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Mouth Ulcers

What are mouth ulcers?

Mouth ulcers are small, greyish/ white sores inside your mouth, where the top layer of the skin is damaged. You can have one ulcer at a time, or several. They often appear on the cheeks, inside the lips and the tongue. The ulcer is usually red around the rim. Everyone has mouth ulcers at some point in their life. Some people keep getting mouth ulcers every few months or weeks, or even every few days. Most mouth ulcers are small and are usually less than 5mm across. They usually heal after a week or two. A few people get ulcers that are bigger and take longer to heal. Bigger ulcers can also leave scars. You can also get lots of small, painful ulcers called herpetiform ulcers. These are caused by the cold sore virus and they need different treatment.

No one really knows what causes mouth ulcers. You may be more at risk if –

  • You have too little iron, folic acid or vitamin B12 in your blood stream
  • You are sensitive to gluten, which is a protein found in wheat ( this is called coeliac disease)
  • You injure your mouth ( for example, by biting the inside of your cheek or grazing it with a sharp tooth)
  • Someone else in your family gets a mouth ulcer

In a small number of people, ulcers are caused by infections or other illnesses. If you have ulcers that are bigger than a few millimetres or you are losing weight you might have something more serious. Occasionally, ulcers may be a reaction to a medication you are taking such as nicotine patches.

What are the symptoms?

Mouth ulcers can be very sore. Eating or talking may make the pain worse. If you often have difficulty eating because of mouth ulcers, you need to take care that you do not lose too much weight. If your child has ulcers and refuses to eat, you may need to supplement their diet in order to maintain nutrition. If you get other symptoms with mouth ulcers, such as fever, stomach upset weight loss or ulcers elsewhere on your body, tell your doctor. It could be a sign that you have another condition.

What treatments work?

Antiseptic mouth washes

Chlorhexidine is an antiseptic that can make your ulcers less painful and go away faster. It comes in the forms of gels, sprays, and mouthwashes that you can use every day.

Chlorhexidine has a bitter taste and may make you feel sick. If you use it every day, it can stain your teeth and tongue brown. This discolouration should go away when you stop using it. You should leave an interval of at least 30 minutes between using chlorhexidine and using toothpaste.

Steroid mouthwashes and ointments

Some steroid medications may make your ulcers less painful and heal them more quickly. It is not clear if they will help you get ulcers less often. They come as mouthwashes, creams, pastes, sprays and lozenges. You can but some of these from pharmacies. For others, you’ll need a prescription from your doctor . The steroids for mouth ulcers have been designed so that very little of the medicine gets into the rest of the body, so side effects are rare. Occasionally, they might cause a mouth infection called thrush.

Things you can do yourself

Here are some things you can try that might help you to avoid getting more mouth ulcers

  • Make sure you clean your teeth properly three times a day to avoid getting infections
  • Ask your dentist what size toothbrush you should use. The wrong size brush can lead to scratches and other injuries in your mouth. This can cause mouth ulcers.
  • Avoid acidic drinks, like fruit juices or fizzy drinks, or drink them through a straw so they do not irritate your mouth.
  • Avoid very spicy food and sharp food, like crisps, which can scratch your mouth
  • Try learning to relax. Some people think stress can bring on mouth ulcers
  • If you are a smoker, talk to your doctor about the best way to give up. Giving smoking up may lower your chance of getting more ulcers

What will happen to me?

If your mouth ulcers keep coming back, or if you have an ulcer that takes more than a week to heal, you should see your doctor to have a review and possibly a blood test. Having repeat attacks of ulcers can be distressing. You can take painkillers, like ibuprofen and paracetamol, to help with the pain. Mouth ulcers are most common In teenagers and young adults. You may find you get them less often as you get older.

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