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All you need to know about mouth ulcers

Mouth ulcers are one of the most common type of ulcers and are the easiest to detect. Along with having multiple reasons for their origin ranging from stress to viral infections to the early signs of fatal autoimmune conditions they could also be an indicator of mouth cancer.

Detected easily because of the burning sensation or pain typically while eating, ulcers in the mouth require a proper evaluation. The treatment is based on the cause, and varies vastly

It is EXTREMLY IMPORTANT that ANY ULCER that fails to resolve within 2 weeks requires IMMEDIATE EVALUATION by a dentist  

 Reasons for mouth ulcers

1)  Stress: Stress is the most common cause of ulcers in the mouth. It generally leads to a type of ulcer known as Canker Sore or Apthous ulcer. These occur in the inside of the lips, underneath the tongue or the inside of the cheeks. Causing burning sensation while eating, especially while consuming something salty, these type of ulcers generally heal by itself within 5 – 10 days. They have a tendency to recur, especially during periods of stress or before/during an episode of flu. For the most part these ulcers heal by themselves without any scarring but in some situations if the ulcers are large and extremely painful they can cause scarring. Thus, treatment is important despite it being self-healing as repeated scarring inside the mouth can lead to difficulty in opening the mouth.

Treatment options:  Although canker sore heals by itself it requires treatment to

a)      Make it possible to eat while the ulcers heal

b)      To avoid scarring while healing as multiple such episodes might be extensively damaging.

The treatment could include a gel to cover the ulcer to medicines to avoid scarring

The entire treatment can be managed remotely and does not require a visit to a dental clinic.

2)      Sharp teeth:  Sharp tooth edges due to fracture of a surface, fillings or wearing off of the teeth can cause ulcers. This type of ulcer is seen either on the cheek or the tongue in the region surrounding the sharp tooth/ teeth. These ulcers aren’t self-healing and if not treated for an extended period of time, these ulcers can become cancerous.

Treatment options:  If there is a sharp tooth/teeth it is best to get it fixed. Get IMMEDIATE help if there is a long standing ulcer due to the same reason.

First line of treatment would involve application of a protective gel which is followed by reshaping the tooth and rounding the sharp edges so it does to cut and ulcerate the surrounding soft tissue.

3)       Viral Infection:  Viral infections are the second most common cause of mouth ulcers after stress. Viruses are present in the dormant form along nerves and can get reactivated due to stress, decrease in immunity or even the cold weather.  Chicken –pox virus and herpes type 1 are common viruses that cause ulcers in the mouth. These ulcers are very small but are in a large number.  In one episode of reactivation of herpes there can be around 20-100 ulcers at a time in the mouth. These type of ulcers are seen on the palate or the gums just adjacent to the teeth. Chicken pox virus generally causes ulceration on the lips and is extremely painful. The reactivation of the virus along with ulcerations in the mouth or the face can also be followed by an episode of facial paralysis.

Treatment options: If you notice a large number of ulcers in the palate or the gums region, consult a dentist immediately. An early dose of antivirals can limit the infection and a (relatively rare) episode of facial paralysis

The treatment can be completely managed remotely and doesn’t require a trip to the clinic  

4)      Burns by eating hot food: very hot pizzas or extremely hot beverages can cause burn ulcers in the mouth. They occur on the tongue, cheek or palate and are (as expected) associated with consuming something very hot. These type of ulcers are self-healing and only cause difficulty in eating till the ulcers heal.

Treatment options: Requires symptomatic treatment to avoid the burning/pain during eating.

5)      Fungal infection of the mouth: Fungal infections in the mouth are rare and are generally associated with stress or a decrease in immunity. The drop in the immunity could be due to immunosuppressant medicines after an organ transplant or steroid therapy for some medical condition. Ulcers due to fungal infections require immediate evaluation as they may signify an early stage of AIDS as well

Treatment options: Treatment options include anti-fungal medicines which would be based on the evaluation of the underlying fungus causing the infection and subsequent ulcerations.

6)      Side effect of medicines: Ulcerations in the mouth can be caused due to cancer chemotherapy medicines or due to the direct contact of certain medicines that need to be chewed.

Treatment options: Treatment is symptomatic and includes the application of protective gel like substances on the ulcers to facilitate eating. These ulcers generally selfheal once the medication is stopped.

7)      Sores in the mouth after dental treatment: Prolonged dental treatment with pressure on the lips / inner surfaces of the cheeks at times causes ulceration due to

a)      Damage to the thin soft tissue in the mouth by the sharp instruments

b)     Allergy to any chemical (e.g. those used in root canal procedures) used during the treatment

c)      Pressure and rubbing of the thin soft tissue in the mouth at times also causes the reactivation of the dormant herpes type – 1 virus resulting in ulcerations

Treatment options: It is best to prevent such ulcers by avoiding the mouth to dry out while undergoing the procedure. Let the dentist know if you have faced allergies to any chemicals used during the procedure. If you already have such ulcers, treatment is symptomatic and requires application of protective gel. Treatment might also include antiviral or antibiotic drugs and thus requires evaluation.

8)      Autoimmune conditions:  These are the conditions wherein the body’s own immune reaction acts against the normal body tissue. These types of conditions are tough to handle and could be potentially fatal unless diagnosed at an early stage.  Some autoimmune conditions show their first signs in the mouth and thus if diagnosed at this stage the outcomes could be better.

Treatment options: An early diagnosis helps in limiting the immune system to attack the skin of the entire body. Treatment would include medicines to reduce the damaging effect of the immune system against the body. Since the medicines used to reduce the immune response can themselves cause ulcers, a complete prescription regime is required rather than a few symptomatic medicines.

9)      Cancer:  Also seen as mouth ulcers. They are a single large ulcer with one of the characteristic factor that this ulcer will NOT heal within 2 weeks.  Mouth cancer generally occurs due to reasons like smoking or chewing tobacco.  Mouth cancer is generally preceded by pre-cancerous changes in the soft tissue and an early diagnosis can reverse the pre-cancerous condition.

Treatment options: Treatment depends on the stage varying from cessation of the abuse habit and vitamin supplements to an extensively invasive surgery.

 Mouth ulcers even though requiring a proper and detailed evaluation before starting the treatment can be handled remotely and if you have such a condition as important as it is to not ignore the situation, the condition can be handled remotely and you could completely avoid a trip to the clinic.

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