Oral Aphthous Ulceration
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.

They are common with over 60% of the population
suffering from recurrent mouth ulcers at some time in their

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 rather than being passed
by infection.

Where do they occur?

Small 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.

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
herpetiform type).  However, these last two types 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 / doctor
about this.
Photos of Oral Ulcers (Aphthæ)
How long do they last for?

The ulcer usually begins with 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 can take up to 6 weeks to heal (and often heal by scarring).

What causes mouth ulcers?

Recurrent mouth ulcers cannot be caught by kissing or sharing drinks and utensils,
as they are not caused by infection.

They may be an
auto-immune 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

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

Should I be worried about my mouth ulcers?

No.  Most ulcers heal up on their own.

In order to reduce the discomfort, it is important that you keep your mouth clean at
all times.  Use a diluted
chlorhexidine mouthwash once a day.  You can buy this at
any chemist.

Sprays, rinses and gels are also available for pain relief.

Consult your dentist / doctor if you think you need additional medication or if the
ulcers persist.

What can the Clinician do?

You may have a blood test taken and you will probably be prescribed some form
of medication to help the
ulcer 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 starting.

Other medications may be prescribed, if necessary.

Useful Websites:

Emedicine.com (Dermatology)

Emedicine.com (Ear, Nose & Throat)

Emedicine.com (Pædiatrics)

Mouth Ulcers

NHS Choices


Useful Articles:

British Medical Journal 2000.  ABC of Oral Health.  Mouth ulcers and other causes
of oro-facial soreness and pain.

BDJ 2005.  Nicorandil induced oral ulceration

BDJ 2005.  Oral Medicine — Update for the Dental Practitioner.  Aphthous and
other common ulcers

Oral Biosci Med 2005.  Clinical Assessment of Disease Severity in Recurrent
Aphthous Stomatitis

BMJ Clinical Evidence 2007. Recurrent Aphthous Ulcers

ENT News 2008. Mouth Ulceration

British Medical Journal 2009.  10-Minute Consultation.  Aphthous Ulcers.

Evidence-Based Dentistry 2009.  Vitamin B12 for the Treatment of Recurrent
Aphthous Stomatitis

BMJ 2010.  Evaluation of oral ulceration in primary care

BMJ Best Practice 2014.  Mouth Ulcers

BDJ 2014.  Content & Quality of Website Information on the Treatment of Oral

Dental Update 2015.  Clinical Challenges Q&A 11. Ulcers

Dental Update 2015.  Clinical Challenges Q&A 13. Painful Lip & Mouth Ulceration

Dental Update 2016.  Clinical Challenges Q&A 18. Oral Ulceration

Guy's & St Thomas' Oral Medicine Clinic.  Ulcer Severity Score Sheet
Last Updated 13th June 2017