MOUTH ULSER

Mouth ulcer - information prescription
Introduction
Mouth ulcers are painful round or oval sores that form in the mouth, often on the inside of the cheeks.
Although mouth ulcers can be uncomfortable, especially when you eat, drink or brush your teeth, they are harmless.
Most mouth ulcers clear up by themselves within a couple of weeks. You only need to see a doctor if the ulcer gets worse or lasts for longer than three weeks.
Read more about the symptoms of mouth ulcers.
How common are mouth ulcers?
Mouth ulcers, which are also known as apthous ulcers, are very common. Most people will have at least one during their lifetime. They're particularly common in women and young adults.
Mouth ulcers can't be passed from person to person. For example, you cannot get an ulcer from kissing someone or from sharing drinking glasses or cutlery.
Recurrent mouth ulcers
Most people only have mouth ulcers occasionally. However, some people find they keep coming back. These are called recurrent mouth ulcers.
In the UK, one in five adults and about 5-10% of children suffer from recurrent mouth ulcers.
Recurrent mouth ulcers are often different from those that cause single ulcers. See the causes of mouth ulcers for more information.
How to treat mouth ulcers
Mouth ulcers usually get better by themselves, but there are some self help measures and medications that can be useful for troublesome ulcers.
Read more about the treatment of mouth ulcers.
One way to prevent getting mouth ulcers in the first place is to make sure you look after your teeth and gums. Find out more about how to look after your dental health and other ways to prevent mouth ulcers.



What type of mouth ulcer is it?
There are three main types of mouth ulcer:
• Minor ulcers are the most common. They are small (2-8mm in diameter) and usually heal naturally, within 10-14 days.
• Major ulcers are deeper and larger than minor ulcers, and usually have a raised or irregular border. They take several weeks to heal and can cause scarring.
• Herpetiform ulcers form as multiple (between 5 and 100) pinhead-sized sores. They often fuse together to form larger, irregular shaped sores, which are very painful.


Symptoms of mouth ulcers
You can easily tell if you have a mouth ulcer by its appearance. A mouth ulcer is:
• round or oval in shape
• white, red, yellow or grey in colour
• inflamed around the edge
Most mouth ulcers appear on:
• the inside of the lips
• the inside of the cheeks
• the floor of the mouth
• the under surface of the tongue
It's rare to get a mouth ulcer on the roof of your mouth.

Most mouth ulcers heal within 10 to 14 days, although they may last for several weeks in more severe cases.
When to see your GP
Visit your GP if you have a mouth ulcer that:
• gets progressively more painful and inflamed
• lasts for more than three weeks
Also visit your GP if you develop an ulcer somewhere else on your body, such as your genitals.
Read more about the diagnosis of mouth ulcer.

Ouch - it's a mouth ulcer
A mouth ulcer can be surprisingly painful and uncomfortable, particularly when you're eating, drinking or brushing your teeth.
Causes of mouth ulcers
Mouth ulcers aren't usually infectious, which means they can't be passed from person to person.
So, you won't get a mouth ulcer from kissing someone with one, or by sharing drinking glasses or cutlery with them.

Most minor, single mouth ulcers are caused by damage to the mouth, for example by accidentally biting the inside of your cheek while you are eating, by using a toothbrush incorrectly, or from a sharp tooth, food or filling.
Other causes of more troublesome mouth ulcers or ones that keep coming back include:
Stress and anxiety
Some people find they develop mouth ulcers during times of stress or when they're feeling particularly anxious.
Hormonal changes
Some women develop mouth ulcers during their period.
Family history
Around 40% of people who have recurrent mouth ulcers report that it runs in their family.
Food triggers
Eating certain foods can increase your likelihood of mouth ulcers. Culprit foods include:
• chocolate
• coffee
• peanuts
• almonds
• strawberries
• cheese
• tomatoes
• wheat flour
Stopping smoking
When you first stop smoking, you may find that you develop mouth ulcers. This is a normal reaction. Your body is dealing with the change in chemicals in your body.
After giving up smoking, any increase in mouth ulcers will be temporary, so don't let it put you off stopping smoking. The long-term health benefits of not smoking are far greater than the short-term discomfort of mouth ulcers.
Medical conditions
If you have mouth ulcers that keep returning, they may be caused by an underlying medical condition such as:
• Vitamin B12 deficiency: a lack of vitamin B12 can cause tiredness, shortness of breath and mouth ulcers.
• Iron deficiency: if your diet is lacking in iron, your red blood cells are unable to carry as much oxygen. This can make you feel tired, lacking energy and dizzy. Sometimes, an iron deficiency can also cause mouth ulcers.
• Coeliac disease is caused by intolerance to a protein called gluten, which is found in wheat, rye and barley. The condition causes the small intestine to become inflamed. Mouth ulcers are also a common symptom of coeliac disease.
• Crohn's disease is a condition that causes inflammation of the gut, leading to ulcers developing in both your stomach and mouth.
• Reactive arthritis is a reaction to another infection within your body. It can cause inflammation, which sometimes spreads to your mouth.
• Immunodeficiency: any condition, such as HIV or lupus, that attacks or suppresses the body's immune system can cause you to develop mouth ulcers.
Medications
Occasionally, mouth ulcers are caused by a reaction to a medicine that you are taking. Some of the medicines that can cause mouth ulcers include:
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.
• Nicorandil, a medicine which is sometimes used to treat angina.
• Beta-blockers, which are used to treat a variety of conditions that affect the heart and blood flow, such as angina, heart failure, high blood pressure and abnormal heart rhythms.
You may notice that you start to get mouth ulcers when you begin taking the medicine, or when you increase the dosage.
Speak to your GP if you think your medication is causing your mouth ulcers. You may be able to take an alternative medication.
Less common causes
There are also a number of other, less common causes of mouth ulcers.
• Herpes simplex infection:. Herpes simplex is a highly contagious virus, also known as the cold sore virus, which can cause cold sores on the mouth and the genitals.
• Skin conditions, such as lichen planus and angina bullosa haemorrhagica
• Gastrointestinal disease: for example, irritable bowel syndrome (IBS) and gastro-oesophageal reflux disease.
• Sore throat
• Chickenpox
• Hand, foot and mouth disease
Now read about how to treat mouth ulcers.
Diagnosing mouth ulcers
If you have a mild mouth ulcer, there is no need for you to have a formal diagnosis from your GP.
You only need to visit your GP if you have a mouth ulcer that is very painful, has lasted for more than three weeks, or if you are getting mouth ulcers regularly.
What the GP will do
In these instances, your GP will probably look inside your mouth to examine your mouth ulcer. They will also look at your medical history to help them work out what is causing your ulcer.
If you have mouth ulcers that keep coming back, your GP may ask you a series of questions to help work out whether your mouth ulcers have an underlying cause. For example, you may be asked about:
• how often you get mouth ulcers
• how long your ulcers last for
• how severe the pain is
• what treatments you have used - either prescribed or over the counter
If your GP is unsure about the diagnosis, they might want to rule out any conditions that could be causing your ulcers to keep coming back. You may be referred you for a series of blood tests such as:
• Full blood count (FBC). This is a common type of blood test that indicates the state of your general health. It shows whether there is an infection in your body, and will also indicate whether you have been exposed to any toxic substances.
• Erythrocyte sedimentation rate (ESR). This test shows whether there is inflammation in your body. If there is, your GP can conduct further tests to help find out what condition may be causing it.
• Ferritin. This test measures how much iron is being stored in your body. A lack of iron in your body can cause mouth ulcers.
• Vitamin B12. This test checks whether you have enough vitamin B12 in your body. A lack of vitamin B12 can also cause mouth ulcers.
Seeing a specialist
If you have had a severe mouth ulcer for more than three weeks, your GP may refer you to a hospital specialist.
You may also be referred if your mouth ulcer looks abnormal, for example if you have large red and white patches in your mouth, which often bleed and are painful.
You may require a biopsy - a procedure in which a small tissue sample is taken from your mouth for further examination.
Is it mouth cancer?
This is because sometimes a severe, long-lasting mouth ulcer can be a sign of mouth cancer. About 80% of people with mouth cancer have a long-lasting mouth ulcer that does not heal.

Ulcers caused by mouth cancer usually appear on or under the tongue, although they can appear elsewhere in the mouth.

You are more at risk of developing mouth cancer if you are:
• male
• over 45 years old
• a heavy smoker
• a heavy alcohol drinker
If mouth cancer is detected early, the chances of a complete recovery are good. This is why it is always important to have regular check-ups with your dentist. They can carry out a thorough assessment of your teeth and mouth, and will be able to spot any possible signs of mouth cancer.
Now, read about how mouth ulcers are treated.

Treating mouth ulcers
Most mouth ulcers do not require specific treatment. They usually heal naturally without if they are:
• occasional
• mild
• do not interfere with your daily activities, such as eating
Self-help tips
If you have a mild mouth ulcer, there are some steps you can take yourself to help your ulcer to heal more quickly. You should:
• use a soft toothbrush when brushing your teeth
• avoid eating hard foods, such as toast, and stick to soft foods that are easier to chew
• avoid eating foods that have triggered an ulcer in the past. You can read about foods that are known to trigger mouth ulcers here.
• reduce your stress levels by doing an activity that you find relaxing, such as yoga, meditation or exercise
If your ulcer has a specific cause, such as a sharp tooth cutting the inside of your cheek, it will usually heal naturally once the cause has been treated. If you suspect that a sharp tooth has caused an ulcer, visit your dentist so that they can repair it.
Medication
If your ulcer is painful, your GP can prescribe a medication to help ease your symptoms.
You can also buy mouth ulcer medicines over the counter without a prescription at your local pharmacy.
Speak to your pharmacist about which medicine would be most suitable for you. Some mouth ulcer gels are not suitable for children under 16.
You can find your local pharmacist here.
These are the main types of medicines used to treat mouth ulcers:
Antimicrobial mouthwash
Antimicrobial mouthwash helps to kill bacteria, viruses or fungi that may cause a mouth infection if you're unable to brush your teeth properly.
Chlorhexidine gluconate is the most commonly prescribed mouthwash. You normally have to use it twice a day.
After using chorhexidine gluconate, you may notice that your teeth are covered in a brown stain. This staining is not permanent, and your teeth should return to their normal colour once you finish the treatment.
The best way to prevent staining is to brush your teeth before using chorhexidine gluconate mouthwash. However, after brushing your teeth make sure that you thoroughly rinse your mouth out with water before using the mouthwash.
Chorhexidine gluconate mouthwash should not be used by infants under two years old.
Corticosteroids
A corticosteroid is a type of medicine that reduce inflammation.
Mouth ulcer medications contain a low dose of corticosteroid to make the ulcer less painful. It's best to start using corticosteroid medication as soon as a mouth ulcer develops.
Hydrocortisone is the most commonly prescribed corticosteroid. It comes as a lozenge, which slowly dissolves in your mouth. You usually have to take a lozenge four times a day.

Children under 12 years old should see a GP before starting this treatment.
Painkillers
If your mouth ulcer is very painful, your GP may prescribe a painkiller that you can apply directly to your ulcer.
Your GP will usually prescribe benzydamine, which can either be taken as a mouthwash or a spray. You will not be able to use benzydamine for more than seven days in a row.
The mouthwash form of benzydamine may sting when you first use it, but this should lessen as you continue to use it. However, if the stinging persists, contact your pharmacist or GP.
You may also find that your mouth feels numb when you first use the mouthwash. This is normal and the feeling will soon return to your mouth.
If you are pregnant, breastfeeding or trying to get pregnant, tell your GP or pharmacist before taking benzydamine mouthwash.

Although all these treatments reduce swelling and discomfort in mouth ulcers that are already present, they won't prevent you developing new mouth ulcers in future.
Read more about how to prevent mouth ulcers.
Complications of mouth ulcers
Mouth ulcers rarely cause any complications. They usually heal naturally. Those that don't can usually be treated with medication.
A mouth ulcer may indicate an underlying health condition, but the ulcer itself will not be the cause of any illness.
Bacterial infection
The only complication mouth ulcers can cause is a bacterial infection. However, this is very rare.
In some cases, an infected ulcer can cause the bacteria to spread to other areas of your mouth, such as your teeth. If your ulcer becomes infected, you might need treatment with antibiotics.
Now, read about how to prevent mouth ulcers.
Preventing mouth ulcers
You can prevent mouth ulcers by looking after yourself generally and taking extra care of your teeth and gums.
Healthy lifestyle
To prevent getting mouth ulcers, try to avoid becoming run down. You can do this by eating a healthy, balanced diet, exercising regularly and learning how to manage stress.
Read our easy-to-read articles on how to get fitter and how to eat a healthier diet.
If you're prone to getting recurrent ulcers, try to avoid damaging the inside of your mouth by using a softer toothbrush. Also avoid eating hard, brittle or sharp-edged foods.
Read this article on how best to brush your teeth.
Good dental hygiene
Another way to prevent getting mouth ulcers is to make sure that your teeth are healthy. The best way to do this is to have regular check-ups at your dentist.
Your dentist can tell you how often you should have a check-up appointment. Depending on your oral health, the length of time before your next check-up could be as short as three months or as long as two years. The better your oral health, the less you will need to visit your dentist.
Regular dental check-ups will also reduce the risk of you getting mouth ulcers as a result of sharp edged teeth or fillings damaging your mouth.
Read about how to find an NHS dentist.
Read more about the causes of mouth ulcers.