MOUTH ULCER / ORAL ULCER / MUCOSAL ULCER

 A mouth ulcer is an ulcer that occurs on the mucous membrane of the oral cavity.

The two most common causes of oral ulceration are local trauma (e.g. rubbing from a sharp edge on a broken filling or braces, biting one's lip, etc.) and aphthous stomatitis ("canker sores"), a condition characterized by recurrent formation of oral ulcers for largely unknown reasons.

EROSION : is a superficial breach of the epithelium, with little damage to the underlying lamina propria. 

MUCOSAL EROSION: is an erosion which specifically occurs on a mucous membrane. 

EXCORIATION: is a term sometimes used to describe a breach of the epithelium which is deeper than an erosion but shallower than an ulcer.

ULCERATION:  is a break in the skin or mucous membrane with loss of surface tissue and the disintegration and necrosis of epithelial tissues.

Diagramatic representation of mucosal erosion (left), excoriation (center), and ulceration (right)

CAUSES:

  • accidentally biting the inside of your cheek.
  • injury from a toothbrush (such as slipping while brushing)
  • constant rubbing against misaligned or sharp/broken teeth.
  • constant rubbing against dentures or braces.
  • burns from eating hot food.
  • irritation from strong antiseptics, such as a mouthwash
  • viral infections 
  • reaction to certain medications
  • skin rashes in the mouth (for example, lichen planus)
  • underlying vitamin or iron deficiency
  • underlying gastrointestinal disease 
SYMPTOMS:
  • one or more painful sores on part of the skin lining the mouth
  • swollen skin around the sores
  • problems with chewing or tooth brushing because of the tenderness
  • irritation of the sores by salty, spicy or sour foods
  • loss of appetite

TREATMENT:

Most mouth ulcers are usually harmless and resolve by themselves within 10 to 14 days. Other types of mouth ulcers, such as the aphthous variety or those caused by herpes simplex infection, need topical treatment such as a mouthwash, ointment or gel.

Treatment options for mouth ulcers include:

  • using a rinse of saltwater and baking soda
  • placing milk of magnesia on the mouth ulcer
  • covering mouth ulcers with baking soda paste
  • using over-the-counter benzocaine (topical anesthetic) products
  • applying ice to canker sores
  • using a mouth rinse that contains a steroid to reduce pain and swelling
  • using topical pastes
  • placing damp tea bags on your mouth ulcer
  • taking nutritional supplements like folic acid, vitamin B-6, vitamin B-12 and zinc
  • trying natural remedies such as chamomile tea, echinacea, myrrh and licorice root 
  • Use an alcohol-free medicated (preferably containing chlorhexidine gluconate) mouthwash twice daily.
  • Use a topical steroid mouthwash or ointment – this is generally prescribed by your dentist or oral medicine specialist. If required in severe cases, immunosuppressant medication may be prescribed by your oral health professional.

PREVENTION:

  • avoid very hot foods and drinks.
  • chew slowly.
  • use a soft toothbrush and practice regular dental hygiene.
  • see your dentist if any dental hardware or teeth may be irritating your mouth.
  • decreased stress.
  • eat a balanced diet.
  • reduce or eliminate food irritants, such as hot, spicy foods.

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