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That Oral Ulcer Could Be A Sign Of Something More Serious

We all get the occasional minor mouth ulcer that annoys us for a few days before disappearing. But w...

We all get the occasional minor mouth ulcer that annoys us for a few days before disappearing. But what if you have a mouth ulcer that just won't go away or keeps coming back? That small sore could potentially be a sign of a more serious systemic disease.
Oral ulcers have a wide range of underlying causes - from vitamin deficiency to viral infection to autoimmune disease. While most solitary ulcers are harmless canker sores, it's important to recognize when a mouth sore needs medical evaluation.

a close-up of a child with aphthae lip

What Diseases Can Cause Oral Ulcers?

Here are some conditions that may first become apparent as unexplained mouth ulcers:

Autoimmune Diseases

Several autoimmune disorders are associated with painful ulcers in the mouth. Behçet's disease specifically causes ulcers in the mouth and genitals. Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis frequently manifest with oral ulcers before bowel symptoms start. Mouth ulcers can also be the initial presentation of lupus, Sjogren's syndrome, and celiac disease.

Viral Infections

Oral ulcers are a classic symptom of infection with herpes simplex virus-1, the culprit behind cold sores. But mouth ulcers can also develop during infection with coxsackievirus, Epstein-Barr virus (which causes mononucleosis), varicella-zoster virus, and HIV. These viral ulcers appear as clusters of small sores.

Oral Cancer

Unexplained mouth ulcers are a red flag for oral cancer, especially in older adults who smoke or frequently drink alcohol. Persistent ulcers that don't heal within 2 weeks warrant an urgent oral cancer screening. Catching it early is crucial.

Oral Lichen Planus

This chronic inflammatory condition affects the mucous membranes inside the cheeks, gums, tongue, and lips. It produces lacy white patches as well as painful ulcerated lesions. Oral lichen planus increases gum recession and tooth decay risk if not treated.

a selective focus of a child who has an oral ulcer

Medication Side Effects

Certain medications list mouth ulcers as a potential adverse effect. Chemotherapy drugs, NSAIDs like aspirin, and bisphosphonates used for osteoporosis can cause ulceration of the delicate oral tissues. This tends to resolve after stopping the medication.

Nutritional Deficiencies

Low levels of key nutrients, including iron, folate, vitamin B12, and zinc, can make the lining of your mouth more prone to ulceration. Even a short-term deficiency in one of these nutrients can quickly lead to the development of mouth ulcers.

When is a Mouth Ulcer a Concern?

See your dentist or doctor promptly if you have a mouth ulcer that:
A. Lasts longer than 2 weeks without healing
B. Is very large or painful
C. Has irregular, blurred borders and base  
D. Is worsening or spreading
E. Keeps recurring frequently  

Asian woman has Aphthous ulcer or Canker sore on the mouth at the lip

Diagnostic Steps and Treatment

When an oral ulcer requires medical evaluation, the first step will be a thorough visual inspection of the lesion by your dentist or doctor. They will note details about the size, location, color, and any irregular borders.
They will also take a comprehensive health history, asking questions about your symptoms, any pain levels, the duration of the ulcer, whether it's a recurring problem, and any remedies you've tried. Your medication list will be reviewed as well, including prescription drugs, supplements, and over-the-counter medications, to identify any that could be contributing to ulceration.
Underlying medical conditions like autoimmune diseases will be discussed during this assessment. After the initial clinical evaluation, your doctor may order some laboratory tests, like complete blood count, nutrient levels, and viral screens, to uncover any systemic issues causing the mouth ulceration.
More extensive blood work to look for autoimmune antibodies may also be undertaken. If there are any worrisome characteristics of the oral ulcer, a biopsy is sometimes warranted to rule out oral cancer as a potential cause.

Asian woman has Aphthous ulcer or Canker sore on the mouth at the lip

Treatments will depend on the cause but may include these points.

When an underlying condition is treated properly, the troublesome oral ulcers generally disappear.

● Using patches, like Ulceloocin oral ulcer patches, in the early stages of canker ulcers can greatly prevent further deterioration.

● Using a topical steroid mouthwash or taking steroid anti-inflammatory medication orally for a brief period can help decrease the swelling and discomfort associated with mouth lesions.

● Your dentist or doctor may prescribe an oral antiviral medication to be taken daily for a week or longer if lab results indicate the mouth ulcer is caused by herpes simplex virus, varicella-zoster virus, or another treatable viral culprit that needs medication.

● For recurrent mouth ulcers stemming from an overzealous autoimmune reaction, a physician may decide to prescribe an oral immunosuppressive medication like cyclophosphamide, mycophenolate mofetil, or tacrolimus to be taken regularly in order to suppress the immune system activity causing the lesions.

● In cases where medication is clearly the culprit behind recurrent oral ulcers, your dentist or doctor will try to have you stop taking that medicine under medical supervision if it is safe and feasible to do so, allowing the mouth sores to resolve.

General Oral Care Tips

Practicing good oral hygiene and avoiding irritants can help prevent ulcers or minimize aggravation:

● Use a soft toothbrush, which should be replaced every 3 or 4 months, and brush all surfaces - front, back, top, and between teeth gently

● Avoid highly acidic, salty, spicy, or abrasive foods, and drink plenty of plain water to produce saliva, which naturally rinses your mouth.

● Rinse your mouth with water after eating any meal or snack to help clear away food particles and debris that can get caught in your teeth.

● Avoid picking at the ulcer or prodding it with your tongue because that unnecessary irritation and manipulation will disrupt the localized healing and result in delayed recovery.

a front close-up view little boy cleaning his teeth

Final thoughts

While the majority of mouth ulcers that crop up are minor and ultimately harmless canker sores, any unexplained oral ulceration that persists longer than normal or keeps recurring should not simply be dismissed.
These types of ulcers that don’t follow the typical pattern you expect can sometimes act as early indicators of an underlying systemic disease that requires prompt medical care and attention. It’s important to carefully pay attention to any changes going on in your mouth – don’t just brush off your oral ulcers as normal. View them as important clues related to your overall health status, and make sure to get checked out if you notice anything unusual.
Catching a developing health issue in its early stages by recognizing and acting on the signs of abnormal mouth ulcers can help you stay ahead of more serious problems and achieve the best outcome. So stay vigilant about what’s happening inside your mouth, and don’t ignore unusual ulcer symptoms.
Don't delay in getting medical attention - early assessment and treatment will allow you to stay ahead of problems before they worsen. If you need any guidance, Yenssen is here to assist.

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