Have you ever developed a white painful sore with red borders inside the mouth??

We all have suffered from ulcers in the mouth at sometimes or other. They are called as oral ulcers, better known as a mouth ulcer. However, they can be painful and extremely troublesome as they interfere with your eating habits.Oral ulcers are one of the most common complaints of the oral mucosa. These ulcers are painful round or oval sores that form in the mouth, most often on the inside of the cheeks or lips. They are usually white, red, yellow or grey in color and are inflamed (red and swollen) around the edge. Although these mouth ulcers can be uncomfortable, especially when you eat, drink or brush your teeth, they are harmless. They are different from cold sores which appear on the outer lips and are caused by virus. Eating becomes next to impossible and whatever little you try to ingest goes down very painfully. Stress has a big role to play on these ulcers appearing inside the mouth along with malnutrition.

Oral ulcers are characterized by a loss of the mucosal layer within the mouth. This loss may be acute or chronic, localized or diffuse. This is one of the most common oral problems presenting in primary care and can arise as a result of a number of disorders. Some of these relate to problems around the oropharynx but there is a wide variety of systemic disorders that can also give rise to these lesions.

These Oral ulcers are also known as Mouth ulcers, Canker Sores, Aphthous ulcer or recurrent oral ulceration.

What are Mouth Ulcers ?   

A mouth ulcer is a lesion that occurs on the mucous membrane of the oral cavity. They are breaks in the tissue lining of your mouth, often along the base of the gums or inside the cheeks or lips, but can form in the floor of mouth or on the tongue.  They can be painful, annoying and sometimes embarrassing interfering with eating, drinking, brushing and even talking. The pain from a mouth ulcer is caused because the nerves just below the surface of the lining of the mouth become exposed. Luckily most mouth ulcers are easy to treat.

These mouth ulcers are very common, particularly in women and young adults. Most people have one or two year. However, some people have mouth ulcers that come back regularly.

What are the Causes of Oral Ulcers ?

Main Causes of Oral Ulcers

Local Trauma:

• Injury from a toothbrush ( such as slipping while brushing)
• It can also be due to tongue or cheek biting, scratching with fingernails or eating rough foods.
• Constant rubbing against misaligned or sharp/ broken tooth.
• Constant rubbing against dentures or braces.
• Minor mouth injury from dental work, hard brushing, sports injury or accidental bite.
• Usually a single mouth ulcer.
• Also known as traumatic ulcer.

• Aphthous Ulcer:

  • These are also referred as canker sores, aphthous stomatitis, recurrent aphthous stomatitis (RAS), recurrent oral ulceration (ROU).
  • When there is number of mouth ulcers and they are coming back, this is called recurrent aphthous stomatitis.
  • This condition tends to start in childhood or adolescence and decrease in frequency/ severity with age.
  • They are not infective.
  • Around 40% of cases have a family history.

    Thermal Injury:

    • Thermal injury arises from mucosal contact with hot food or liquid.
    • Burns from eating hot food.
    • Palate is most commonly affected.
    • These injuries can also occur on the lip, tongue or oropharyngeal region.

    Chemical Injury:

    • This can be caused by improperly cleaned/ rinsed dentures.
    • These are associated with dentures usually occur in a line alone the gums.
    • They are usually more painful than mechanical ulcers.
    • Aspirin- leaving white plaques which slough off.
    • Bisphosphates – can also cause chemical burns if allowed to dissolve in the mouth rather than taken as instructed.

  • Systemic Causes of Oral Ulcers

    Oral Thrush

    • These are yeast infection that develops on the side of your mouth and on your tongue.
    • Common in infants and children.
    • Dry cracked skin at the corner of the mouth.
    • Soreness or burning in your mouth.  

  •  Oral Lichen Planus

    • It is a chronic inflammatory disorder affects gums, lips, cheeks and tongue.
    • White lacy raised patches of tissue in the mouth resemble spider webs/ tender swollen patches that are bright red and may ulcerate.
    • These are open ulcers may be bleed and cause pain while eating and brushing teeth.
    •  Other Symptoms- Sensitivity to hot, acidic or spicy food, burning sensation or pain, inflammation of the gums.

     Mouth Cancer

    • Cancer affect any of the working parts of the mouth or oral cavity including lips, cheeks, teeth, gums, front two-third of the tongue, roof and floor of mouth.
    • Ulcer, white patches/ red patches appear inside the mouth or on the lips that do not heal.
    • Other Symptoms- Weight loss, bleeding gums, ear pain and swollen lymph nodes in the neck.

    Other Causes for Oral Ulcers

    Burning Mouth Syndrome

    • This idiopathic condition is characterized by a burning sensation in the tongue or other parts of the mouth in the absence of medical or dental causes.
    • Exclude local and systemic factors such as xerostomia, infections, allergies, ill- fitting dentures, hypersensitivity reactions and hormone and vitamin deficiency.
    • Dryness and taste disturbance is also present.
    • More common in older adults.

     Geographic Tongue

    • It is often painless condition where spots or patches appear on the top and sides of the tongue.
    • It present with map-like red areas of atrophy of filiform tongue papillae.
    • The areas and patterns may change rapidly. The tongue is often fissured.
    •  
    • Lesions may be asymptomatic but can cause soreness.
    • Causes- smoking, chewing tobacco, spicy or acidic food, hot food, etc