Mouth Ulcers

Mouth ulcers, also known as aphthous stomatitis or canker sores, are among the most common diseases affecting the mouth. They typically present as painful, round or oval ulcers with a yellow-white center and a red inflammatory border. Although they are usually benign and self-limiting, recurrent episodes can significantly affect eating, speaking, and quality of life.

Causes and Risk Factors

The exact cause of recurrent mouth ulcers remains unclear. Current research suggests that it results from a complex interaction of genetic susceptibility, immune dysregulation, and environmental triggers. 

Factors associated with ulcer development include:

• Local trauma (e.g., accidental cheek biting or sharp teeth)
• Psychological stress
• Nutritional deficiencies, particularly iron, folate, zinc and vitamin B12
• Hormonal changes
• Food sensitivities
• Certain systemic conditions, such as inflammatory bowel disease, coeliac disease, and Behçet’s disease

Three clinical forms are recognised

1. Minor aphthous ulcers – the most common type, usually less than 10 mm in diameter and healing within 1/2 weeks without scarring.
2. Major aphthous ulcers – larger, deeper ulcers that may persist for several weeks and can heal with scarring.
3. Herpetiform ulcers – numerous small ulcers that may merge into larger lesions. Despite the name, they are not caused by the herpes virus.

Diagnosis is primarily clinical and based on patient history and examination. Persistent, unusually severe, or frequently recurring ulcers warrant further investigation to exclude underlying systemic disease or nutritional deficiencies. There is no specific laboratory test for RAS. 

Treatment focuses on reducing pain, promoting healing, and decreasing recurrence.

Current evidence supports:

1. Topical corticosteroids as first-line therapy for reducing inflammation and symptom severity.
2. Chlorhexidine mouth rinses to reduce secondary infection and improve comfort.
3. Protective pastes, topical analgesics, and anti-inflammatory agents for symptom control.
4. Investigation and correction of underlying nutritional deficiencies when identified.
5. For severe or refractory cases, specialist management may involve systemic medications under medical supervision.

Mouth ulcers are a common and often painful oral condition with a multifactorial origin. While no definitive cure currently exists, evidence-based treatments can effectively reduce symptoms and improve patient quality of life. Dental professionals play a key role in diagnosis, identification of contributing factors, and implementation of appropriate management strategies.