Mouth ulcers

• Mouth Ulcers


  Normally appear on the inside of the mouth, lips and cheeks (can be tongue as well)
• Mouth ulcers are not contagious
• Minor aphthous ulcers TREAT


  • Appear in crops of 1-5
  • Up to 5mm diameter
  • White/yellowish centre with inflamed red outer edge
  • Locations: gum, around the tongue, inside of the lips/cheeks
  • Symptoms last 7-14 days
• Major aphthous ulcers REFER


  • Uncommon
  • Appear in crops of up to 10
  • Can be as large as 30mm diameter
  • Locations: lips, cheeks, tongue, pharynx and palate
  • Symptoms can last up to 30 days
• Causes of mouth ulcers

  • Vitamin B12 or iron deficiency
  • Trauma: cuts/burns/spicy foods/ biting inside of cheek/poor fitting dentures
  • Hormonal changes
  • Genetics
  • Stopping smoking (initial symptoms)
• Refer criteria for mouth ulcers?

  • Ulcer that last longer than 3 weeks
  • Ulcer >10mm in diameter
  • Crops of more than 5 ulcers
  • Recurrent Ulcer - (suspect mouth cancer)
  • Weight Loss, Persistent recurrent diarrhoea
  • Medication causing mouth ulcers (NSAIDS, cytotoxic drugs (remember methotrexate), Sulfasalazine)
• Treatment for mouth ulcers : Local analgesics

  • Provide pain relief
  • Benzydamine (Difflam orał rinse >12yrs old)
  • Choline salicylate (Bonjela adult version >16 yrs old) - interacts with methotrexate/anticoagulants
• Treatment for mouth ulcers :Local anaesthetics

  • Provide pain relief (numbing)
  • Benzocaine (Iglu, Oragel)
  • Lidocaine (Anbesol)
• Treatment for mouth ulcers :Topical corticosteroids

  • Anti-inflammatory action
  • Hydrocortisone buccal pellets (>12 yrs old). DO NOT SWALLOW > BUCCAL
• Treatment for mouth ulcers: Chlorhexidine Gluconate

  > mouthwash prevents secondary bacterial infection and relieves pain

  > Can stain teeth brown, discolour the tongue & possible taste disturbance.

  >Brush teeth BEFORE use to counter staining
• Counselling for mouth ulcers

  > Avoid spicy foods and hot drinks until ulcer is healed

  > Use soft bristled toothbrush, Eat softer foods