Mouth ulcers are sores or open lesions in the mouth. (See also mouth sores or canker sores)

Oral ulcer; Stomatitis - ulcerative; Ulcer - mouth

Mouth ulcers are caused by many disorders. These include:

• Canker sores
• Gingivostomatitis
• Herpes simplex
• Leukoplakia
• Oral cancer
• Oral lichen planus
• Oral thrush

The skin lesion of histoplasmosis may also appear as a mouth ulcer.

Canker sores are more common in young adults than in children or older adults.

• Open sores in the mouth
• Pain or discomfort in the mouth

The appearance and exact location of lesions varies with the specific disorder.

A health care provider or dentist usually diagnoses the type of mouth ulcer, based on its appearance and location. Blood tests or a biopsy of the ulcer may be needed to confirm the cause.

The goal of treatment is to relieve symptoms. The cause, if known, should be treated.

Gentle, thorough oral hygiene may relieve some of the symptoms. Topical (rubbed on) antihistamines, antacids, corticosteroids, or other soothing preparations may be recommended for applying directly to the ulcer.

Avoid hot or spicy foods, which often increase the pain of mouth ulcers.

The outcome varies depending on the cause of the ulcer. Many mouth ulcers are harmless ( benign)and heal without treatment. Sometimes, mouth cancer first appears as an ulcer that won't heal.

• Cellulitis of the mouth, from secondary bacterial infection of ulcers
• Dental infections (tooth abscesses)
• Oral cancer
• Spread of contagious disorders to other people

Call for an appointment with your health care provider if your mouth ulcers don't go away after 3 weeks. Call for an appointment with your health care provider if mouth ulcers return frequently, or if new symptoms develop.

Good oral hygiene may help prevent some types of mouth ulcers, as well as some complications from mouth ulcers. Good oral hygiene includes brushing the teeth at least twice per day, flossing at least daily, and getting regular professional dental cleanings and examinations.

Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part I. Superficial mucosal lesions. Am Fam Physician. 2007;75(4):501-507.

Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part II. Masses and neoplasia. Am Fam Physician. 2007;75(4):509-512.

Gonsalves WC, Wrightson AS, Henry RG. Common oral conditions in older persons. Am Fam Physician. 2008;78(7):845-852.

Aphthous stomatitis

Most mouth sores are cold sores (also called fever blisters), canker sores, or other irritation caused by:

• Biting your cheek, tongue, or lip
• Chewing tobacco
• Braces
• A sharp or broken tooth or poorly fitting dentures
• Burning your mouth from hot food or drinks

Cold sores are caused by herpes simplex virus and are very contagious. Usually, you have tenderness, tingling, or burning before the actual sore appears. Herpes sores usually begin as blisters and then crust over.

The herpes virus can reside in your body for years, appearing as a mouth sore only when something provokes it. Such circumstances may include another illness, especially if there is a fever, stress, hormonal changes (such as menstruation), and sun exposure.

Canker sores are NOT contagious and can appear as a single pale or yellow ulcer with a red outer ring, or as a cluster of such lesions. The cause of canker sores is not entirely clear, but may be related to:

• A virus
• A temporary weakness in your immune system (for example, from cold or flu)
• Hormonal changes
• Mechanical irritation
• Stress
• Low levels of vitamin B12 or folate

For unknown reasons, women seem to get canker sores more often than men. This may be related to hormonal changes.

Less commonly, mouth sores can be a sign of an underlying illness, tumor, or reaction to a medication. Such potential illnesses can be grouped into several broad categories:

• Infection (such as hand-foot-mouth disease)
• Autoimmune disorders (including systemic lupus erythematosus)
• Bleeding disorders
• Malignancy(cancer)
• Immunosuppression (that is, when your immune system is weakened -- for example, if you have AIDS or are receiving medication after a transplant)

Drugs that may cause mouth sores include chemotherapeutic agents for cancer, aspirin, barbiturates (used for insomnia), gold (used for rheumatoid arthritis), penicillin, phenytoin (used for seizures), streptomycin, or sulfonamides.

Mouth sores generally last 10 to 14 days, even if you don't do anything. They sometimes last up to 6 weeks. The following steps can make you feel better:

• Gargle with cool water or eat popsicles. This is particularly helpful if you have a mouth burn.
• Avoid hot beverages and foods, spicy and salty foods, and citrus.
• Take pain relievers like acetaminophen.

For canker sores:

• Rinse with salt water.
• Apply a thin paste of baking soda and water.
• Mix 1 part hydrogen peroxide with 1 part water and apply this mixture to the lesions using a cotton swab.
• For more severe cases, treatments include fluocinonide gel (Lidex), the anti-inflammatory amlexanox paste (Aphthasol), or chlorhexidine gluconate (Periden) mouthwash.

Nonprescription preparations, like Orabase, can protect a sore inside the lip and on the gums. Blistex or Campho-Phenique may provide some relief of canker sores and fever blisters, especially if applied when the sore initially appears.

Additional steps that may help cold sores or fever blisters:

• Apply ice to the lesion.
• Take L-lysine tablets.

Antiviral medications for herpes lesions of the mouth may be recommended by your doctor. Some experts feel that they shorten the time that the blisters are present, while others claim that these drugs make no difference.

Call your doctor if:

• The sore begins soon after you start a new medication
• You have large white patches on the roof of your mouth or your tongue (this may be thrush or another type of lesion)
• Your mouth sore lasts longer than 2 weeks
• You are immunocompromised (for example, from HIV or cancer)
• You have other symptoms like fever, skin rash, drooling, or difficulty swallowing

Your doctor will perform a physical examination, focusing on your mouth and tongue. Medical history questions may include the following:

• Are the sores on your lips, gums, tongue, lining of your cheeks, or elsewhere?
• Are the sores open ulcers?
• Are there large, white patches on the roof of the mouth or on your tongue?
• How long have you had the mouth sores? More than 2 weeks?
• Have you ever had sores of this type before?
• What medications do you take?
• Do you have other symptoms like fever, sore throat, or breath odor?

Treatment may depend on the underlying cause of the mouth sore.

A topical anesthetic (applied to a localized area of the skin) such as lidocaine or xylocaine may be used to relieve pain (but should be avoided in children).

An antifungal medication may be prescribed for oral thrush (a yeast infection).

An antiviral medication may be prescribed for herpes lesions (although, some feel that this does not shorten the length of time that the lesions are present)

Anti-inflammatory medications may be prescribed for severe or persistent canker sores.

You can reduce your chance of getting common mouth sores by:

• Reducing stress and practicing relaxation techniques like yoga or meditation
• Avoiding very hot foods or beverages

You can avoid mechanical irritation by:

• Visiting your dentist right away if you have a sharp or broken tooth or misfitting dentures
• Chewing slowly
• Using a soft-bristle toothbrush

If you seem to get canker sores often, talk to your doctor about taking folate and vitamin B12 to prevent outbreaks.

If you get cold sores often, taking L-lysine tablets or increasing lysine in your diet (found in fish, chicken, eggs, and potatoes) may reduce outbreaks. Do NOT use L-lysine if you have high cholesterol, heart disease, or high triglycerides.

To prevent the spread of herpes sores, do not kiss or have oral sex with someone with a cold sore or fever blister. Do not participate in these activities when you have an active cold sore. Do not share razors, lip balm, toothbrushes, or lipsticks.

To prevent cancerous mouth lesions:

• Do not smoke or use tobacco.
• Limit alcohol to 2 drinks per day.
• Wear a wide-brimmed hat to shade your lips. Wear a lip balm with SPF 15 at all times.

Daniels TE. Diseases of the mouth and salivary glands. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 451.

Mouthwash overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this substance.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

Listerine overdose; Antiseptic mouth rinse overdose

• Chlorhexidine gluconate
• Ethanol (ethyl alcohol)
• Hydrogen peroxide
• Methyl salicylate

Many brands of mouthwash.

• Abdominal pain
• Burns and damage to the clear covering of the front of the eye (cornea)
• Coma
• Diarrhea
• Dizziness
• Drowsiness
• Headache
• Low body temperature
• Low blood pressure
• Low blood sugar
• Nausea
• Rapid heart rate
• Rapid, shallow breathing
• Skin redness and pain
• Slowed breathing
• Slurred speech
• Throat pain
• Uncoordinated movement
• Unconsciousness
• Unresponsive reflexes
• Urination problems (too much or too little urine)
• Vomiting (may contain blood)

Seek immediate medical help. Do NOT make a person throw up unless told to do so by Poison Control or a health care professional.

Determine the following:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

The health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive:

• Activated charcoal
• Breathing support, including a breathing tube
• Fluids through a vein (by IV)
• Kidney dialysis (in serious cases)
• Laxative
• Tube through the mouth into the stomach to wash out the stomach (gastric lavage)

You may be admitted to the hospital.

How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery. Drinking large amounts of mouthwash may lead to a syndrome similar to alcohol intoxication.