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Mouth ulcer- Types, Causes, Home Remedies and Prevention

Definition

Mouth ulcer is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually, there is no serious underlying cause.

The two most common causes of oral ulceration are local trauma (e.g. rubbing from a sharp edge on a broken filling) and aphthous stomatitis (“canker sores”), a condition characterized by the recurrent formation of oral ulcers for largely unknown reasons. Mouth ulcers often cause pain and discomfort and may alter the person’s choice of food while healing occurs (e.g. avoiding acidic, salty or spicy foods and beverages).

They may form individually or multiple ulcers may appear at once (a “crop” of ulcers). Once formed, the ulcer may be maintained by inflammation and/or secondary infection. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer.

Epidemiology

The prevalence and epidemiology of MU is poorly understood. hey occur in all ages but it has been reported that they are more common in patients aged between 20 and 40, and up to 66% of young adults give a history consistent with MAU. Lifetime prevalence is estimated to affect one in five of the general population.

Types of Mouth ulcer

There are three main types of mouth ulcer:

Minor ulcers are the most common type, accounting for 80% of all cases. They are small (2-8mm in diameter) and usually heal naturally, within 10-14 days. A minor ulcer will not cause any scarring.

Major ulcers are deeper and larger than minor ulcers, and usually have a raised or irregular border. They are usually 1cm or more in diameter. Major ulcers take longer to heal (several weeks) and can cause scarring.

Herpetiform ulcers form as multiple, pinhead-sized sores. The number of ulcers can range from five to 100. These tiny ulcers often fuse together to form larger, irregular shaped sores, which are very painful. Around 5-10% of mouth ulcers are herpetiform. Herpetiform ulcers are not related to the herpes virus.

Recurrent Herpetiform ulcers

Risk factors

A risk factor is something that increases your chance of developing a condition or disease. Risk factors for developing mouth ulcers include:

Gender: Women experience more incidences of ulcers due to their hormone changes during their monthly cycle.

Heredity: The tendency to get mouth ulcers runs in families.

Stressful lifestyle: Stress is a known factor for developing mouth ulcers.

Diet: Excessive intake of coffee, chocolate, strawberries, almonds, cheese and peanuts can increase your risk of ulcers.

Causes of Mouth ulcer

Mouth ulcers can be caused by a wide range of factors including:

Mouth ulcer symptoms

Ulcers can be painful, and the pain can be made worse by food, drink, and poor oral hygiene.

Herpetiform ulcers lesions may:

They tend to be found in more females than males and are more common in older adults.

Symptoms of minor and major ulcers include:

During more extreme outbreaks of mouth ulcers, some people may experience fever, sluggishness, and swollen glands.

Complications            

Complications may include:

Diagnosis

Mouth ulcers are usually easy to diagnose. Occasionally biopsy is performed, particularly if considering cancer. It should be taken from the indurated edge of an inflammatory ulcer or from an inflamed but non-ulcerated site.

If the patient has frequent, prolonged or large ulcers, or is unwell, the following tests may be done to assess general and gastrointestinal health.

Selected patients may undergo further assessment including endoscopy if there is suspicion of inflammatory bowel disease.

If specific toothpaste or food is thought to precipitate ulcers, allergy tests including prick tests, patch tests and specific IgE testing may be performed. The results can be difficult to interpret.

Treatment of Mouth ulcer

Most mouth ulcers get better on their own within 1 to 2 weeks. Until your ulcer heals:

Medicines for mouth ulcers

If your mouth ulcer is causing a lot of pain or not healing, there are medicines that can help relieve pain, protect the ulcerated area, reduce inflammation or prevent further infection. The choice of medicine will depend on how much discomfort you are experiencing and the cause of the ulcer. Talk to a pharmacist about the following options:

Antiseptic mouthwashes- (such as chlorhexidine) are used to prevent infection by stopping the build-up of bacteria

Protective pastes (such as Orabase®) act as a protective covering when applied to the ulcer

Steroid-containing pastes (such as Kenalog in Orabase® and Oracort®) help to relieve pain, inflammation (redness), discomfort and speed up healing

Local analgesics (pain relievers applied to the area) come in the form of a mouthwash, spray, gel or ointment and offer pain relief to the area, in and around the ulcer

Antiviral creams are available if your mouth ulcer is caused by the herpes simplex virus (also called cold sores or fever blisters).

Your GP may prescribe a stronger medication to treat severe, recurrent or infected mouth ulcers.

Home remedies for mouth ulcers

Turmeric with honey: Take a pinch or two of turmeric and mix it with honey to form a paste and apply it on the ulcer. Turmeric is known as a natural antiseptic, which can help to prevent infection at the ulcer site. Honey acts as a humectant and hastens the formation of new tissues and rapid healing.

Holy basil: You can either chew 4-5 leaves of Tulsi or can have a cup of Tulsi green tea, two to three times a day, to improve the healing of ulcers. Tulsi, by virtue of its adaptogenic properties, helps the body to adapt to the illness and fight inflammation.

Coconut oil and coconut water: According to Ayurveda, drinking tender coconut water reduces heat in the body and hasten the healing of mouth ulcers. Applying coconut oil on the ulcer prevents further scarring and helps in faster new tissue generation.

Licorice: Liquorice is a well-documented remedy for mouth ulcers in the Ayurveda. Studies show that the application of licorice paste or powder on the ulcer reduces pain, redness, and swelling due to its inherent anti-inflammatory properties.

Baking soda: Make a paste of baking soda with water and directly apply it on the ulcer. Baking soda neutralizes the acid formed at the site of the ulcer and therefore provides quick pain relief.

Important note: Mouth ulcers resolve within 5-7 days. If you find a persistent mouth ulcer which does not cause much pain, it could be a sign of cancer or any other complication. Such patients are recommended to consult a physician.

Prevention of Mouth ulcer    

You may be able to reduce the risk of mouth ulcers by:

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