Mouth Ulcers

A Mouth Ulcer is the erosion of part of the delicate tissue that lines the inside of the mouth (mucous membrane).

Certain medications, chemicals and infectious diseases such as herpes or thrush can cause Mouth Ulcers. The most common cause is injury, such as from ill-fitting dentures or accidentally biting your cheek. In most cases, Mouth Ulcers are harmless and resolve without treatment within a few days.

APTHOUS ULCERS
Aphthous ulcers are recurring ulcers with no known cause that affect around 20 per cent of the population. Aphthous ulcers usually first occur between the ages of 10 and 40, recurring from time to time. There can be days, weeks, months, or years between each bout of ulcers.
As a person becomes older, apthous Mouth Ulcers tend to recur less often and in many cases, stop coming back altogether. Some people feel a burning in part(s) of the mouth for a day or so before an ulcer appears.

• Minor aphthous ulcers are the most common. These are small, round, or oval, and are less than 10 mm across. These ulcers are pale yellow with red and swollen surrounding tissue. Between 1 to 5 ulcers may develop at the same time. Each ulcer lasts from 10 to 14 days, is not very painful and resolves without leaving a scar.
• Major aphthous ulcers occur in about 1 in 10 cases. These are 10 mm or larger. Usually only one or two appear at a time. Each ulcer lasts from two weeks to several months, and then resolves, leaving a scar. These ulcers can be very painful and eating and talking may become difficult.
• Pinpoint aphthous ulcers occur in about 1 in 10 cases. These are tiny, between 1 to 2 mm across. Many occur at the same time, but some may join together and form irregular shapes. Each ulcer lasts from 1 week to 2 months.

SYMPTOMS
The symptoms of a Mouth Ulcer depend on the cause but may include:
• A round sore or sores inside the mouth
•Swollen tissue around the sores
•Tenderness
•Problems with chewing or tooth brushing because of the tenderness
•Irritation of the sores by salty, spicy or sour foods
•Loss of appetite.

TREATMENT OPTIONS
As with all medical conditions your Doctor should be consulted for diagnosis and treatment. Most Mouth Ulcers are harmless and resolve without treatment within 2 weeks. Health management involves relieving the symptoms and protecting the ulcers from further irritation. Other types of Mouth Ulcers, such as the major aphthous variety, or those caused by herpes simplex infection, need medical treatment. Your Doctor may prescribe anti-inflammatory, anti-viral or anti-fungal drugs depending on the cause of the Mouth Ulcer. It is not possible to speed the recovery of Mouth Ulcers, but the symptoms can be managed and the risk of complications reduced.
The range of treatment options includes:
• Avoiding spicy and sour foods until the ulcers heal
• Drinking plenty of fluids
• Regularly rinsing your mouth out with warm, slightly salted water
• Keeping the mouth clean
• Taking pain-killing medication, such as paracetamol
• Applying antiseptic gel to the ulcers
• Using a medicated mouthwash
• Using steroid gels or tablets.

DIET HINTS
Mouth Ulcers are thought to occur from a low immunity and poor nutrition.
• A wholesome diet including plenty of fresh green vegetables is recommended. Foods should be only lightly cooked to keep the vitamin level high. Fresh fruits are also vital but some acid fruits, particularly citrus fruits, are not recommended as they may irritate the ulcers.
• Acidic and salty foods, for example vinegar, sugary foods, meats and coffee, should be eaten only in moderation.
• Garlic and onions can also be used in cooking.
• Foods high in B vitamins (particularly B5 & B12) may help the nervous system. These include beans, eggs, sprouts, currants, brewers yeast and vegetables.
• Natural unsweetened yoghurt, which contains acidophilus, may help healing and infection.

VITAMINS/MINERALS/HERBS
• A deficiency in iron, folic acid or vitamin B12 may increase the risk of Mouth Ulcers
• Vitamin C can be taken to stimulate the immune system.
• Zinc solution may be gargled to aid accelerate wound healing.
• Acidophilus bifidus may be taken to control microbial overgrowth in the gut. Microbial overgrowth may play a role in this condition. Acidophilus also aids in the absorption of the B vitamins.
• Echinacea may be taken for its immune stimulating properties.
• Vitamin A may be taken for its healing of mucous membranes properties along with calendula, which has, astringent and tissue healing properties.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. Use an antiseptic ulcer gel or an anti-inflammatory paste available at your Pharmacy. Ask your Pharmacist to recommend a suitable product.
3. A local anaesthetic mouthwash will help take away the pain of a Mouth Ulcer before eating.
4. Check for food reactions e.g., chocolate, wheat foods, dairy foods, and citrus fruits. Try to minimise stress. Stress is thought to promote the development of ulcers in the body.
5. Try using non-fluoride toothpaste with as little flavouring as possible. Some people may be sensitive to fluoride and/or artificial flavourings, which are added to many types of toothpaste.
6. Pain relief tablets (e.g., aspirin), should not be held in the mouth or placed in the area of the Mouth Ulcers before swallowing as the chemical may burn and damage the gums. Paracetamol has a less irritating effect on the mucous membrane, which lines the mouth and entire digestive tract.
7. If the diet is inadequate consider the supplements suggested in this topic. A deficiency in iron, folic acid or vitamin B12 may increase the risk of Mouth Ulcers Ask your Pharmacist for advice.

Aspirin should not be given to children under 16 years of age unless specified by a Doctor.