Mouth Ulcers: Causes, Symptoms, and When to Seek Help

Mouth ulcer

I have been experiencing mouth ulcers frequently for the past few years, and there is also a foul odor.
However, as long as I drink plenty of water, I can avoid getting mouth sores.
I'm not sure what the cause is; my family says it's due to excessive heat in the body, and despite taking some traditional Chinese medicine, I still cannot prevent the occurrence of mouth sores.
Could you please explain the possible causes of mouth ulcers? How can I differentiate between these causes or what tests should I undergo? Recently, I am considering checking my liver for any issues; is that necessary?

Xiao Wei, 20~29 year old female. Ask Date: 2000/11/16

Dr. Yang Guojun reply Internal Medicine

Mouth ulcers are a matter of constitution and can recur.
However, using oral ointments can help them heal within one to three days.
Taking traditional Chinese medicine may not improve the condition, but since you frequently consume Chinese herbal medicine, it is advisable to check your liver function to rule out drug-induced liver disease.

Reply Date: 2000/11/16

More Info

Mouth ulcers, also known as canker sores or aphthous ulcers, are painful lesions that can occur in the oral cavity. They can significantly affect a person's quality of life, making eating, drinking, and even speaking uncomfortable. Understanding the causes, symptoms, and when to seek medical help is crucial for effective management.

Causes of Mouth Ulcers
Mouth ulcers can arise from various factors, including:
1. Stress and Anxiety: Emotional stress is a common trigger for mouth ulcers. Many individuals report that their ulcers appear during stressful periods.

2. Nutritional Deficiencies: Deficiencies in vitamins and minerals, particularly vitamin B12, folic acid, iron, and zinc, can lead to the development of mouth ulcers.

3. Hormonal Changes: Some women experience mouth ulcers in relation to their menstrual cycle, indicating a possible hormonal influence.

4. Food Sensitivities: Certain foods, especially acidic or spicy items, can irritate the oral mucosa and lead to ulcer formation.

5. Underlying Health Conditions: Conditions such as celiac disease, inflammatory bowel disease (IBD), and autoimmune disorders can manifest with recurrent mouth ulcers.

6. Infections: Viral infections, such as herpes simplex virus, can cause painful sores in the mouth. Bacterial infections may also contribute to ulcer formation.

7. Mechanical Trauma: Accidental biting of the cheek or tongue, dental braces, or ill-fitting dentures can cause localized trauma, leading to ulcers.

8. Medications: Certain medications, including non-steroidal anti-inflammatory drugs (NSAIDs) and some chemotherapy agents, can cause mouth ulcers as a side effect.

Symptoms of Mouth Ulcers
The primary symptom of mouth ulcers is pain, which can be exacerbated by eating, drinking, or talking. Other symptoms may include:
- Red or white lesions in the mouth
- Swelling around the ulcer
- A burning or tingling sensation before the ulcer appears
- Bad breath, particularly if the ulcer is infected

When to Seek Help
While most mouth ulcers heal on their own within one to two weeks, you should consult a healthcare professional if:
- The ulcers persist for more than two weeks.

- You experience severe pain that is not relieved by over-the-counter medications.

- You have difficulty swallowing or breathing.

- You notice a significant increase in the number of ulcers or their size.

- There are accompanying symptoms such as fever, rash, or gastrointestinal issues.

Diagnostic Tests
If you are concerned about the frequency of your mouth ulcers or suspect an underlying condition, your healthcare provider may recommend several tests, including:
- Blood Tests: To check for nutritional deficiencies, autoimmune disorders, or infections.

- Allergy Testing: If food sensitivities are suspected.

- Biopsy: In rare cases, a biopsy of the ulcer may be necessary to rule out malignancy or other serious conditions.

Liver Health and Mouth Ulcers
Regarding your concern about liver health, while liver disease can lead to various systemic symptoms, mouth ulcers are not typically a direct manifestation of liver issues. However, if you have other symptoms related to liver dysfunction (such as jaundice, abdominal pain, or unexplained fatigue), it would be prudent to discuss liver function tests with your healthcare provider.

Management and Prevention
To manage and prevent mouth ulcers, consider the following strategies:
- Maintain Good Oral Hygiene: Regular brushing and flossing can help prevent infections.

- Avoid Trigger Foods: Identify and avoid foods that irritate your mouth.

- Manage Stress: Techniques such as meditation, yoga, or counseling can help reduce stress levels.

- Nutritional Support: Ensure a balanced diet rich in vitamins and minerals. Consider supplements if deficiencies are identified.

- Stay Hydrated: Drinking plenty of water can help keep the mouth moist and reduce irritation.

In conclusion, mouth ulcers can be a frustrating condition, but understanding their causes and symptoms can help you manage them effectively. If you have ongoing concerns, especially regarding liver health or recurrent ulcers, seeking professional medical advice is essential for appropriate diagnosis and treatment.

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