Table of Contents
Odds are likely that you have experienced at least one mouth ulcer in your lifetime. Mouth ulcers – commonly called canker sores – are round, painful sores that form on the mucous membrane inside of the mouth, usually on the inside of the cheeks and lips but sometimes on the tongue or gums as well. They can hurt an awful lot, making eating and drinking unpleasant and painful.
Mouth ulcers are not contagious and cannot be spread to other people, usually fading away on their own within a week or two. However, sometimes they can be especially common, large, painful or reoccurring, in which case there are medicines available and an appointment should be made with a personal health care professional.
The most common kind of mouth ulcers are called aphthous mouth ulcers. The condition of continuous reoccurring aphthous mouth ulcers is called aphthous stomatitis, stomatitis just meaning oral inflammation. However, not every mouth ulcer is related to aphthous stomatitis, as simple trauma to mouth tissue can also create a sore. Aphthous ulcers often first appear somewhere between the ages of 10 and 40 years. For reasons unknown, they become less common as we grow older.
Multiple mouth ulcers can form in the mouth at one time. They can also grow worse and spread if left untreated or irritated further by certain food or beverage. It’s important to see a doctor if you have mouth ulcers that reoccur frequently or are very large and inflamed, as there could be underlying causes that need to be addressed.
Causes of Mouth Ulcers
Often the cause of a single, one time mouth ulcer is tissue trauma. Traumatic ulceration occurs when there is damage to the tissue in the oral cavity, for instance from accidentally biting the inside of the cheek. The tissue of the mucous membrane inside the mouth is thinner than the rest of our skin, making it susceptible to damage from hot and cold temperatures, chemicals, and irradiation.
Orthodontics may damage mouth tissue as well as other dental work. Brushing teeth too hard can also lead to such minor injury. Some people have found that sodium lauryl sulfate, an ingredient included in many toothpastes and mouth rinses, irritates the tissue inside their mouth, which can lead to traumatic ulceration. Finding a toothpaste that’s free of SLS can often times fix many issues with mouth ulcers. Some people also find that food and drink such as chocolate and coffee may irritate the tissue of the mucous membrane. Other irritants, such as salty or spicy food, can also be the cause.
The other reason for the formation of mouth ulcers is aphthous stomatitis, which occurs due to many different factors that can be difficult to identify and are not always definite. The term just refers to the condition of reoccurring mouth ulcers. Discussing the mouth ulcers with a doctor can help determine the factors behind what may be causing your aphthous stomatitis, as there is yet no determined definite cause for the condition.
Changes in Diet and Consumption
One of the factors often attributed to aphthous stomatitis is the lack of certain vitamins, such as B-12, iron, folic acid and zinc. Hormonal changes (related to menstruation or menopause), stress, and lack of sleep may also be behind reoccurring mouth ulcers. Quitting smoking has been known to temporarily cause mouth ulcers.
Mouth ulcers can be a symptom of other underlying conditions. Some examples of conditions that may cause reoccurring ulcers include celiac disease, diabetes mellitus, Bechet’s disease, Crohn’s disease, inflammatory bowel disease, reactive arthritis, HIV/AIDs, and any condition that strongly compromises the immune system, such as lupus.
Any type of radiation therapy can also lead to recurrent mouth ulcers. Radiation-induced stomatitis can develop after radiation therapy, as well as xerostamia – more commonly called dry mouth. Extreme dry mouth from such therapy can cause mouth tissue to be more susceptible to tissue damage from friction. If you are undergoing any kind of radiation therapy, this is something you can discuss with your doctor.
When informing your doctor about mouth ulcers you are experiencing, be sure to mention all other symptoms, such as possible joint pains and other inflammation elsewhere on your body. All information can assist the doctor to determine the underlying cause of the ulcers. In some instances, a blood test can help determine certain factors that might be causing the sores.
How Mouth Ulcers Form
Mouth ulcers may occur individually, one ulcer at a time, or you may experience the appearance of multiple sores at the same time in multiple locations in your mouth. Once the damaged tissue appears, it may be sustained by inflammation and a secondary infection. Since they are prone to infection, it’s important to take anti-bacterial measures such as rinsing with mouth wash or salt water to kill bacteria in the mouth that may cause more serious infection.
A mouth ulcers forms when the tissue of the mucous membrane in the oral cavity is eroded from damage. In the majority of instances, particularly if the cause is traumatic local injury, the tissue will heal on its own without requiring any medical assistance.
Kinds of Mouth Ulcers
There are three different kinds of mouth ulcers that can form. Two of the kinds are forms of aphthous ulcers that affect around 20 per cent of the population. These kinds do not form from tissue injury, such as biting the cheek, but from a mix of many unknown factors addressed earlier in the causes section.
The first two kinds of mouth ulcers are minor and major aphthous ulcers. Minor aphthous ulcers are small, oval canker sores that are less than 10 millimeters across. They are the most common type of ulcer experienced. They can appear singly or multiple may appear in a cluster at the same time. They typically only exist for about a week or less before they disappear without leaving a scar. Due to their small size, they are not usually as painful as more major ulcers, though they will still hurt and sting.
Major aphthous ulcers make up 1 out of every 10 instances of aphthous ulcers. They are larger than minor ulcers at 10 millimeters or more across and are also deeper into the mucous membrane. Due to their size, they can take up to six weeks to heal completely and can lead to a scar on the tissue inside the mouth. It’s possible for multiple major canker sores to appear at one time. They are very painful and can make eating and drinking difficult and uncomfortable.
The third type of mouth ulcer that can form is not aphthous. Herpetiform ulcers are very small, only about 1-2 millimeters in size, and form in clusters that can consist of several to up to 100 small ulcers. It is possible for multiple ulcers to merge together. Each individual sore can last from just one week up to two months. Do not let the name mislead you – they are not related to the herpes virus.
Some people say they can feel a burning sensation in their mouth before a canker sore appears, but most of the time they can appear suddenly or overnight without any sign or warning. If you accidentally bite the inside of your cheek or scrape your gums, you run the risk of developing an ulcer in that location.
When mouth ulcers first form, the damaged outer tissue on the mucous membrane (called the epithelium) is eroded and the underlying lamina propia, the red inner layer of the mucous membrane, shows through. This process is called ulceration. After ulceration occurs, the exposed lamina propia is covered in a fibrinous exudate – what we might think of as a scab – which is yellow-grey-white in color. Since the epithelium lining has been eroded, the canker sore often is indented into the mouth, like a crater. Often the lesion is surrounded by a red lining, which is inflammation from the bordering epithelium. Swelling and inflammation may surround the ulcer after it forms. In extreme cases, the ulcer may have a rough and raised edge.
Symptoms of Mouth Ulcers
Mouth ulcers are visible and can be seen by pulling back the lips and looking into the mouth. They are round or oval in shape and can appear white, grey, yellow or red in color. The area surrounding the sore may be red and swollen as well. If multiple ulcers have formed together, they may be irregular in shape.
Odds are that you will feel the canker sore before you see it. The area will feel tender and painful, causing sharp, shooting pains when objects come in contact with the ulcer, such as your teeth, your tongue, a toothbrush, food or liquid. Salty, spicy and sour foods will especially irritate the lesion. All of this can cause a loss of appetite.
How to Prevent Mouth Ulcers
If you are prone to mouth ulcers, there are things that you can do to prevent them before they appear. The simplest step is to avoid foods that can possibly irritate the mucous membrane inside your mouth. This includes foods that are acidic, like certain fruits (oranges, strawberries, limes), salty foods like nuts and potato chips, and spicy foods. Eating a healthy diet that is balanced and full of essential vitamins is important as well. Taking a daily multi-vitamin can help too.
General Oral Care
Make sure you brush your teeth twice a day, but do not brush too hard or use a toothbrush with very hard bristles. Slipping and hitting the sides of your mouth or scraping your gums with hard bristles can lead to the formation of an ulcer if you damage the tissue. If you suspect the sodium lauryl sulfate in your toothpastes and mouth rinses might be irritating the inside of your mouth, try purchasing products that do not contain it in the ingredients. Many toothpastes are sold that do not contain sodium lauryl sulfate.
Chew carefully when you’re eating, making sure not to accidentally bite the inside of your cheek or scrape any foods against the tissue. Try to reduce your stress level and receive enough sleep every night – in general, this helps with any health condition. If you have any chronic illness that has ulcers as a symptom, such as diabetes and celiac disease, be sure to manage your condition and see your doctor regularly regarding treatment.
If your orthodontics are irritating the inside of your mouth, your dentist can provide you with wax that covers the edges of your orthodontic device.
In most instances, minor mouth ulcers do not require treatment of any kind. It’s normal for one to occur every now and then. However, if you have a major ulcer or reoccurring ulcers that are painful, there are many kinds of treatments that will help ease the pain and protect the lesion until it heals completely.
Benzocaine medicines like Orajel Mouth Ulcer Gel are useful when it comes to soothing the pain and protecting the ulcer. They numb the pain and also perform a protectant seal around the sore. If you don’t want to purchase medicine or are sensitive to benzocaine, you could try creating a salt water rinse or placing baking soda mixed with water over the sore. Applying ice to the lesion can ease pain and reduce swelling as well.
If you think you might have a vitamin deficiency and that could be causing your ulcers, try taking daily vitamin supplements such as vitamin B6, vitamin B12, folic acid and zinc. They can be purchased at any pharmacy and many general stores.
If your mouth ulcer(s) does not clear up within a week, you are plagued with reoccurring canker sores, are experiencing severe problems with eating and drinking, or have a high fever and diarrhea when the ulcer forms, call your health care professional’s office and schedule an appointment. The doctor will perform an oral examination and ask you about the duration of the ulcer, the color, the size, the number of ulcers and what the edge looks like. It’s important to tell the doctor about any other symptoms you might be experiencing as well. The doctor may test you for other medical conditions that might be causing the ulcers.