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DocSpot: Mouth ulcers

Dear Dr Margaret
I’m bothered with mouth and tongue ulcers from time to time. Someone told me it was poor oral hygiene which upset me very much. I visit the dentist regularly and he says I have healthy gums and perfect teeth and it could be a vitamin deficiency. Now my doctor has prescribed a steroid paste. I have been using this each time but the ulcers are never completely gone. I’m absolutely fed up. How can I get rid of the problem once and for all? I’m on HRT for the past 7 years. Could this be the cause?

You may be one of the unlucky 1-2% of the population who gets recurrent, ordinary mouth ulcers. The medical term for these is ‘aphthous ulcers’. Usually the problem starts in childhood or adolescence, and seems to get better in the 40s. Typically, the ulcers come in crops of one to five at a time. The mouth is remarkably good at healing, so the ulcers last for only 1-2 weeks. Then, a few weeks later, it happens again.
The cause is not known. In one in three sufferers, it seems to run in the family. A few people who constantly get aphthous ulcers are anaemic or short of iron, folate or vitamin B12. Your doctor could arrange for these to be checked on a blood sample. Zinc deficiency, food hypersensitivity and psychological stress have all been blamed for mouth ulcers, but specialists now think these are unlikely to be responsible. I cannot definitely answer your question about HRT, but I have never heard of this as a cause. On the other hand, a few women find that mouth ulcers are more likely before their periods, so hormones might perhaps have an influence.
I wish I could suggest a treatment to prevent the ulcers, but there isn’t one. The corticosteroid paste that your doctor has prescribed is the best treatment for getting rid of them, but of course it does not prevent them from occurring again. Apply it as soon as you suspect that an ulcer is forming. Dry the area with a tissue first, so that the paste sticks on. You could also try chlorhexidine gluconate mouth rinse which, in the UK, you can buy from a pharmacy without a prescription. Use it twice daily. There is some evidence that this may reduce the frequency and severity of recurrent aphthous ulcers.
Although ordinary aphthous ulcers are the most likely, there are other possibilities. Trauma from dentures that don’t fit properly is a common cause. Mouth ulcers can be part of several medical and skin conditions, so tell your doctor if you have any other symptoms, or if you have blisters or sores on any other part of your body. Of course, anyone with a mouth ulcer that does not go away in 3 weeks should see their doctor, because a persistent ulcer that refuses to heal could be cancerous.

Last updated; Sunday, August 30th 2020

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