Mouth Ulcers

What is a mouth ulcer?

A mouth ulcer is a loss of part of the mucous lining of your mouth. Most single mouth ulcers are the result of minor trauma (e.g., accidentally biting yourself while eating) and will heal within a week or two. Although troublesome and painful, these ulcers are usually benign and are no cause for worry.

Recurrent or non-healing mouth ulcers

Some people develop ulcers in the mouth that keep coming back. Although in many cases the cause is not clear, certain underlying medical conditions can predispose a person to having recurrent ulcers.

Could non-healing mouth ulcers be cancerous, and when should you see a doctor?

If an ulcer fails to heal within 2-3 weeks, it is important to have it evaluated by a doctor. In some instances, these ulcers can turn out to be cancerous. 

If you smoke, drink alcohol or chew betel nuts, you are at a higher risk of developing mouth or tongue cancers. However, even if you do not smoke, drink alcohol or chew betel nut, it is still important to see a doctor if your ulcer fails to heal after 2-3 weeks as it may still be a cancerous ulcer.

What causes mouth ulcers?

Mouth ulcers can be caused by the following:

1. Viral infections
   The Herpes Simplex Virus causes cold sores. The virus causes painful ulcers that are usually located over the lips or mouth. Although the ulcers may recover, the virus usually lies dormant (inactive) but can be activated by various triggers such as stress, or in women, their menstrual period. Other virus such as the Coxsackie, Varicella and HIV viruses can also cause mouth ulcers.
   
2. Nutritional deficiencies
   Deficiencies of certain vitamins (e.g., vitamin B12) and minerals (e.g iron, folate) can also predispose a person to recurrent ulcers.
   
3. Medications
   Certain medications can cause ulcers as a side effect. These include drugs such as bisphosphonates (used for osteoporosis), NSAIDs (a class of pain-killer), beta-blockers and certain cytotoxic drugs.
4. Inflammatory bowel disease
   Patients with inflammatory bowel disease, especially those with Crohn’s disease, may also develop recurrent mouth ulcers.
5. Behçet’s Disease
   Behçet’s disease is a poorly understood disease that causes inflammation of the blood vessels throughout the body. Patients may develop recurrent mouth ulcers, eye inflammation, skin rashes as well as genital sores.
   
6. Connective tissue diseases
   Patients with connective tissue diseases such as systemic lupus erythematosus (SLE), reactive arthritis and Sweet’s syndrome (rare skin disease, characterised by fever and appearance of tender solid red lumps).