Mouth ulcers are small and painful sores that develop anywhere in your mouth, located on the gums, tongue, palate, inner cheeks, and inner lips. They appear as round or oval lesions with a white or yellowish centre surrounded by a red, inflamed border. 

The ulcers are non-contagious but can interfere with your eating, drinking, and talking activities. 

Yet the exact cause is unknown; some factors, like daily activities, family history, and some underlying health conditions, may trigger them. 

In most cases, it can be curable by using some basic care or medication within 10-14 days. However, if they persist or worsen despite treatment with unusual features, further investigation, such as blood tests or a biopsy, may be necessary to identify the underlying cause, as non-healing ulcers can sometimes be a sign of oral cancer.

What are the Causes of Mouth Ulcers? 

The actual cause of mouth ulcers is unknown; however, it is believed that the following factors may trigger this: 

• Family history or genetic tendency to develop recurrent mouth ulcers
• Accidental biting of the cheek or tongue
• Irritation from braces, dentures, or sharp teeth
• Aggressive tooth brushing or use of a hard-bristled toothbrush
• Reaction to toothpaste or mouthwash containing sodium lauryl sulfate (SLS)
• Injury from hot, spicy, or rough-textured foods
• Deficiency of vitamin B12, Iron, folic acid, and zinc
• Emotional stress or anxiety
• Lack of sleep or fatigue
• Hormonal changes, especially during menstruation
• Consumption of acidic, spicy, or salty foods like citrus fruits, tomatoes, and vinegar
• Sensitivity to certain foods like chocolate, coffee, nuts, or gluten
• Use of certain medications such as NSAIDs (ibuprofen, aspirin), beta-blockers, Nicorandil, chemotherapy drugs, or methotrexate

Sometimes, frequent or long-lasting mouth ulcers may be linked to other health issues, such as:

• Celiac disease
• Inflammatory bowel disease (IBD)
  • Ulcerative colitis
  • Crohn’s disease
• Diabetes
• HIV
• Autoimmune diseases
  • Lupus
  • Oral lichen planus
  • Behçet’s disease

What are the Symptoms of Mouth Ulcers? 

Mouth ulcers are easy to spot. They usually appear as;

• Small, round, or oval sores inside the mouth
• White, yellow, or gray center with a red or inflamed border
• Found on the inner cheeks, lips, tongue, gums, or roof of the mouth
• Burning, tingling, or stinging sensation before the sore appears
• Pain or discomfort, especially while eating, drinking, or brushing
• Sensitivity to hot, spicy, or acidic foods
• Swelling or redness around the sore
• Difficulty talking, chewing, or swallowing (if large or multiple ulcers)
• In rare cases, mild fever or feeling tired if ulcers are severe

What are the Types of Mouth Ulcers? 

The most common type of mouth ulcers is aphthous ulcers, or canker sores; the following are their subtypes: 

• Minor Aphthous Ulcers (Mikulicz Ulcers): The size of the ulcer ranges <1 cm and may heal without scarring within 7–14 days. These are typically small, shallow, round or oval ulcers that occur singly or in small numbers (1–5 lesions). 
• Major Aphthous Ulcers (Sutton’s Ulcers): A severe type where healing may take about 2-6 weeks. These ulcers size can be up to 3 cm and are larger, deeper, more painful, and take longer to heal. They may be associated with underlying systemic diseases. 
• Herpetiform Ulcers: This is a rare subtype, seen more commonly in adult women, and may heal in about 1-2 weeks. They are small, multiple, and cluster-like ulcers that may coalesce to form larger irregular lesions. 

Some other types of mouth ulcers may be caused by certain infections, injuries, and systemic conditions, such as; 

• Oral Lichen Planus: An immune condition causing white, lacy patches or sores inside the mouth.
• Leukoplakia: Thick white or grey patches in the mouth, often from cell overgrowth or tobacco use.
• Erythroplakia: Red patches under the tongue or near the front teeth, often linked to smoking or tobacco use.
• Oral Thrush: A yeast infection, Candida albicans, causing white patches in the mouth, common with weak immunity or after the use of antibiotics.
• Mouth Cancer: Red or white sores or ulcers that don’t heal and may become painful or bleed.

Diagnosis

If you have ulcers that are affecting your daily activities or are certainly persistent for more than 2 weeks, then it is advisable to see your dentist as early as possible. 

Also, in some cases, the condition may get worse, and to check if some underlying conditions, like deficiency or inflammatory conditions, are responsible for ulcers, the doctor will advise you to get blood tests. 

If your doctor cannot determine the actual cause and no treatment is relieving this, then you may need to get a biopsy of the part of the ulcer or the tissue around it. A biopsy is a procedure used for the examination of tissues. 

Can a Mouth Ulcer Be a Sign of Mouth Cancer? 

In most cases, mouth ulcers are harmless and heal on their own within 1–2 weeks. However, in rare cases, a non-healing ulcer in the mouth can be an early sign of mouth cancer.

You should see a doctor or dentist if you have:

• An ulcer that lasts longer than 2 weeks
• A sore that doesn’t heal or keeps returning
• An ulcer with hard edges or unusual bleeding
• A lump, numbness, or pain in the mouth
• Unexplained weight loss or difficulty swallowing

Early detection is key, so it’s important to get any unusual or persistent mouth sores checked by a healthcare professional.

Treatment

Most of the ulcers can be treated on their own, which may take about 10 to 14 days. To relieve pain and speed up the healing, you can try the following treatments: 

• Gels and Ointments: Contain ingredients like benzocaine, lidocaine, or hydrocortisone, which may help relieve pain and reduce inflammation. 
• Mouthwashes: Use antiseptic or anti-inflammatory mouthwashes (e.g., chlorhexidine or hydrogen peroxide) to prevent infection and promote healing
• Pain relievers: Over-the-counter options like acetaminophen or ibuprofen can reduce pain
• Saltwater rinse: Dissolve 1 teaspoon of sea salt in warm water and rinse your mouth for 30 seconds to reduce swelling and kill bacteria
• Coconut oil (Oil pulling): It has antimicrobial properties. Swish a spoonful in the mouth for a few minutes, then spit into a bin (not the sink) and rinse with water afterward. 

However, in severe and recurring mouth ulcers, you may require some advanced medications.

Also Read: Oral Cancer Surgery Cost in India

Prevention of Mouth Ulcers 

While you can’t prevent mouth ulcers altogether, listed are the things you can follow to lower the risk. 

• Maintain good oral hygiene by brushing and flossing regularly
• Use a soft-bristled toothbrush to avoid injuring the mouth
• Avoid spicy, acidic, or rough-textured foods that may irritate the mouth
• Stay hydrated and avoid smoking or tobacco use
• Manage stress and anxiety, which can trigger ulcers
• Take a balanced diet rich in vitamin B12, iron, folic acid, and zinc
• Avoid toothpaste or mouthwash with sodium lauryl sulfate (SLS)
• Get prompt dental care for sharp teeth, braces, or ill-fitting dentures
• Avoid known food triggers, such as nuts, chocolate, or citrus, if sensitive
• Treat underlying health conditions like IBD, celiac disease, or anemia

Key Takeaways

Mouth ulcers are common and often harmless, but they can cause significant discomfort in daily life. While most heal on their own within a couple of weeks, persistent or recurring ulcers should not be ignored, as they may signal an underlying health issue. If they last more than two weeks or keep coming back, it’s important to seek medical advice. Simple care and attention can help speed up healing and prevent future ulcers.