The most annoying complaint of mouth is ‘mouth ulcer’ and it is the most common complaint often left untreated.

Mouth ulcer is an inflammatory and ulcerative condition of the mouth. It is medically termed as stomatitis or apthous mouth or canker sores. It is mostly superficial, shallow and non contagious. The sores are usually small, occurring in the oral mucosal lining, due to irritants or infection. It often has the tendency to recur with the precipitating factors. It occurs commonly in lips, cheeks and tongue as oval or round whitish or yellowish or grayish ulcer surrounded by reddish mucous membrane. The ulcers, on treating with medicines, or on its own go off in a week, without leaving any scar.

Incidence - Even though it can occur in all age groups, its peak incidence is during the adolescent period, irrespective of the sex of the individual. At least 25 per cent of the people would have suffered from it at one time or the other. The incidence of mouth ulcer is also found to be more common in the urban than in the rural areas due to its relationship to habits of food, sleep and a tense life. Exam-going students often suffer from this complaint due to tension and sleeplessness.

Causes of mouth ulcer – In many cases, the causes remain unknown. Stress is supposed to be the major causative factor. Nowadays fast foods, carbonated drinks and preservatives-added, tinned foods add fuel to a hurried life to produce ulcers. Some relate it to the moon’s phases and some with exams, some with sleeplessness and some with menses. The bacterial infections (fever of scarlatina), viral infection – Herpes Simplex (gingivo stomatitis) and fungal infection – Candida (thrush) - can also resemble mouth ulcers in its initial stages.

The common external and internals factors which favour mouth ulcers are

External factors

• Unhygienic food or conditions
• Mechanical injuries from any hard food substances, cheek biting, sharp- edged teeth, dentures, etc. Many a time, patients are reluctant to replace older dentures and suffer from constant dental stomatitis.
• Foods - spicy, salty and hot foods (with a lot of chillies) can cause ulcers. Likewise sour foods and sour fruits / juices can cause ulcers – orange, lemon, pine apple, etc.
• Habit of smoking and drinking alcohol
• Chemical toothpaste which has toxic chemicals can cause mouth ulcers
• Drugs - Pain killers and Non Steroidal Anti-Inflammatory Drugs (NSAIDs)

Internal factors

• Mind - Stress, anxiety and worries can cause mouth ulcers
• Deficiency of vitamins, minerals and zinc
• Diseases - Systemic lupus erythematosus, AIDS, cancer, tuberculosis, diabetes, etc.

Symptoms – Depending upon the size, number, location, intensity and duration, the presenting features of mouth ulcers may vary. Clinical presentation of mouth ulcers may be usually single or clusters of shallow, whitish or pale or yellowish punched out ulcers with surrounding reddish swollen mucous membrane. The common symptom is burning and throbbing pain in the ulcers with difficulty in mastication or swallowing. There will also be excessive salivation with foul odour. Lymph node enlargement can also be noticed sometimes. Fatigue, fever, burning eructations, constipation or diarrhoea may also follow mouth ulcers.

Site or location – Depending upon the cause, the site varies. In dental stomatitis, it will be seen as delineated mucousal oedema due to the scratching of dental appliances on the roof of the mouth or on pressure spots. In case of cheek biting, it will be seen in the centre of the inner cheek. In case of bacterial or viral infection, it can be seen anywhere in the mouth. The commonest spots are inner lip (lower - more common), inner cheek, floor of the mouth and gums occasionally.

Size – The size usually varies depending upon the duration, i.e. from a dot to 1cm.

Character – The ulcers are mostly superficial, and they are painful only during intake of food. But sometimes they will be deep and very painful all the time.

Duration – Most ulcers heal within 5-7 days or at the maximum get cleared within 14 days. If it persists longer, it should be seriously investigated to rule out other serious illnesses.

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