Recurrent Oral Ulcers: Causes and Treatment Options

Recurrent oral ulcers?

Hello Doctor: My 53-year-old mother has diabetes and hypertension, and she has been troubled by recurrent oral ulcers lately.
She has wounds on both sides of her cheeks and around her lips.
Initially, we thought it was just a simple mouth sore that would heal after a while, but the ulcers have lasted nearly two weeks.
Applying ointment even seems to delay the healing process.
On average, she experiences a recurrence once a month, and during severe episodes, it affects her ability to eat.
Recently, the oral ulcers have been accompanied by red, itchy rashes on her body.
When we consulted a dermatologist, they suggested it could be vasculitis.
Subsequently, we visited a Chinese medicine family practice in Taichung, where we were advised to see a rheumatologist for blood tests, but the results came back normal, and we were told it was unrelated to that specialty.
We also went to the oral surgery department at a Chinese medicine hospital, but they were unable to determine the cause.
This condition has been a persistent issue for my mother, so we would like to know which direction we should seek assistance in now.
Thank you.

YJ, 10~19 year old female. Ask Date: 2016/08/16

Dr. Ji Zhaoyun reply Otolaryngology

Hello YJ, most oral ulcers heal within two weeks after treatment.
If the ulcer persists beyond two weeks, further examination is necessary to rule out 1) malignant lesions (which can be biopsied by an otolaryngologist or oral surgeon), 2) autoimmune diseases (rheumatology), and 3) infections caused by viruses, bacteria, or fungi (which can also be assessed by an otolaryngologist or oral surgeon).
Additionally, it is important to control blood sugar levels, maintain good oral hygiene, and follow a light diet.
Currently, avoid using strong mouthwashes containing alcohol or other irritants.
It is advisable to seek a follow-up consultation for appropriate treatment based on your condition.
Wishing you safety and health.
Sincerely, Dr.
Chi Chao-Yun, Head of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/08/16

More Info

Recurrent oral ulcers can be a frustrating and painful condition, particularly for individuals with underlying health issues such as diabetes and hypertension, as in the case of your mother. Understanding the potential causes and exploring treatment options is crucial for managing this condition effectively.

Causes of Recurrent Oral Ulcers
1. Underlying Health Conditions: Conditions like diabetes can affect the immune system and healing processes, making individuals more susceptible to infections and ulcers. Additionally, autoimmune diseases, such as Behçet's disease or systemic lupus erythematosus, can manifest as recurrent oral ulcers.

2. Nutritional Deficiencies: Deficiencies in vitamins and minerals, particularly B vitamins (like B12, folate), iron, and zinc, can lead to the development of oral ulcers. A balanced diet is essential for maintaining oral health.

3. Stress and Hormonal Changes: Stress can trigger or exacerbate oral ulcers. Hormonal fluctuations, particularly in women, can also play a role in the frequency and severity of these ulcers.

4. Infections: Viral infections, such as herpes simplex virus, can cause painful sores in the mouth. Fungal infections, particularly in immunocompromised individuals, can also lead to ulceration.

5. Allergic Reactions: Allergies to certain foods, medications, or dental products can lead to oral ulcers. Identifying and avoiding these triggers is essential.

6. Trauma: Physical injury to the oral mucosa, whether from dental work, biting the cheek, or irritation from braces, can result in ulcers that may become recurrent if the underlying cause is not addressed.

Treatment Options
1. Topical Treatments: Over-the-counter topical anesthetics, such as benzocaine, can provide temporary relief from pain. Prescription medications, like corticosteroid ointments, may help reduce inflammation and promote healing.

2. Oral Rinses: Antiseptic mouthwashes can help keep the area clean and reduce the risk of secondary infections. Rinses containing corticosteroids may also be prescribed to reduce inflammation.

3. Nutritional Supplements: If deficiencies are suspected, a healthcare provider may recommend dietary changes or supplements to address these issues. A diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health.

4. Stress Management: Techniques such as mindfulness, yoga, or counseling can help manage stress levels, potentially reducing the frequency of ulcer outbreaks.

5. Identifying Triggers: Keeping a food diary or noting stress levels can help identify potential triggers for the ulcers. Once identified, avoiding these triggers may help reduce the frequency of outbreaks.

6. Medical Evaluation: Since your mother has been experiencing these ulcers alongside skin symptoms, it may be beneficial to consult with a rheumatologist or an immunologist. They can evaluate for systemic conditions that may be contributing to her symptoms.

7. Blood Tests: If not already done, comprehensive blood tests to check for autoimmune markers, vitamin deficiencies, and other underlying conditions may provide additional insights.

8. Alternative Therapies: Some patients find relief through alternative therapies, such as acupuncture or herbal remedies. However, these should be approached with caution and discussed with a healthcare provider.

Conclusion
Given the complexity of your mother's case, it is essential to take a multidisciplinary approach. Consulting with specialists in rheumatology, immunology, or even a dietitian may provide further insights into her condition. Continuous communication with her healthcare providers is crucial to ensure that all potential causes are explored and managed appropriately. Encouraging her to maintain a healthy lifestyle, manage stress, and adhere to any prescribed treatments will also be beneficial in managing her recurrent oral ulcers.

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