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Mouth Ulcers Symptoms Causes Treatment Preventions & More

You must have experienced small ulcers in your mouth, usually at the base of your gums. These mouth sores or ulcers are painful and make eating, drinking, and talking difficult.

The mouth ulcers, also called canker sores or aphthous mouth ulcers, are small yet painful. They affect people from all walks of life. People with a family history of canker sores are at high risk of developing mouth ulcers.

Mouth ulcers are not contagious. They usually resolve on their own. Home-based remedies may help speed up their recovery. If a mouth ulcer becomes too large or does not resolve, then medical advice should be sought.

The terms mouth sores and mouth ulcers are often used interchangeably. However, these are different and distinct conditions affecting the mucosa of the mouth.

mouth ulcers

 Mouth sores are more common than mouth ulcers or canker sores. They usually affect everyone at some point in their lives. Mouth sores can appear anywhere in the mouth, lips, gums, cheeks, tongue, floor, or roof.

Mouth sores are usually found in the soft mucosal tissue of the mouth.  Since the lesions affect the mucosal tissue, they can extend and involve the esophagus (the tube connecting the throat to the stomach). The esophagus is lined with the same mucosal lining as that of the mouth.

Mouth sores are a general term that includes canker sores. They are usually mild and resolve within few days to weeks. Rarely, they indicate a serious infection such as herpes simplex, a contagious infection called cold sores. On other occasions, a mouth sore may be the early sign of cancer.

Causative factors of mouth ulcers and mouth sores

What causes mouth ulcers?

Mouth ulcers causes are not definite. However, some triggers can cause mouth ulcers. These include;

  • Minor injuries to the mucosa of the mouth; for example, injuries occurring due to dental work, enthusiastic brushing, accidental bites during chewing or talking, injuries to the face, etc.
  • Chemical injuries due to sodium lauryl sulfate present in some toothpaste and mouth rinses
  • Minor chemical injuries due to acidic food; these usually occur in people with food sensitivities; some examples of acidic foods are strawberries, citrus, and pineapples,
  • Other trigger foods like chocolate and coffee may also incur mouth ulcers in sensitive people.
  • Lack of some essential vitamins and minerals; these include vitamin B-12, vitamin C, zinc, folate, and iron
  • An intrinsic allergic response of the body to mouth flora
  • Mucosal injury or repeated irritation due to dental braces
  • Hormonal changes during menstruation in women
  • Emotional stress and anxiety
  • Lack of sleep
  • Certain bacterial, viral, or fungal infections

Mouth ulcers may also indicate underlying disease states. Such ulcers do not resolve and tend to recur. These mouth ulcers require specific treatment directed at them. Some of the conditions associated with mouth ulcers include;

  • Celiac disease; a state of gluten sensitivity of the body
  • Inflammatory bowel disease (IBD)
  • Diabetes mellitus
  • Behcet’s disease; a condition associated with widespread inflammation in the body
  • Autoimmune reaction; hyper immune system that malfunctions and attacks the healthy mucosa of the mouth
  • HIV/AIDs associated with a weak immune system

What causes mouth sores?

Mouth sores can have an array of causative factors, ranging from minor injuries to serious underlying diseases. The mouth sores cause often overlap the triggering factors for mouth ulcers. These include;

  • An accidental bite on one’s tongue, cheek, or lips
  • Burn injuries to mouth like sipping on hot coffee or tea
  • Repeated injuries or irritation from a sharp object like ill-fitted braces, retainers, or dentures
  • Over-brushing one’s teeth
  • Using a hard toothbrush
  • Chewing tobacco
  • Viral infection like herpes simplex
  • As a side effect of certain medications taken for some other ailment

Some factors predispose you to get mouth sores. These include;

  • Illness or general stress
  • Hormonal changes may happen during menstruation or menopause
  • Deficiency of folate
  • Vitamin B-12 deficiency
  • A side effect of drugs that are used in organ transplant
  • A weakened immune system as in AIDS/HIV infection

Mouth sores are also indicative of certain underlying medical conditions like;

  • Gingivostomatitis
  • Infectious mononucleosis
  • Oral thrush
  • Hand, foot, and mouth disease
  • Radiation or chemotherapy
  • Autoimmune disorders
  • Bleeding disorders
  • Cancer
  • Celiac disease
  • Bacterial, viral, or fungal infection affecting mouth mucosa
  • GIT issues that disturb the gut flora
  • Other intestinal issues, for example, Crohn's disease or irritable bowel syndrome (IBS)

Symptoms of mouth ulcers (canker sores) and mouth sores

Mouth ulcers or canker sores present as ulcers with different characteristics. That is why they are classified as three variants, namely;

  • Minor
  • Major
  • Herpetiform

The signs and symptoms of the above-mentioned canker sores are;

  1. Minor sores are small, usually round or oval-shaped. They heal quickly, usually within a week or so. Minor sores leave no scars.
  2. Major canker sores are larger, involving deeper mucosal tissue. They have irregular edges, so their shape is not defined. They take longer to heal, usually six weeks. Since they involve deep tissue, they leave behind much scarring.
  3. Herpetiform sores are very small, but they occur in clusters, a feature that distinguishes them from other types of mouth sores. A single cluster may contain several pin-point size sores, ranging from tens to hundreds. Herpetiform sores are quick to heal, and there is no scarring associated with them.

Mouth sores are similar to mouth ulcers. However, they present with distinguishing features according to the underlying causative disease. Here are few examples of mouth sores and their signs and symptoms;

  1. Cold sores
  • Painful, red-colored, fluid-filled blisters
  • Cold sores appear near the mouth and lips.
  • An obvious tingle or burning sensation before the appearance of sore
  • Associated mild, flu-like symptoms; low-grade fever, body pains and aches, and swelling of lymph nodes
  • Gingivomatitis
  • infection of the mouth and gums commonly seen in children
  • tender and painful sores on the gums or insides of cheeks
  • red-colored sores surrounded by a grey or yellow-colored area
  • associated with mild, flu-like symptoms
  • Folate deficiency anemia
  • Mouth sores appear on the inside surface of lips, cheeks, or gums
  • Associated symptoms like fatigue, weakness, pale skin, swelling of the tongue, gray hair, and growth delay (in children)
  • Oral thrush (fungal infection of the mouth)
  • Infection apparent on the tongue, inner cheeks, gums, and even tonsils
  • Common in infants and children
  • Adults with weak immune systems develop thrush
  • Cream-colored white bumps that can be scraped off
  • The affected site is painful
  • Associated symptoms include loss of taste, difficulty swallowing, and dry cracked skin at the corners of the mouth.
  • Hand, foot, and mouth disease
  • Common in children below age five
  • Red blisters in the mouth, tongue, and gums
  • Blisters are painful
  • Associated symptoms are red spots (flat or raised) on the palms of the hand and soles of the feet, occasionally appearing on the buttocks or genital area.
  • Oral lichen planus
  • A chronic inflammatory disorder affecting the gums, lips, cheeks, and tongue
  • White, raised patches of tissue in the mouth.
  • On other occasions, bright red, swollen patches are present that are painful and may ulcerate.
  • Open mouth ulcers may bleed while eating, drinking, or brushing teeth.
  • Celiac disease
  • Anemia and dietary deficiencies (vitamin B group, D, iron, and calcium) associated with celiac disease predispose to mouth sores.
  • Other associated symptoms include diarrhea, weight loss, stomach pain, joint pain, bloating, gas, fatty stools, and skin rash.
  • The disease presents with weight loss, delayed growth and puberty, chronic alternating diarrhea and constipation, stomach pain and cramps, and yellow discoloration of teeth.
  • Cancer of mouth
  • Mouth sores involve the mouth, including lips, cheeks, teeth, gums, tongue, roof, and floor of the mouth.
  • Mouth sores appear as white or red patches that do not heal
  • Associated symptoms are weight loss, gum bleed, loose teeth, presence of a growth or lump inside the mouth, pain in the mouth, mouth pain that may get referred to an ear, difficult or painful swallowing, and swollen lymph nodes in the neck

Warning signs for mouth ulcers and mouth sores

The following signs and symptoms should alert you about the seriousness of mouth ulcers and sores;

  • Unusual mouth ulcers that involve larger areas, usually sores and ulcers more than half an inch in diameter, need an expert's opinion.
  • Development of new mouth ulcers before healing of the old ones, frequent and recurring sores and ulcers
  • Sores and ulcers that persist more than three weeks
  • Painless sores and ulcers (usually indicate cancerous lesions)
  • Mouth ulcers that extend and involve the lips
  • Painful sores or ulcers that do not respond to OTC analgesics
  • Severe difficulty in eating, drinking, and talking
  • Sores and ulcers associated with high fever or diarrhea, rash, and joint pain

Treatments for mouth ulcers and mouth sores

How to get rid of mouth ulcers and mouth sores?

The first line of therapy is to identify and treat any underlying cause of either condition. This is particularly important in the case of recurring mouth ulcers and mouth sores.

Mouth ulcers do not require treatment. However, they are painful till they last. Here are some remedies for mouth ulcers treatment that cut back on the pain and speed up recovery.

  • Over-the-counter topical anesthetics benzocaine for the mouth, for example, Orajel or Anbesol. 
  • A prescriptive mouth rinse containing steroids or anesthetic, dexamethasone, or lidocaine, helps alleviate pain and swelling.
  • OTC mouth rinses containing hydrogen peroxide, antimicrobials (Listerine), chlorhexidine (Peridex)
  • Oral pills containing steroid doxycycline
  • Nutritional or dietary supplements including folic acid, vitamin B-6, vitamin B-12, and zinc

Mouth sores also resolve on their own if they are not associated with any complications or underlying disease. Treating any underlying viral, fungal or bacterial infection is important to treat mouth sores completely. Mouth sores due to cancer require vigilant care. Your doctor may take a sample for biopsy followed by surgery or chemotherapy.

Some remedies that help manage the condition include;

  • Taking OTC painkillers
  • Using a solution made of one part hydrogen peroxide and one part water on mouth sores
  • Use of other OTC medications, pastes, or mouthwash containing analgesic, steroid, or anti-inflammatory agents

How to cure mouth ulcers fast naturally

Mouth ulcers remedy usually include lifestyle changes, including regular brushing and flossing teeth. This helps to prevent bacterial infection.

Some home remedies for treating mouth ulcers and sores faster include;

  • Avoid spicy, hot, salty, acidic, and sugar-laden foods
  • Avoid chewing tobacco
  • Consume more cold milk, yogurt, or ice cream
  • Gargle with mouthwash or saltwater
  • Applying ice to mouth sores
  • Apply milk of magnesia in minute amounts
  • Rinse mouth with a mixture of warm water and baking soda (1 teaspoon in half a cup of water)
  • Apply honey on sores and ulcers
  • Apply baking soda paste on sores and ulcers
  • Place cold, damp tea bags
  • Drink natural herbal teas like chamomile tea,
  • Other natural remedies for mouth sores and ulcers include echinacea, myrrh, and licorice root.
  • Do not squeeze or pick the sores or ulcers

Tips to prevent mouth ulcers

Mouth sores and ulcers can be prevented by adopting good oro-dental hygiene. If you are at high risk of getting mouth ulcers or sores, then you must modify lifestyle habits to reduce the recurrence of sores and ulcers in the mouth.

Do not consume foods that irritate your mouth. These include acidic fruits like pineapple, grapefruit, oranges, or lemon. Avoid food items that require crushing like nuts, hard candies, chips. Also, avoid spicy foods that may irritate your mouth mucosa. Drink your tea or coffee warm, not scalding hot.

Choose whole grains and alkaline foods that bolster your immune system. Fresh fruits and vegetables with plenty of water do the trick. Supplement your diet with vitamins and minerals.

Avoid talking while eating; that has been the gold standard of eating etiquette for ages. This helps accidental bites and injuries.

Reduce stress from your life. Take adequate sleep and rest when tired.

If you use dentures, orthodontic mouth devices, or braces, ask your dentist to provide an adequate safeguard for each case. Consult your dentist if your braces do not fit appropriately. Sharp edges of any mouth gadget should be waxed or filed away.

Quit smoking, chewing tobacco or betel nut, or drinking excess alcohol.

Using vitamin-enriched lip balms also helps to keep mouth and lip sores at bay. Protect your lips from the sun by using SPF lip balm.

Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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