Persistent Mouth Ulcer: Causes, Treatment, and When to Seek Help

Mouth ulcer for one month?

Hello.

1.
I initially bit the inside of my lower lip in the same spot twice, which developed into an ulcer that has persisted for a full month now.
About two weeks in, it expanded to approximately 1 cm.
I visited an ENT clinic, and the doctor prescribed non-steroidal anti-inflammatory drugs and antibiotics.
I have returned for three follow-up visits.
Although it is slowly shrinking, the progress is very gradual, and it is currently about 5-7 mm in size.
There are no other symptoms in my oral cavity, and it is not as red and swollen as it was initially.
I also accidentally bit other areas, which healed within 3-4 days, and my upper lip showed minor signs of an ulcer that disappeared on its own after two days.
Only this particular area is healing extremely slowly.
At first, even toothpaste contact was excruciating, but now I can brush my teeth normally.
I only experience slight pain if the toothpaste is in contact for too long, but my mouth still stings when it is dry.
Should I continue to return to the clinic for medication until it fully heals, or is it necessary to go to a larger hospital for an examination? Which department should I consult?
2.
During the ulcer period, I accidentally brushed the gum next to my canine tooth too hard while brushing, causing it to bleed for a moment.
After stopping the bleeding, the redness and swelling persisted for four days.
Initially, there was soreness when pressed, but now there is only slight tenderness.
There is no bleeding while brushing anymore.
Is it okay to let this heal naturally? This series of oral issues has made me a bit anxious...

Max, 20~29 year old female. Ask Date: 2023/06/24

Dr. Zeng Guanghui reply Dentistry

Mouth ulcers may result from physical injuries such as bites, sharp edges of teeth, or dentures, as well as allergic reactions to certain components in food, toothpaste, or mouthwash.
Nutritional deficiencies (such as vitamin B or folic acid), hormonal changes during menstruation or pregnancy, and emotional stress can also contribute to their development.
It is recommended to seek medical evaluation if the ulcers do not heal within 1-2 weeks.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/06/24

More Info

Persistent mouth ulcers can be quite distressing and may significantly impact your quality of life, especially when they linger for an extended period. Based on your description, it seems you have been dealing with a persistent ulcer on the inside of your lower lip for about a month, which initially developed after biting the same spot twice. This situation can be frustrating, particularly when the healing process is slow, and you have experienced varying degrees of pain and discomfort.

Causes of Persistent Mouth Ulcers
Mouth ulcers can arise from various causes, including:
1. Trauma: As you've experienced, biting the inside of your lip can lead to an ulcer. Repeated trauma to the same area can prevent healing.

2. Infections: Viral infections, such as herpes simplex, can cause ulcers. Bacterial infections may also contribute, especially if the area becomes inflamed or infected after trauma.

3. Autoimmune Conditions: Conditions like Behçet's disease or systemic lupus erythematosus can lead to recurrent ulcers.

4. Nutritional Deficiencies: Deficiencies in vitamins such as B12, folate, and iron can contribute to the development of mouth ulcers.

5. Stress and Hormonal Changes: Emotional stress and hormonal fluctuations can trigger or exacerbate ulcers.

6. Underlying Health Issues: Chronic conditions like diabetes or gastrointestinal diseases (e.g., Crohn's disease) can also manifest as persistent mouth ulcers.

Treatment Options
Given that you have already consulted with an ENT specialist and received non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, it seems you are on the right track. Here are some additional treatment options and considerations:
1. Topical Treatments: Over-the-counter topical anesthetics (like benzocaine) can help numb the area and reduce pain. Additionally, corticosteroid ointments may be prescribed to reduce inflammation and promote healing.

2. Oral Rinses: Antimicrobial mouthwashes or saltwater rinses can help keep the area clean and may promote healing.

3. Dietary Adjustments: Avoiding spicy, acidic, or abrasive foods can help minimize irritation. Soft, bland foods may be easier to tolerate during this time.

4. Hydration: Keeping your mouth moist can help reduce discomfort. Drinking plenty of water and using saliva substitutes if necessary can be beneficial.

5. Follow-Up Care: Since your ulcer has not fully healed after a month, it is advisable to continue follow-up visits with your ENT specialist or consider consulting a dentist or an oral surgeon. They may perform further evaluations, including a biopsy, to rule out any underlying conditions.

When to Seek Further Help
You should seek further medical attention if:
- The ulcer persists beyond six weeks without improvement.

- You experience significant pain that is not alleviated by over-the-counter treatments.

- New ulcers develop in other areas of your mouth.

- You notice systemic symptoms such as fever, weight loss, or fatigue, which could indicate a more serious underlying condition.

Addressing Your Concerns
Regarding the bleeding and swelling from brushing your teeth, it sounds like you may have caused some irritation to the gum tissue. As long as the bleeding has stopped and you are no longer experiencing significant pain, it is likely safe to allow it to heal naturally. However, maintaining good oral hygiene is crucial to prevent further issues. Use a soft-bristled toothbrush and be gentle around sensitive areas.

In summary, while persistent mouth ulcers can be concerning, they are often manageable with appropriate care. Continue to monitor your symptoms, maintain good oral hygiene, and follow up with your healthcare provider as needed. If you have any further questions or concerns, don’t hesitate to reach out to a healthcare professional for personalized advice.

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