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Mouth ulcers


Ear, nose and throat
Mouth ulcers, also known as aphthous ulcers, are small, hard sores that appear inside the mouth that can be itchy and painful. Small ulcers can appear inside the cheeks, on the lips, tongue, gums and more rarely, the roof of the mouth. Most of these ulcers are just a few millimetres in size but can sometimes affect a larger area when they come in clusters.

Most people will have an ulcer at some time during their life, often beginning in childhood but then stopping later in adolescence. About 20% of people will have recurrent mouth ulcers; that is ulcers which can come and go every few weeks.
Mouth ulcers may be caused by a slight injury in the mouth, for example through biting the inside of the cheek, through ill-fitting dentures or by eating food that is too hot. Recurrent ulcers may be due to a variety of causes including vitamin or iron deficiency, sensitivity to certain foods, hormonal changes, diseases affecting the skin or gut, or certain conditions where the body's defence system begins to attack the cells lining the mouth. Mouth ulcers are not infectious, so they cannot be passed from one person to another through kissing or sharing food.

In some circumstances, a mouth ulcer can be one of the first signs of mouth cancer. The ulcers caused my mouth cancer usually occur singly, on or under the tongue, without any obvious cause and last for a long time. The risk of mouth cancer is increased by smoking and drinking alcohol.
Mouth ulcers appear as round, inflamed sores on the inside of the lips, on the inside of the cheeks, on the gums and tongue. They are usually red or yellow in colour and can occur as a single ulcer or in clusters of around three to six. Mouth ulcers can be very painful, particularly if they get in the way when eating or swallowing, or are knocked when brushing teeth.

The first sign of an ulcer developing is an itching sensation at the site where the ulcer eventually appears. The ulcer forms over a period of 6 to 24 hours and may be intensely painful for 3 to 4 days. Symptoms gradually ease as the ulcer heals over a period of about a week. Very large ulcers can take up to 6 weeks to heal.
Mouthwashes or sprays containing the antibacterial agent chlorhexidine will help keep the mouth clean and reduce the chances of ulcers developing or will help ease discomfort if the ulcer is already present. Gels containing local anaesthetics such as lidocaine may be applied directly to the mouth ulcer to help ease pain. Alternatively, there are gels such as Orabase that form a coating over the ulcer, help protect it and allow healing to take place. If the mouth ulcer is particularly swollen corticosteroids such as triamcinolone or hydrocortisone may be used in the form of an oral paste or in the form of pellets to help reduce inflammation.

Gels containing the anti-inflammatory agent choline salicylate or paints containing the anti-inflammatory agent salicylic acid may also be applied directly to the mouth ulcer to help ease pain, but these products must not be used in children under the 16 years of age because of the risk a condition known as Reye's syndrome.
When to see your pharmacist
Visit your pharmacist if you are concerned about mouth ulcers. Most of the preparations that will ease discomfort or will help healing are available from your local pharmacy without the need for a prescription. Let your pharmacist know if you are taking any other medicines as these may be the cause of your problem. If your pharmacist thinks that your ulcers are caused by a problem with your teeth or dentures you will be advised to visit a dentist.

If you, or your child, is under 16 years of age and has previously been using gels containing the anti-inflammatory agent choline salicylate (Bonjela, Bonjela Cool Mint) or paints containing the anti-inflammatory agent salicylic acid (Pyralvex) to relieve pain associated with mouth ulcers, stop using these products as they are no longer recommended in children under 16 years of age.
When to see your doctor
If an ulcer fails to heal in three weeks or if you have recurring ulcers, particularly if you smoke and drink alcohol, you should see your doctor or dentist, just in case your ulcers are a sign of another illness.
Living with mouth ulcers
Prevention is the best approach if you suffer from mouth ulcers. Register with a dentist and have regular appointments to keep your teeth and gums in a healthy state. Your dentist will be able to identify and treat any teeth or dentures that may be rubbing against your cheeks or tongue and causing the irritation that starts a mouth ulcer. Regular inspection of your mouth by a dentist will also provide an early warning of any signs of mouth cancer.

Your dentist or the dental hygienist will give you advice about brushing and flossing, and will recommend suitable tooth brushes and tooth pastes that will help reduce mouth irritation. Follow this advice and maintain oral hygiene between visits to the dentist by twice daily tooth brushing and flossing at night.

Eat a balanced diet, rich in fresh fruit and vegetables, to make sure that you are getting enough iron and vitamins, especially vitamins A, B12, C and E.

If you do get a mouth ulcer, avoid hot drinks or spicy foods that irritate the ulcer and make pain worse. Make sure that your hands and fingers are clean if applying any of the local treatments described above to avoid the risk of causing an infection.

If your mouth ulcer does not get better within 3 weeks or your mouth ulcers come back time and time again, see your doctor or dentist.
Further information
Further information on mouth ulcers may be obtained from British Dental Health Foundation, an independent charity that along with its global arm, the International Dental Health Foundation, is dedicated to improving the oral health of the public by providing free and impartial dental advice, by running educational campaigns and by informing and influencing the public, profession and government on issues such as mouth cancer awareness and fluoridation