Aphthous Mouth Ulcers

mouth ulcers


Aphthous mouth ulcers are painful, and recur from time to time. The ulcer(s) will usually go without treatment in 10-14 days. Mouthwashes and lozenges may ease the pain, and may help the ulcers to heal more quickly.

What are aphthous mouth ulcers?

Aphthous ulcers are painful sores that can occur anywhere inside the mouth. At least 1 in 5 people can develop aphthous mouth ulcers at some stage in their life. Women are affected more often than men.

There are three types:

  1. Minor aphthous ulcers are commonest. They are small, round, or oval, and are less than 10 mm . They look pale yellow, but the area around them may look swollen and red.,up to five may appear at the same time. Each ulcer lasts 7-10 days, and then goes without leaving a scar. They are not usually very painful.
  2. Major aphthous ulcers occur in about 1 in 10 cases. They tend to be 10 mm or larger . Usually only one or two appear at a time. Each may lasts from two weeks to several months, and heals leaving a scar. They can be very painful and eating may become difficult.
  3. Herpetiform ulcers occur in about 1 in 10 cases. These are tiny pinhead-sized ulcers. Multiple ulcers occur at the same time, but some may join together and form irregular shapes. Each ulcer lasts one week to two months. They have nothing to do with herpes .

Aphthous ulcers usually first occur between the ages of 10 and 40. They then recur but there can be days, weeks, months, or years between each bout of ulcers. The ulcers tend to recur less often as you become older. In many cases, they eventually stop coming back.

What causes aphthous mouth ulcers?

The cause is not known. They are not infectious, the ulcers develop for no apparent reason in people who are healthy.
In some cases the ulcers are related to other factors or diseases.
Injury –from a badly fitting dentures, a graze from a harsh toothbrush, etc.
Changes in hormone levels. women find that mouth ulcers occur just before their period. In some , the ulcers only develop after the menopause.
Some ex-smokers find they develop ulcers only after stopping smoking.
A lack of iron, or a lack of certain vitamins (vitamin B12 and folic acid) may be a factor in some cases.
Rarely, a food allergy may be the cause.
Genetic factor may play a part in some cases.
Stress or anxiety mayto trigger it in some people.
Medicines such as nicorandil, anti-inflammatory drugs, and oral nicotine replacement therapy.
Mouth ulcers are more common in people with Crohn's disease, coeliac disease, HIV infection, and Behçet's disease. But the ulcers may not be aphthous-type.

What are the treatments for aphthous ulcers?

Treatment aims to ease the pain when ulcers occur, and to help them to heal as quickly as possible. There is no treatment that prevents aphthous mouth ulcers from recurring.
No treatment may be needed

General measures include:

Avoid spicy foods, acidic fruit drinks, and very salty food, which can make the pain and stinging worse.
Use a very soft toothbrush. See a dentist if you have badly fitting dentures.
If you suspect a medication is causing the ulcers, then a change may be possible. Contact your doctor.

Some medicines may ease your symptoms from the mouth ulcers:

Chlorhexidine mouthwash may reduce the pain. It may also help ulcers to heal more quickly. It also helps to prevent ulcers from becoming infected .Chlorhexidine mouthwash is usually used twice a day.
A painkilling oral rinse, gel, or mouth spray may help to ease pain. should not be used in children under the age of 16.The effect is unfortunately short-lived.

When should I see a doctor?

Rarely mouth ulcer can become secondarily infected with bacteria. In this case you may notice increased pain or redness, or you may be feeling unwell with fever,itmay need antibiotic treatment. Not all mouth ulcers are aphthous ulcers. Other types of ulcer can occur in the mouth and mouth ulcers can be a sign of an underlying illness or disease.

Important: cancer of the mouth can sometimes start as an unusual mouth ulcer that does not heal. You should see a doctor or dentist if you have a mouth ulcer that has lasted more than 2-3 weeks without sign of healing, or is different in any way. This is especially important if you are a smoker.

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