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Most people experience mouth ulcers from time to time, some more frequently than others. Also known as aphthous ulcers or canker sores, they can be painful and uncomfortable, especially when talking, eating, drinking, or brushing your teeth.

Symptoms

Mouth ulcers are usually small (less than 5mm), painful sores that appear inside the mouth—on or under the tongue, inside the cheeks, or on the lips or gums. They are typically white or yellowy-grey with a red border. You may feel a burning or tingling sensation before an ulcer appears.

Most mouth ulcers heal without treatment within 1 to 2 weeks, but see a doctor if you:

• Have unusually large or painful ulcers
• Have ulcers that recur frequently
• Experience ulcers lasting more than 2 weeks
• Have ulcers alongside fever, fatigue, or swollen lymph nodes
• Have multiple ulcers and are taking immunosuppressant medication

Causes

Mouth ulcers occur more often in teenagers and young adults, and they are more common in females than males.

The exact cause is unknown, but there are several factors that may trigger one or make you more susceptible, including:

• A minor injury, for example from biting the inside of your cheek, brushing your teeth too hard, or ill-fitting dentures or braces
• Insufficient sleep
• Stress and anxiety
• Nutritional deficiencies (e.g. vitamin B12, iron, folate)
• Food sensitivities (e.g. acidic, spicy, or rough foods)
• Hormonal changes
• Viral infections or illness
• Some medications (e.g. non-steroidal anti-inflammatory drugs or beta blockers)
• Autoimmune or gastrointestinal conditions (e.g. coeliac disease or Crohn’s disease).

Lifestyle options

Mouth ulcers generally heal on their own without treatment in about a week or two, but you can reduce discomfort and support healing by:

• Avoiding spicy, salty, or acidic foods
• Using a soft toothbrush and brushing gently
• Rinsing your mouth with saltwater or an antiseptic mouthwash
• Drinking cool liquids and avoiding alcohol and tobacco
• Managing stress with relaxation techniques

Maintaining good oral hygiene is important in preventing recurrence.

Pharmacy options

Always inform pharmacy staff if you are taking other medicines or have existing medical conditions, because not all medications are compatible.

Pharmacy products that may help include:

• Antiseptic or antibacterial mouthwashes, a good choice is an alcohol-free medicated product which contains chlorhexidine
• Protective pastes are used to cover and soothe ulcers. Some contain an anti-inflammatory medication triamcinolone which provides pain relief and promotes healing
• Anaesthetic and anti-inflammatory lozenges, gels, rinses or sprays: May relieve the pain. These contain ingredients such as benzydamine or lidocaine
• Vitamin or mineral supplements, such as B12, folate and iron, may be useful if you have a deficiency

Note: Topical preparations that contain salicylates may increase your pain and discomfort.

Your pharmacist can help identify the most suitable treatment and advise whether a medical review is needed.

More information

Health Direct: www.healthdirect.gov.au/mouth-sores-and-ulcers

Mayo Clinic: www.mayoclinic.org/diseases-conditions/canker-sore

Disclaimer: The information provided is a guide only, is current at time of publishing, and is not intended to replace the advice of your pharmacist or doctor.

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