Treatment and Prevention of Aphthous Ulcers



Aphthous ulcers, also known as canker sores, are small, painful lesions that develop inside the mouth. They are quite common and can affect individuals of any age. Typically, these ulcers are round or oval, usually less than 1 centimeter in diameter, and are often white or gray with a red border. They can occur anywhere within the oral cavity, most commonly on the inside of the cheeks, lips, tongue, or gums.

Causes of Aphthous Ulcers

The exact cause of aphthous ulcers remains unknown, but several factors may contribute to their development, including:

  • Stress: A common trigger for aphthous ulcers.
  • Nutritional Deficiencies: Deficiencies in iron, vitamin B12, or folate can increase the risk.
  • Allergic Reactions: Certain foods or substances may provoke aphthous ulcers.
  • Autoimmune Diseases: Conditions like celiac disease or Crohn’s disease are sometimes associated with aphthous ulcers.

Treatment of Aphthous Ulcers

Most aphthous ulcers heal on their own within 10-14 days. However, several strategies can help alleviate the pain and discomfort:

  • Avoid Acidic Foods and Drinks: These can irritate the ulcers.
  • Over-the-Counter Pain Relievers: Medications like ibuprofen or acetaminophen can reduce pain and inflammation.
  • Topical Medications: Benzocaine or lidocaine can numb the pain.
  • Mouthwash: Helps kill bacteria and reduce inflammation.

For frequent or severe cases, consulting a doctor is advisable. Prescription medications can be more effective in treating or preventing aphthous ulcers.

Prescription Medications for Aphthous Ulcers

  • Corticosteroids: Anti-inflammatory medications that reduce ulcer size and pain.
  • Immunosuppressants: Used for severe or frequent aphthous ulcers unresponsive to other treatments.
  • Other Medications:
    • Antiviral Medications: Helpful for ulcers caused by viral infections.
    • Antibiotics: Useful for bacterial infections associated with ulcers.

Prevention of Aphthous Ulcers

While it’s challenging to prevent aphthous ulcers entirely, the following measures can reduce the risk:

  • Healthy Diet: Ensure a diet rich in fruits, vegetables, and whole grains to maintain a strong immune system.
  • Stress Management: Exercise, relaxation techniques, or spending time with loved ones can help manage stress.
  • Avoid Irritating Foods and Drinks: Steer clear of acidic, hot, or spicy foods.
  • Oral Hygiene: Brush and floss twice daily to remove plaque and bacteria.


Aphthous ulcers, though common and usually harmless, can be quite painful. By adopting certain habits and treatments, it’s possible to manage and reduce the frequency of these ulcers.

What are Aphthous Ulcers?

Aphthous mouth ulcers (aphthae), also known as canker sores or aphthous stomatitis, are ulcers that form on the mucous membranes inside the mouth. They are usually round and appear in soft areas like the inside of the lips, cheeks, or underside of the tongue. They are benign, non-contagious, and can appear singly or in clusters. Most often, aphthous ulcers recur, a condition known as recurrent aphthous stomatitis (RAS), with episodes typically lasting 7 to 10 days.

Good to Know

Aphthous ulcers are the most common type of mouth ulcers, but not the only kind. There are three main types:

  • Minor Aphthous Ulcers: The most common, small (less than 5 mm), and typically not very painful.
  • Major Aphthous Ulcers: Less common, larger (5 mm or more), can be painful and last from two weeks to several months.
  • Herpetiform Ulcers: Consist of multiple pinpoint lesions that fuse together to form large, irregular ulcers. Named for their resemblance to herpes, though not caused by the herpes virus.

Symptoms of Aphthous Ulcers

Before ulceration, a burning or itching sensation might be felt in the mouth. Once ulcers appear, localized pain of varying intensity is common. They start pale yellow and turn gray, often ringed or fully red when inflamed. Eating, drinking, and talking may become uncomfortable. In severe cases, symptoms like swollen lymph nodes, fever, and fatigue may occur, though this is rare.

Causes of Aphthous Ulcers

The exact cause is unclear, but potential triggers include:

  • Emotional Stress
  • Mouth Injuries: From cuts, burns, bites, dental work, or hard brushing.
  • Familial Tendency
  • Sodium Lauryl Sulfate: Found in some toothpastes and mouthwashes.
  • Certain Foods and Drinks: Including coffee, chocolate, eggs, cheese, acidic, or spicy foods.
  • Vitamin/Mineral Deficiencies: Zinc, B-12, folate, and iron.
  • Allergic Reactions: To oral bacteria.
  • Tobacco Use
  • Hormonal Changes: During pregnancy.
  • Weakened Immune System: Due to chronic conditions.

Good to Know

Dentists can recommend ways to reduce the risk of aphthous ulcers, such as using toothpastes and mouthwashes without sodium lauryl sulfate or advising on proper brushing techniques.

Medications Linked to Aphthous Ulcers

Certain medications may cause ulcers, including:

  • Nicorandil: Used for angina.
  • Ibuprofen and Anti-inflammatory Medicines
  • Oral Nicotine Replacement Therapy
  • Aspirin: If left to dissolve in the mouth.
  • Illegal Drugs: Like cocaine.

Recurrent ulceration can signal serious diseases like Crohn’s disease, celiac disease, Behcet’s disease, or HIV/AIDS. These are known as aphthous-like ulcerations.

Diagnosing Aphthous Ulcers

Diagnosis typically involves medical examination and history review. For recurrent ulcers, ruling out serious conditions through blood tests or less commonly, gastroscopy or colonoscopy, might be necessary.

Not to be used for advertising or in a defamatory context
Aphthous ulcer on the inside a 31 year old woman’s tongue. An aphthous ulcer usually occurs on a mucous membrane, inside a cheek or on the lips. The small painful sore lasts up to two weeks before disappearing. The cause is not fully understood. Treatment is with soothing ointments and painkilling drugs.

Complications of Aphthous Ulcers

Most ulcers heal within two weeks, but in rare cases, they may become infected. Antibiotic mouthwash and pain management may be prescribed, or oral antibiotics if necessary.

Aphthous Ulcers Treatment

There is no cure, but symptoms can be managed:

  • Avoid Hard or Irritative Foods: Such as pineapples.
  • Apply Cold Substances: To the affected area.
  • Use Numbing Preparations: Like topical lidocaine or benzocaine.

Other treatments may include:

  • Anti-inflammatory Treatment: Topical pastes for minor ulcers.
  • Antiseptic and Antibiotic Treatment: Antiseptic mouthwash or prescribed antibiotics.
  • Steroids: For unresponsive ulcers.
  • Other Treatments: Local anesthetics, silver nitrate, and nutritional supplements.

Home Remedies for Aphthous Ulcers

Popular home remedies include:

  • Salt Water Rinses
  • Baking Soda Solution
  • Milk of Magnesia Application
  • Ice Chips or Cubes
  • Teething Ointments
  • Reducing Stress
  • Avoiding Hard Foods
  • Nutritional Supplements: Like Vitamin B-12, Vitamin D, folate, or zinc.

Prevention of Aphthous Ulcers

To reduce the risk of outbreaks:

  • Avoid Trigger Foods
  • Maintain a Healthy Diet
  • Good Dental Hygiene: Use a soft toothbrush.
  • Reduce Stress and Get Adequate Sleep

Aphthous Ulcers Prognosis

Aphthous ulcers are generally non-serious and resolve without treatment. Persistent ulcers lasting longer than three weeks should be evaluated by a doctor, as they may indicate oral cancer.

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