Mouth ulcers come in three main types: traumatic, cold-sore induced and
aphthous. Your doctor or dentist will be able to determine which type of mouth
ulcer you have just by looking at it - there are no medical "tests"
for determining the different types of ulcers.
Traumatic ulcers, caused by some trauma to the inside of the mouth, such as
bites, cuts and scalds, are large red areas with yellow centers, particularly
inside the cheeks.
Cold sores can produce mouth ulcers too. Mouth ulcers caused
by cold sores are white blister-like spots inside the mouth, which can sometimes
be accompanied by fever.
Aphthous ulcers are the most common type of mouth ulcer. They are also referred to
as oral ulcers, ulcerative stomatitis, and denture sores.
They are small,
creamy-white, painful raised areas appearing in the lining of the mouth, singly
or in clusters. Aphthous ulcers only form on the loose tissues of the mouth
(those areas where the skin is not tightly bound to the underlying bone). These
types of tissues include the skin found on the inside of the lips and cheeks,
the floor of the mouth, the tongue, the soft palate, and the tonsillar
Outbreaks of aphthous ulcers can range from being a simple annoyance to an intensely painful period which interferes with normal oral
activities.They can be expected to heal in between 4 and 14 days. Usually this healing
is uneventful and with no residual scaring.If, however, and ulcer has
become seriously infected, some permanent scaring may occur.
Once a person has initially experienced an outbreak of aphthous ulcers the
probability of their reoccurrence is high.
Aphthous ulcers usually first appear between the ages of 10 and 20 years and
then decrease in frequency and severity as a person matures.Women are more likely to experience aphthous ulcers than men.
The goal of treatment is relief of symptoms. The cause, if known, should be treated.
Gentle, thorough oral hygiene may relieve some of the symptoms.
Clean the area gently with a very soft brush and mild (1-1/2%) hydrogen peroxide or a warm salt water solution made by adding 1/2 teaspoon salt to a full glass of warm
Keep the area clean and clear of food scraps.
- Avoid hot or spicy foods, which often increase the pain of mouth ulcers.
- Avoid toothpastes which contain sodium lauryl sulfate. Most toothpastes contain
this foaming agent. Some research suggests that this agent may either cause mouth ulcers, or make them worse.
Dietary supplements of iron, folic acid and vitamin B12 for people deficient in them have
appeared to help in the curing of mouth ulcers.
Over The Counter Medications
There are many mouth ulcer treatments available over the counter in
pharmacies. Most of these contain a localised anaesthetic such as benzocaine, benzoin tincture, camphor,
phenolor or lidocaine and are applied directly to the ulcer. These treatments
often sting a little on application, but very shortly the area becomes numb. It
is a good idea to take extra care in eating and drinking while using these
medications, as it is much more easy to bite or scald yourself badly while you
cannot feel it. These medications are usually sold in a gel form.
Some over the counter medications for mouth ulcers create a protective
barrier over the mouth ulcer to stop irritating substances, particularly foods
and drinks, making them worse. These medications are usually in a paste form.
Some mouth ulcer medications also contain an pain-killing ingredient called choline salicylate which is related to aspirin.
If you are allergic to aspirin, check with your pharmacist that the medication
you are purchasing does not contain choline salicylate.
Some treatments for mouth ulcers contain antibacterials such as copper
sulfate and iodine, which are used to kill any bacteria which may be affecting
the mouth in general, or the ulcer in particular. Use of these medications can
protect the mouth ulcer against a secondary bacterial infection, as well as
speeding the healing. Antibacterial mouth ulcer treatments are sold alone, as
mouth washes, or as an added ingredient in the pain relieving treatments
Some mouth ulcer treatments contain an anti-inflammatory ingredient - usually
a corticosteroid - which helps soothe the ulcer's inflammation and speed
Some medications are sold which aid in the removal of accumulated debris on
the surface of the mouth ulcer. If the debris is alowed to build up, it can
inhibit the mouth ulcer's healing. The active ingredients which are most commonly found in these types of products
are carbamide peroxide, hydrogen peroxide, or sodium perborate monohydrate.
If you have had a mouth ulcer for more than forteen days, whether or not you have been treating it with over the counter medications, you should visit your doctor
, in case the ulcer has a more sinister
cause. He or she is likely to prescribe
one of the following medications:
Prescription medications for mouth ulcers are of two types. Some work to
limit the size of the ulcer, because the smaller the lesion is, the more quickly
it will heal, and some are antibacterial and work in the same way as over the
counter antibacterial mouth ulcer medications.
Size Limiting Medications.
Aphthasol (amlexanox) is a fairly new product and its sole intended usage is for the treatment of aphthous ulcers. The precise mechanism of action of Aphthasol is unknown but it has the effect of limiting the full extent to which a mouth ulcer's ulceration will progress.
Aphthasol is a paste. When it is applied it forms a film over a sore so to both hold the product's active ingredient in place and also to cover over and protect the canker sore's surface.
Kenalog in Orabase
Kenalog (triamcinolone acetonide) is a synthetic corticosteroid. Corticosteroids have anti-inflammatory properties and therefore can help to limit the full extent to which a mouth ulcer's ulceration will develop.
The Orabase aspect of this product is a paste specially designed to adhere to the surface of oral lesions. As used in this formulation, the Orabase creates a protective film over the canker sore which holds the Kenalog in place, and also covers over and protects the canker sore's surface.
Clinical studies at the National Institute of Dental Research have found that rinsing with the antibiotic tetracycline several times a day can reduce the pain associated with mouth ulcers and also speed up their healing. It is thought that tetracycline helps to prevent bacterial infections in mouth ulcers.
Peridex (chlorhexidine gluconate) is a prescription antibacterial mouthwash whose use has been shown to speed up the healing of canker sores.