Mouth sores

Answer 1

DefinitionVarious types of sores can appear anywhere within the mouth, including the inner cheeks, gums, tongue, lips, or palate. Alternative Names

Aphthous stomatitis

Common Causes

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.

Home Care

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 health care provider if

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

What to expect at your health care provider's office

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.

Prevention

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.

References

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.

Answer 2

DefinitionDifferent types of sores can appear anywhere in the mouth, including the inner cheeks, gums, tongue, lips, or palate. Alternative Names

Aphthous stomatitis

Common Causes

Mouth sores may be caused by irritation from:

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

Cold sores are caused by the herpes simplex virusand are very contagious. Usually, you will have tenderness, tingling, or burning before the actual sore appears. Cold sores usually begin as blisters and then crust over. The herpes virus can live in your body for years. It only appears as a mouth sore when something triggers it, such as:

• Another illness, especially if there is a fever
• Hormone changes (such as menstruation)
• Stress
• Sun exposure

Canker sores are NOT contagious. They can appear as a single pale or yellow ulcer with a red outer ring, or as a cluster of these sores. Women seem to get them more than men. The cause of canker sores is not clear, but may be related to:

• A weakness in your immune system (for example, from the cold or flu)
• Hormone changes
• Stress
• Lack of certain vitamins and minerals in the diet, including vitamin B12 or folate

Less commonly, mouth sores can be a sign of an illness, tumor, or reaction to a medication. This can include:

• Autoimmune disorders (including systemic lupus erythematosus)

• Bleeding disorders
• Cancer of the mouth
• Infections such as hand-foot-mouth disease
• Weakened immune system -- for example, if you have AIDS or are taking medication after a transplant

Drugs that may cause mouth sores include aspirin, chemotherapy, penicillin, sulfa drugs, and phenytoin (used for seizures)

Home Care

Mouth sores often go away in 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:

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

For canker sores:

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

Over-the-counter medications, such as 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 first appears.

To help cold sores or fever blisters, you can also apply ice to the sore.

Call your health care provider if

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 infection)
• Your mouth sore lasts longer than 2 weeks
• You have a weakened immune system (for example, from HIV or cancer)
• You have other symptoms like fever, skin rash, drooling, or difficulty swallowing

What to expect at your health care provider's office

Your doctor will perform a physical examination, focusing on your mouth and tongue. You will be asked questions about your medical history and symptoms.

Treatment may include:

• A medicine that numbs the area when applied such as lidocaine may be used to relieve pain. This should be avoided in children.
• An antiviral medication to treat herpes sores (although some experts don't believe medication will make the sores go away sooner)
• Steroid gel applied to the sore
• A paste that reduces swelling or inflammation (such as Aphthasol)
• A special type of mouthwash such as chlorhexidine gluconate (such as Peridex)

Prevention

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

• Avoiding very hot foods or beverages
• Reducing stress and practicing relaxation techniques like yoga or meditation
• Chewing slowly
• Using a soft-bristle toothbrush
• Visiting your dentist right away if you have a sharp or broken tooth or misfitting dentures

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

To prevent cancer of the mouth:

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

References

Daniels TE. Diseases of the mouth and salivary glands.In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed.Philadelphia,PA: Saunders Elsevier; 2011:chap 433.

Reviewed By

Review Date: 11/13/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.