitivity.

There are many possible causes of mouth ulcers, although in many instances no definite cause can be found. They can result from the mechanical rubbing of an ill-fitting denture, or a rough filling on the cheek or tongue, and can be related to dietary factors (sensitivities to certain foods), stress at work or at home, vitamin deficiencies (the B group vitamins and also lack of zinc and iron) or hormonal changes associated with menstruation.

Heredity appears to be a potential factor, suggesting that some people will be more prone to mouth ulcers than others.

Certain medical conditions can cause ulcers to appear in the mouth, as can some infections. In these cases the mouth ulcer may be the first sign of a wider health problem.

It is also possible that a sensitivity to a chemical found in some toothpastes (sodium lauryl sulphate) may trigger attacks of mouth ulcers, but this has not been proven.

What complications might occur?

Complications are rare as mouth ulcers will in most cases clear up by themselves within 1-2 weeks. It is possible that an ulcer may become infected by bacteria – this will prolong the duration of the ulcer and intensify the discomfort.

What can I do to treat myself?

There may be a particular causative factor that can be eliminated. Attention must be paid to general oral hygiene. Badly fitting or loose dentures, rough fillings, or decaying teeth can all cause ulcers; until the causes are removed or treated, there is a good chance that the ulcers will recur. In this instance, your dentist will be the best point of contact for treatment and advice.

Chlorhexidine mouthwashes may be of benefit for some people in reducing the number and severity of the attacks.

Take care when brushing the teeth, as over-vigorous brushing can damage the gums and tongue. Using a brush that is too stiff may also cause problems.

There are some soothing gels available which can be applied to the ulcer to ease the pain and discomfort and speed up the healing process. These will be described in greater detail in the next section.

If attacks of ulceration seem to follow on from eating certain foods, identify and avoid them if possible. Coarse or crunchy foods may either cause ulcers, by tearing at the surfaces of the gums or tongue, or may aggravate existing ones. Very acidic, salty or spicy foods are also likely to increase the pain and discomfort of a mouth ulcer.

If the ulcers are persistent, and your doctor or dentist can find no underlying cause, then it may be worth keeping an ‘ulcer diary’ for two to three months. Note down in the diary the dates that ulcers occur and also what factors may have contributed or caused it. These could be diet related (particular meals or types of food), for example, or linked into lifestyle (stressful incidents arising at work) or physiological (menstruation). By carefully logging the incidence of the ulcers, and other factors that may be implicated, some trends may be noted which will help the doctor to provide you with the right type of treatment.

What treatments are available for me to purchase?

Treatments for mouth ulcers may treat the pain and discomfort caused, or remove the inflammation.

Pain Killers
These contain either a local anaesthetic (as in Anbesol, Rinstead Adult Gel and Medijel) that numbs the mouth ulcer, or a pain-killing ingredient (as in Bonjela). These products are in either gel or liquid form and should be applied directly to the mouth ulcer with a clean finger. Some of these products also contain an antibacterial that helps to prevent secondary bacterial infection of the ulcer.

Adcortyl in Orabase Paste contains triamcinolone, a steroid-based anti-inflammatory to reduce the inflammation and soreness of the ulcer, in a special dental paste that is not easily washed away by the contents of the mouth; it should be applied to the ulcer with a clean finger up to four times a day.

Corlan pellets contain hydrocortisone, another mild steroid ingredient, that should be placed near the ulcer in the mouth and allowed to dissolve slowly, up to four times a day.