Coping with mouth ulcers - myths and truth
Mouth ulcers can be painful - photo by stuartpilbrow
Mouth ulcers are an annoying and common problem, affecting as many as one in five people on a regular basis. They can occur at any age and, for some reason, women are more susceptible than men.
Most mouth sores have no obvious cause, and are known as aphthous ulcers (or canker sores). These appear singly or in a group on the inside of the cheek, typically behind the lower lip, and under the tongue. They are usually oval shaped with a grey centre and red surround and occur where the top layer of the mouth lining is missing. Despite their tiny size they are extremely painful, especially if you eat acid or salty foods. Although their exact cause is unknown, aphthous ulcers are more likely to appear during times of stress, and have also been linked with over-sensitivity to a common mouth bacterium, haemolytic streptococcus. They are identical to the 'worry' sores you can get on the tip of your tongue if you keep using it to explore a sharp piece of tooth. Most aphthous sores heal within seven to ten days.
Photo by digicla
Researchers from Norway have suggested that aphthous ulcers may be linked with sensitivity to a chemical, sodium lauryl sulphate (SLS) found in many brands of toothpaste. As it is a detergent, it is possible that SLS dries out the protective mucous membranes in the mouth so that irritants or infection can trigger ulceration. The researchers found that, when people with recurring mouth ulcers switched to using an SLS-free toothpaste, the number of mouth ulcers they experienced reduced by 70%, so this is worth trying if you are plagued with problems.
Mouth ulcers with a recognised underlying cause include cold sores, due to the Herpes simplex virus. Although cold sores are more common around the lips, they can cause widespread ulceration of the mouth during the first (primary) infection, especially in young children. Soreness can also result from a Candida infection, especially in children, the elderly and people with reduced immunity.
Mouth ulcers often accompany other health problems such as Coeliac disease (dietary sensitivity to gluten), inflammatory bowel disease, lack of white blood cells (neutropenia), and some autoimmune problems such as systemic lupus erythematosus (SLE), lichen planus and pemphigoid.
Occasionally, mouth ulcers are a side effect of medication - check with a pharmacist if this seems likely.
Any mouth ulcer or area of soreness that lasts longer than three weeks should always be checked by your doctor and, in most cases, investigated to exclude a mouth cancer.
Inspect your mouth regularly - photo by Llewleyn Williams
Other signs to look out for include a persistent white patch (leukoplakia) or a red velvety lesion (erythroplakia). These pre-cancerous changes may cause a slight burning sensation in the mouth, but most are painless. As the tumour develops, however, it will form a small, raised lump which eventually ulcerates or forms a deep crack. This may bleed and is usually quite painful. Mouth cancer now accounts for 5% of all tumours. Early diagnosis and treatment leads to a cure in three out of four cases but, sadly, many mouth cancers have grown quite large before they're picked up. Those that develop on the roof of the mouth or on top of the tongue are often spotted quickly, but those on the floor of the mouth, under the tongue or in the crevices at the back of the throat are difficult to detect in the early stages. Most mouth cancers are detected by dentists - an excellent reason for having a regular dental check-up, even if your teeth are perfect. It's also worth inspecting the inside of your mouth yourself from time to time - especially if you're over 40. Use a dental mirror to view the floor of your mouth, the sides and underneath of your tongue, and the gutters around your gums.
Pain-killing gels, mouthwashes and barrier pastes are available from pharmacies to help relieve pain. One of the most effective treatments is Gengigel, which contains a substance (hyaluronic acid) that can absorb up to 1000 times its own weight in water. This forms an effective barrier that rapidly stops pain - research shows it helps heal aphthous ulcers within 3 to 7 days.
Cranberry juice may help - photo by Julie Falk
Take a multivitamin and mineral supplement to help correct any nutritional deficiencies.
Substances with a natural anti-inflammatory action will help, such as flaxseed oil, evening primrose oil and omega-3 fish oil supplements.
When feeling run down, it's worth taking a herbal adaptogen such as Siberian ginseng or an immune stimulant such as Echinacea.
Probiotic bacteria may play a role in improving the balance of friendly bacteria found in the mouth, while preliminary evidence suggests that cranberry juice may prove effective in reducing gum disease. It contains substances called antiadhesins that help to stop potentially harmful bacteria from sticking to gums to trigger symptoms.
Sucking Zinc gluconate lozenges can improve sore throat and mouth ulcers.
Myths about ulcers
Mouth ulcers have attracted a lot of myths, perhaps because thy are so common and so painful.
Myth: Ulcers on the tip of your tongue are caused by telling lies
Myth: You can catch mouth ulcers from kissing.
True. Herpes cold sores are highly infectious and some people shed the virus without having signs of a sore. However, many adults are immune to the virus so don't let this put you off kissing (unless someone has an obvious cold sore, in which case postpone things 'til its fully healed).
Myth: Smokers are more likely to develop mouth sores
Don't be put off kissing - photo by Walt Stoneburner
True. Smoking reduces immune function in the mouth, and makes mouth ulcers more likely. Two recent studies also show that stopping smoking can bring them on. In one study, involving 1234 smokers, 40% developed mouth ulcers after quitting - mostly in the first 2 weeks. The problem was generally mild, and resolved within 4 weeks. The researchers say the lesions are a result of stopping smoking, and are not due to using smoking cessation medication.
Myth: Women are more likely to get them before their period.
True. Hormone changes and stress appear to make mouth ulcers more likely at this time of the month. Research from China suggests that acupuncture is an effective treatment for premenstrual mouth ulcers.
Myth: Mouth ulcers are due to a lack of certain vitamins or minerals.
True. Severe lack of vitamin C causes scurvy, one of the first signs of which is mouth ulceration and bleeding gums. This is now rare in the UK. Lack of iron and lack of B vitamins can also cause cracking in the corners of the mouth.
Myth: Eating crisps can cause mouth ulcers.
Possibly. You can cut your gums with a sharp piece of crisp, and the pain is aggravated by salt, so crisps can cause transient mouth ulceration (although this is unlikely to stop anyone wanting to eat crisps from doing so!)
Myth: You can treat mouth ulcers with a slice of pineapple.
True. This is an old remedy that works surprisingly well. Hold a piece of fresh pineapple against a mouth ulcer to hasten healing.
To read more articles by Dr Sarah Brewer, Editor of YourWellness magazine, visit www.yourwellness.com.