Causes and treatment of ulcers in the mouth (Oral cavity)

Recurrent ulceration (Apthous Ulcer) in the oral cavity (Mouth)


Recurrent aphthous ulceration of unknown aetiology (reason) is a common oral mucosa disorder affecting 20% of the population. It consists of recurrent bouts of one or more rounded, shallow, painful ulcers recurring at intervals of days to a few months.

Minor aphthous ulcers are the most common. They are less than 10 mm diameter, have a grey/white centre with a thin erythematous (red colored) halo and heal within 14 days without scarring.

Major aphthous ulcers are larger (more than 20 mm diameter), often persist for weeks or months and heal with scarring.

Most patients with recurrent ulcers are otherwise well. Various nutritional deficiencies of iron, folic acid or vitamin B12 (with or without gastrointestinal disorders) are occasionally found.


There are no specific, effective therapies. Corticosteroids may lessen the duration and severity of the attacks. Chlorhexidine gluconate mouthwash, dapsone, colchicine, systemic steroids and azathioprine have all been used with variable effect.


Ulceration associated with other diseases

Oral ulceration is seen in gastrointestinal disorders, such as Crohn's disease, ulcerative colitis and coeliac disease in approximately 10-20% of cases. Other diseases associated with oral ulceration include lupus erythematosus (systemic and discoid), Behcet's disease, neutropenia and immunodeficiency disorders (HIV). In Reiter's disease, ulceration occurs in approximately 25-30% of patients.


Ulceration associated with dermatological disorders / Skin Diseases


Oral cavity is also a part of our skin so many skin disorders also produce lesion in the oral cavity as well. These include erythema multiforme major, toxic epidermal necrolysis, lichen planus, pemphigus vulgaris, bullous pemphigoid , epidermolysis bullosa and dermatitis herpetiformis.


Ulceration associated with viral infection

Herpes simplex virus. Primary herpes simplex (usually type I but rarely type II) presents with fever and widespread confluent painful ulcers. After resolution, the virus remains latent and recurs as herpes labialis (ulcers in the angle of the mouth) also commonly known as cold sores.

Other viruses. Herpes zoster and cytomegalovirus are among many viruses that can produce mouth ulceration, usually during the acute infective phase.

Ulceration associated with bacterial infection

Syphilis and tuberculosis can rarely cause oral ulcerations and are seen mainly in developing countries.

Ulceration associated with drugs

Certain drugs can cause oral lichenoid eruptions. They include antimalarials, methyldopa, tolbutamide, penicillamine and gold salts.

Traumatic Ulcers

Traumatic ulcers may be due to ill-fitting dentures, tooth brushing or lacerations by sharp teeth.

Neoplastic lesions (squamous cell carcinoma)

The majority of such ulcers develop on the floor of the mouth or lateral borders of the tongue. Early tumours may be painless, but advanced tumours are easily recognizable as indurated aphthous ulcers with raised and rolled edges.

Causative agents include tobacco, heavy alcohol consumption and the areca nut.

Intra-oral lesions which undergo malignant transformation include leucoplakia, lichen planus, submucous fibrosis and erythroplaki a (a red patch). The previous male predominance has declined. Treatment is by surgical excision and/or radiotherapy.