Ulcers
What are recurrent mouth ulcers?
Ulcers are sores that appear inside the mouth and can be itchy or painful. A recurrent ulcer is one that comes and goes, sometimes every few weeks. They are different from cold sores, which appear on the outer lips and are due to a virus infection.


Are they common?
Yes. Over 60% of the population have recurrent oral ulcers at some time in their lives. Often they begin in childhood but most people grow out of them by their late twenties. In many cases several members of the family may suffer from these ulcers, which can be due to a family tendency and not to infection.


Where and how can they appear?
Minor ulcers can appear inside the cheeks, on the lips, tongue, gums and, more rarely, the roof of the mouth. Most of these ulcers (minor type) are the size of the top of a pencil and can sometimes come in clusters.

Large ulcers (major type) may appear near the tonsils and can be very painful, especially when swallowing. It is also possible to have up to 100 very small ulcers (herpetiform type). However these last two varieties are very rare.

You may get ulcers in other parts of the body e.g. eyes or genital area. It is important to tell your dentist about this.


How long do they last?
The ulcer is usually preceded by an itchy feeling at the spot where it is due to appear. After 6-24 hours an ulcer forms and can last 7-10 days. The very large ones usually take up to six weeks to heal.


What causes mouth ulcers?
Recurrent mouth ulcers cannot be caught by kissing or sharing drinks and utensils as they are not caused by an infection. They may be an autoimmune disease caused by the body attacking the cells lining the mouth. It has been suggested that the following factors have a role in causing mouth ulcers:

· Too little iron or a lack of vitamins, especially B12 and C, in the diet.
· Bowel disease such as Crohn’s disease or ulcerative colitis.
· Coeliac disease (gluten sensitivity).
· Hormonal changes; many women get ulcers at the time of their period.
· Stress
· Certain foods.

Should I worry about my ulcers?
No. Most ulcers heal up on their own. In order to reduce the pain from these ulcers it is important that you keep your mouth clean at all times. Use a diluted chlorhexidine mouthwash once daily. You can buy this in any chemist. Sprays and rinses are also available for pain relief. It is advisable to consult your dentist in case you need additional medications or if the ulcers persist.


What will the dentist do?
The dentist may refer you to have blood tests taken and will probably prescribe some form of medication to help the ulcer to heal faster and so reduce the pain. However these medications cannot stop the ulcers from appearing. Most are steroid based but are safe to use provided they are not swallowed. It is usually recommended to use them as soon as you feel an ulcer coming.

· Adcortyl in Orabase. Dry the area first with a cotton wool bud and then use a wet finger or a wet cotton wool bud to put the cream on the sore area. It is most effective to use this cream last thing at night as it stays there for longer. You can use it up to four times a day after meals. You may find it leaves a gritty feel in your mouth. You can buy this yourself
· Corlan Pellets are small, bitter tasting tablets that dissolve in your mouth releasing a drug that acts on the ulcer. Place it near the ulcer. You can buy these yourself and can use them four times a day
· Becotide spray is occasionally used for those areas of the mouth which are difficult to reach with other remedies. Use 2-3 puffs of the pump on the area that is sore. Do NOT breathe in at the time of puffing, hold your breath as you do not want the spray to go down into the lungs. You can use it up to four times a day.
· Bioplex is a non steroidal powder which you make up as a mouthwash in a quarter of a cup of warm water. Use up to four times a day.

Other medications can be prescribed by your dentist or specialist, if necessary.

If an ulcer fails to heal in three weeks, see a dentist who will refer you to a specialist if necessary.