Mouth Ulcers or Canker Sores – Causes, Types & Treatment

By Dr. Kanika Rana in Cancer Care

Feb 28, 2023

Mouth Ulcers Overview

Mouth ulcers, also widely called canker sores, are small painful lesions or sores that develop within the mouth or at the base of your gums. They typically develop in the soft tissue lining of your gums, tongue, inner cheeks, inside lips, or palate. Also called aphthous ulcers, these mouth ulcers are usually pink, red, or yellow in colour, depending on their manifestation stage.

While mouth ulcers are mostly harmless, they can be extremely uncomfortable for the affected person to eat, drink, speak, or open their mouth. They could even get worse by brushing their teeth as the bristles rub against the sores causing pain.

All mouth ulcers range in size and shape and their symptoms largely depend on the type of mouth ulcer the affected person has. Most mouth ulcers are harmless and non-contagious. They usually go away within 1-2 weeks, even without any treatment. However, if you’ve developed an unusually large mouth ulcer that is extremely painful, you should see a doctor or a dentist.

Mouth Ulcers Causes

Wondering what causes mouth ulcers? While mouth ulcers are those recurrent nuisances that don’t have any definite cause, there are certain risk factors and triggers that lead to their development. The exact cause of mouth ulcers is unknown and its reasons and symptoms vary from one person to another. Here are some common causes of mouth ulcers or canker sores:

Minor mouth injury incurred due to dental work-up like cavity filling
Injury while hard brushing
Sharp teeth
Accidental tongue bite while talking or eating
Allergic response to oral bacteria
Using abrasive or harsh toothpaste containing SLS
Wearing orthodontic braces and retainers that are poor-fitting
Emotional stress, anxiety, and lack of sleep
Any bacterial, fungal, or viral infection in the mouth like HFM (hand, foot & mouth disease, Herpes infection)
Sensitive response to certain acidic foods and beverages like strawberry, pineapple, chocolate, coffee, and citrus fruits (every person affected by mouth ulcers have distinct food triggers)
Nutritional deficiencies like vitamin B12, B9, zinc, iron, and more
Lack of sleep or disturbed sleep pattern
Hormonal changes during menstruation, menopause, puberty, and pregnancy
Response to certain medications like beta-blockers and painkillers
Genetic reasons

The above points are only a trigger of what can lead to the formation of mouth ulcers. The above points are mostly harmless and manageable. However, there are some other signs that can be a cause of something serious or any underlying condition. Such causes require medical attention and proper treatment, these include:

Irritable Bowel Syndrome (IBS), including ulcerative colitis
Celiac disease
HIV
Diabetes
Autoimmune diseases like lupus, oral lichen planus, and Behçet’s disease, pemphigus

Mouth Ulcers Symptoms

Ulcer symptoms may vary from one person to the other but there are some symptoms that are common to all. Its symptoms also depend on the cause of mouth ulcers. Let’s look at some of the common mouth ulcer symptoms:

Red, white, yellow, or pink sores that are painful
Sores developed on the inside of the mouth, cheeks, tongue, and gums
A red area surrounding the sores that looks like a red ring
Emanating pain from the sores that get even worse while talking, eating or drinking spicy, salty, or citrus foods and drinks
Take 1-3 weeks to heal without any treatment

You may typically have more than one mouth ulcer at the same time either in the same area or different. Mouth ulcers are typically non-contagious in nature unless they have developed due to an infectious disease like HFM.

Types of Mouth Ulcers

Standard and typical mouth ulcers are those that appear on the inside of the cheek and go away on their own within 1-3 weeks without any medical attention. Three main types of mouth ulcers are:

Minor Ulcers : Minor ulcers are categorised based on their size which can range from about 2mm to 8mm approx. These ulcers are generally less painful and clear away within 1-2 weeks without any treatment.

Major Ulcers : Major ulcers are usually bigger than the minor ones, have an indefinite shape, penetrate deeper into the tissue, and have a raised texture. These ulcers take longer to go away, more than 2 weeks and are highly likely to leave scar tissue once they heal.

Herpetiform Ulceration (HU) : Herpetiform ulcers, as the name indicates, have got their name from herpes because they resemble the appearance of sores as in herpes. They are usually a subtype of aphthous ulcers and are not contagious. HU ulcers have a tendency of recurrence and seem like the situation never heals.

Mouth Ulcers Diagnosis

Mouth ulcers are pretty easy to diagnose with a physical examination by the doctor. However, if you have a severe spread of mouth ulcers and doctors are suspecting it to be a viral infection, they may order certain medical tests and investigations to confirm the mouth ulcers diagnosis. Cases with recurrent and severe mouth ulcers are often backed up with certain investigations for diagnosis and treatment.

Mouth Ulcers Treatment

Most mouth ulcers are harmless, don’t require any mouth ulcer medicine, and heal on their own within 1-3 weeks. However, if you have this tendency of getting painful, severe, and recurrent ulcer breakouts, a bunch of treatment options and certain home remedies can reduce the pain and expedite the healing time and process. These treatment options include some home remedies to help you get rid of mouth ulcers fast:

Applying a paste made of baking soda to the ulcer
Using topical gels to ease the pain and discomfort
Rinsing the mouth frequently with salt and baking soda mixed water
Using a steroid-containing mouth rinse or mouth wash to reduce pain and inflammation
Applying ice to the ulcer
In cases of nutritional deficiencies, taking vitamin, zinc, and iron supplements help instead of taking antibiotics for mouth ulcers treatment
Applying over-the-counter topical numbing gels to reduce pain
Placing a wet tea bag on the ulcer

Preventing Mouth Ulcers

If you want to save yourself from the unpleasant and painful situation of that of a mouth ulcer, practising the following points below will help:

Identify your triggers and avoid them by all means. If there are certain foods and drinks that you know cause the formation of mouth ulcers, you can refrain from consuming them. These food items may include chips, nuts, acidic or citrus fruits, spicy food, and more. Each person has their own trigger, making note of them and avoiding them is the key.
Eat a well-balanced diet with fruits and vegetables. Choose to eat whole grains and avoid acidic fruits and veggies.
Include a multivitamin in your daily diet.
Identify certain medications that can cause mouth ulcers.
Refrain from talking while having your meals to avoid accidental tongue bites.
Reduce or avoid emotional stress and stress-induced eating.
Practice excellent oral hygiene by brushing twice a day and daily flossing.
Avoid toothbrushes with hard bristles and toothpaste containing SLS or alcohol.
Seek wax from your orthodontist to cover the braces having sharp edges.
Get plenty of sleep and adequate rest to avoid mouth ulcers and other illnesses.

While mouth ulcers aren’t a dangerous condition, living with them can be painful and uncomfortable. Fortunately, there is a multitude of mouth ulcer treatments available to ease the pain and discomfort. If you notice the following conditions, please see a doctor for mouth ulcers asap: