Mouth Ulcers – How to Treat and Prevent Recurrent Aphthous Stomatitis

by L Matthews on January 29, 2018

prevent mouth ulcers treat aphthous stomatitisMouth ulcers can be very painful and may make it difficult to eat, drink, brush your teeth, or even speak. However, effective prevention and treatment of mouth ulcers has proven elusive. Have researchers in Israel finally found a way to prevent mouth ulcers, reduce pain, and help clear existing ulcers?

Prevent Mouth Ulcers

In a randomized, double-blind, placebo-controlled trial, 58 people with recurrent aphthous stomatitis (RAS) were given either a placebo or a daily sublingual dose of 1000 mcg of vitamin B12 for six months.



By the fifth and sixth months of treatment, the B12 group had a significant reduction in the duration of mouth ulcer outbreaks. They also had significant reductions in the number of ulcers, and the pain associated with the ulcers. What’s more, in the last month of the trial, three quarters (74.1%) of people in the B12 group were assessed as ‘no aphthous ulcers’. Just 32% of the placebo group were ulcer-free.

The improvement in mouth ulcers in the B12 group was the same regardless of original B12 status. This suggests that the effect of the sublingual B12 supplements was not connected to correcting an existing B12 deficiency.

Vitamin B12 is a low-cost, low-risk, easily accessible intervention that appears to be an effective way to prevent mouth ulcers and to reduce pain from mouth ulcers.

What are mouth ulcers?

Mouth ulcers are the most common type of oral mucosa lesion seen by primary care physicians. Around 1 in 4 people experience mouth ulcers. They are also known as recurrent aphthous stomatitis or canker sores.

Mouth ulcers can be painful and uncomfortable. They usually occur on the tongue, gums, soft palate, or in the cheeks. Ulcers vary in shape, size, and colour, although they are typically round, with a red border and a white or grey centre.

There are three main types of mouth ulcers:

  • Minor ulcers – usually 2-8 mm across. These normally go away in 10-14 days
  • Major ulcers – usually bigger, deeper, and with a raised border or irregular shape. These large ulcers can take weeks to heal and may cause scars to form
  • Herpetiform ulcers – a cluster of smaller, pinhead-sized, ulcers.

Most mouth ulcers are considered a minor annoyance. Some, however, can be accompanied by fever, swollen lymph nodes, and a general feeling of sluggishness. As they can make it hard to eat, drink, and brush your teeth, mouth ulcers may also lead to dehydration, malnutrition, and poor oral hygiene that results in infection.

Are mouth ulcers contagious?

In short, no, mouth ulcers are not contagious. However, a sudden outbreak of several ulcers in the mouth could indicate hand, foot, and mouth disease, which is contagious. This viral infection also causes a rash or sores on the hands and feet and is typically accompanied by a fever.


What causes mouth ulcers, and how to prevent them

There is no single cause for all occurrences of mouth ulcers. There are, though, many known factors that can trigger an outbreak.

The main cause of mouth ulcers seems to be irritation to the tissues in the mouth. Stress, certain foods, poor dental hygiene, and some medications or underlying health issues can also be factors in the appearance and recurrence of mouth ulcers.

Avoiding certain foods may help reduce or prevent mouth ulcers. Specifically, citrus fruits and acidic fruits and vegetables. Some common offenders include lemons, oranges, and pineapples, as well as tomatoes, papaya, apples, figs, and strawberries. These can also exacerbate existing ulcers.

Impaired immune function, malnutrition, and underlying diseases such as Celiac disease and Crohn’s disease have also been linked to mouth ulcers. Deficiencies in specific nutrients, including vitamin B12, zinc, folic acid, and iron appear to be linked to an increased risk of mouth ulcers.

Good dental hygiene helps to prevent mouth ulcers and reduce your risk of infection. Brush twice a day using a soft-bristled electronic tooth brush, and remember to floss! Avoid toothpaste and mouthwash that contains sodium lauryl sulphate as this can cause irritation and ulceration. Ill-fitting dental braces, dentures, or tooth guards can also cause mouth ulcers, as can tissue trauma from a dental check-up, mouth injury, or jagged tooth.

Unusual causes of mouth ulcers

Interestingly, mouth ulcers appear to be more common in people who have just quit smoking. This temporary increase in mouth ulcers is shortlived, however. There is no clear explanation for this phenomenon, although replacing cigarettes with gum may be one reason for an increase in mouth ulcers as chewing gum can cause irritation and ulceration.

Some medications may also cause mouth ulcers. These include common painkillers such as aspirin, as well as beta-blockers and medications for angina or chest pain. If mouth ulcers are causing you significant pain and discomfort, and you suspect that they are connected to your medications, it is essential to talk to your physician. Do not adjust your dose or stop taking medications without medical supervision.

Crunchy, sharp foods can also cause mouth ulcers, as can hot drinks. Common culprits include toast, chips, granola, and other types of food and drink that can cause tissue irritation. Try replacing these with softer foods and cooler drinks to help prevent mouth ulcers.

How to treat mouth ulcers

For the most part, mouth ulcers will stop being painful within a few days, and heal without treatment within 7-14 days. For persistent, large and/or painful sores, an antimicrobial mouth rinse or corticosteroid treatment can help alleviate pain and discomfort. In some cases, your dentist or physician may prescribe medication to reduce pain.

Unfortunately, there are some downsides to corticosteroid treatment for mouth ulcers. They can suppress immune function and leave you vulnerable to infection. And, overuse of corticosteroid ointments may affect the health of the mucous membranes in your mouth. In theory, this may make these tissues more easily irritated and prone to ulcers.

A natural antimicrobial mouthrinse containing oil of oregano and clove may help reduce pain from mouth ulcers and prevent infection. And, of course, it seems that a 1000 mcg vitamin B12 supplement may help prevent mouth ulcers if taken daily.

When to seek medical care for mouth ulcers

Most mouth ulcers do not require medical attention, do not indicate an underlying health issue, and resolve by themselves in a week or two. Some mouth ulcers do warrant medical attention, however. For instance, you should talk to your physician if you have unusually large sores, or sores that have not healed within three weeks. A long-lasting mouth ulcer may be a sign of mouth cancer.

You should also seek medical attention if you have severe pain from mouth ulcers, despite minimizing triggers and using over-the-counter analgesics. And, talk to your doctor if you are finding it hard to drink enough fluids or eat well, or if mouth ulcers occur in combination with a high fever.


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