Oral Ulcers: Causes, Treatments, and When to Seek Help

More than ten oral ulcers suspected to be caused by a viral infection?

Hello, Doctor: I hope you can answer my questions, as I am really troubled.
Initially, my lower lip was slightly swollen and felt grainy to the touch, but it was not visible.
Inside my mouth, there were a few rough areas (inside the right cheek and the upper palate) that felt a bit coarse.
After two days, I noticed red spots on the rough areas when I looked in the mirror, so I immediately made an appointment at a moderately sized hospital in Zhongli's oral and maxillofacial surgery department, but I had to wait two days for the consultation.
The next day, my lower lip developed three or four small sores, but they didn't hurt much, and there were also multiple sores inside my mouth, including under my tongue.
When I went to see the doctor, he briefly examined my sores and speculated that it was a viral infection.
He had me rinse with a medication called Valtrex, prescribed pain relief medication (which can also be taken for menstrual pain), and instructed me to buy Valtrex spray from the pharmacy.
He advised me on foods to avoid and to refrain from staying up late, then sent me home.
Now, the day after my visit, following the doctor's instructions to use the spray, my lips continue to develop many small sores, and I often feel warm and slightly dizzy.
I truly don't know what to do, so I'm reaching out to ask the doctor.

I have a few questions for you:
1.
I feel that the doctor did not provide further treatment for the viral infection during my visit.
Should I just continue using the Valtrex spray twice a day, or are there other more proactive treatment options? This situation is really inconvenient.
Should I consider seeing another doctor? If so, what specialty should I look for?
2.
I found online that Valtrex can be sprayed every three hours if necessary, but the doctor initially advised me to use it only twice a day.
I am hesitant to spray more frequently, but since my condition has worsened, I would like to know if spraying every three hours is feasible?
3.
When using the Valtrex spray, since the sores are dispersed, where should I aim the spray? Additionally, the doctor instructed me to spray twice a day, with two sprays each time, but I found online that it can be sprayed two to four times at once.
Should I choose the areas with more sores and spray once or twice on each?
Thank you very much for your response, and I appreciate your help again.

Guo, 20~29 year old female. Ask Date: 2017/09/15

Dr. Zeng Guanghui reply Dentistry

1.
If there is a viral infection of the oral mucosa, most symptoms are characterized by vesicular ulcers.
In addition to using anti-inflammatory and analgesic medications to alleviate pain, it is advisable to consider using mouthwash to enhance oral hygiene and prevent bacterial infections.

2.
If there is discomfort in the oral mucosa, it is possible to spray three times a day, targeting the vesicular ulcer wounds to more effectively relieve symptoms.
These measures are only symptomatic treatments; it is crucial to maintain a regular lifestyle, get plenty of rest, and avoid staying up late to ensure the immune system functions properly, providing sufficient resistance to overcome the viral infection.

Reply Date: 2017/09/15

More Info

Oral ulcers, commonly referred to as canker sores, can be a significant source of discomfort and distress. Understanding their causes, treatment options, and when to seek further medical help is crucial for effective management.

Causes of Oral Ulcers
Oral ulcers can arise from various factors, including:
1. Infections: Viral infections, such as herpes simplex virus, can lead to painful sores in the mouth. Bacterial infections can also contribute to ulcer formation.

2. Nutritional Deficiencies: Lack of essential vitamins and minerals, particularly vitamin B12, folic acid, iron, and zinc, can predispose individuals to develop ulcers.

3. Stress and Hormonal Changes: Emotional stress and hormonal fluctuations, particularly in women, can trigger the onset of oral ulcers.

4. Mechanical Trauma: Accidental biting of the cheek, aggressive brushing, or dental appliances can cause irritation and subsequent ulceration.

5. Underlying Health Conditions: Conditions such as autoimmune diseases (e.g., lupus, Behçet's disease), gastrointestinal disorders (e.g., Crohn's disease), and certain systemic diseases can manifest as recurrent oral ulcers.

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

2. Mouth Rinses: Antiseptic mouthwashes or medicated rinses (like chlorhexidine) can help reduce bacterial load and promote healing.

3. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain associated with ulcers. In severe cases, stronger pain medications may be prescribed.

4. Nutritional Support: If deficiencies are suspected, dietary adjustments or supplements may be necessary to ensure adequate intake of essential nutrients.

5. Avoiding Irritants: It is advisable to avoid spicy, acidic, or abrasive foods that may exacerbate the pain and irritation of existing ulcers.

When to Seek Help
If you experience persistent or recurrent oral ulcers, or if they are accompanied by other concerning symptoms such as fever, significant swelling, or difficulty swallowing, it is essential to consult a healthcare professional. Here are specific scenarios where further evaluation is warranted:
1. Prolonged Duration: If ulcers last longer than two weeks without improvement, further investigation may be needed to rule out underlying conditions.

2. Severe Pain or Discomfort: If the pain is debilitating and not relieved by over-the-counter treatments, a healthcare provider may need to assess the situation more thoroughly.

3. Systemic Symptoms: The presence of systemic symptoms such as fever, weight loss, or swollen lymph nodes may indicate a more serious underlying issue that requires immediate attention.

4. Recurrent Episodes: Frequent occurrences of oral ulcers may necessitate a comprehensive evaluation to identify potential triggers or underlying health conditions.

Conclusion
In summary, oral ulcers can be caused by a variety of factors, including infections, nutritional deficiencies, and mechanical trauma. Treatment options range from topical applications and mouth rinses to pain management strategies. It is crucial to monitor the duration and severity of symptoms and seek medical advice when necessary. If you find that your condition is worsening despite treatment or if you have concerns about the nature of your ulcers, consider consulting a specialist, such as an oral surgeon or an ENT specialist, for a more in-depth evaluation and tailored treatment plan.

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