Mouth ulcers

Mouth ulcers can be caused by a myriad of reasons and I will take a careful history which combined with a meticulous examination can come to the correct diagnosis in the majority of cases.

What are the possible causes of mouth ulcers?

Common causes may include traumatic ulceration (e.g. from a sharp tooth) or recurrent aphthous ulceration (RAU, or aphthae). Aphthae are benign, inflammatory ulcers that typically appear in crops rotating around the mouth. The cause is unknown but they can be a nuisance for many patients. We may need to try to identify dietary precipitants and/or toothpastes that make things worse, to avoid these in the first instance. Treatments can include topical and systemic agents (e.g. steroids, immunosuppressants and tetracycline antimicrobials among others).

There is a link between RAU and stress and methods to counteract the latter can be expected to have a beneficial effect on the frequency and severity of oral ulceration in many patients. Aphthae can also be symptomatic of an underlying medical condition such as inflammatory bowel disease (e.g. Crohn’s disease).

Oral ulcers may also be seen in certain infections (e.g. herpangina, herpes simplex) and the pattern of these is often indicative of the diagnosis. Many of these are self-limiting conditions (i.e. they will resolve on their own and require no specific treatment).

Are there any more worrying causes of mouth ulcers?

Perhaps the most concerning differential diagnosis of mouth ulcers is oral cancer. These are relatively uncommon and will often have particular appearances (e.g. induration, rolled borders) but suspicion can come down to pattern recognition as a result of looking in thousands of mouths over many, many years. Ultimately, if I have a suspicion of this, I will arrange an urgent biopsy and appropriate staging scans before making a referral to my colleagues in Head and Neck in Birmingham and Solihull for timely treatment.