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

Oral ulceration

Hello, Doctor.
I had an encounter with a woman at the end of July and subsequently developed a gonococcal urinary tract infection complicated by prostatitis.
During the treatment period from September 5 to 25, I took doxycycline and diclofenac.
On September 17, I experienced a sore throat, and since then (throughout October until now), I have been experiencing recurrent oral ulcers—one ulcer heals, and then another appears shortly after.
I reported this to my doctor, who suggested it might be a drug allergy.

After the encounter, I went to the hospital for a fourth-generation HIV antigen/antibody rapid test three times over the next three to four months, all of which were negative.
Does this rule out an immune system disorder as the cause? Could HPV also be a factor? I only had contact with the woman's mouth and chest, and I don't recall any specific incidents of oral ulcers until I noted the recurring ulcers on November 10.

On November 15, I sprained my back and received treatment until November 22, during which I took a pain medication called nefopam, which, like diclofenac, is an NSAID.
On November 22, I developed another ulcer, but the one from November 10 had healed.
Is it possible that this is due to a drug allergy? Can drug allergies persist for such a long time?
Additionally, the ulcers have been appearing one or two at a time, and recently on December 14, I had three ulcers.
I also examined my mouth and found no hard lumps or protrusions.
Today, I supplemented with B vitamins and noticed that my urine did not have the typical color associated with B vitamin metabolism.
Does this indicate a deficiency in B vitamins that could be causing the ongoing ulcers, suggesting that my body absorbs them quickly?
I would appreciate your guidance on these questions.
Lastly, could you recommend any self-monitoring practices, which specialty I should consult, and what tests should be performed during the visit? Thank you.

J, 30~39 year old female. Ask Date: 2023/12/14

Dr. Zheng Jueyi reply Otolaryngology

There are many factors that can cause oral ulcers.
Generally, drug allergies may lead to multiple ulcers appearing in a short period, along with symptoms such as swelling of the eyes and lips.
After changing or discontinuing the medication, improvement is typically seen within about a week.
If oral ulcers persist without improvement, it is advisable to continue supplementing with vitamin B, maintain good oral hygiene, and follow a light diet.
If ulcers last for more than two weeks without healing, it is recommended to consult an otolaryngologist, oral surgeon, or infectious disease specialist for further evaluation.

Reply Date: 2023/12/14

More Info

Understanding oral ulcers, their causes, treatments, and when to seek medical help is crucial for anyone experiencing this painful condition. Oral ulcers, also known as canker sores, can be quite distressing and may arise from various underlying issues.

Causes of Oral Ulcers
1. Infections: Viral infections, such as herpes simplex virus, can lead to painful oral ulcers. Bacterial infections, including those associated with sexually transmitted infections like gonorrhea, can also contribute.

2. Medication Side Effects: Certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like Diclofenac and Nefopam, can cause mucosal irritation and lead to ulcer formation. If you have recently taken these medications and noticed a correlation with the onset of ulcers, it is worth discussing with your healthcare provider.

3. Nutritional Deficiencies: Deficiencies in vitamins, particularly B vitamins (B12, folate, and B6), iron, and zinc, can predispose individuals to develop oral ulcers. If you suspect a deficiency, a blood test can help confirm this.

4. Stress and Hormonal Changes: Emotional stress and hormonal fluctuations, especially after significant life events like childbirth, can trigger the recurrence of oral ulcers.
5. Autoimmune Conditions: Conditions such as Behçet's disease or systemic lupus erythematosus can manifest with recurrent oral ulcers.
6. Allergic Reactions: Allergies to certain foods, dental products, or medications can also lead to ulcer formation.

Treatments for Oral Ulcers
1. Topical Treatments: Over-the-counter topical anesthetics can provide temporary relief from pain. Products containing benzocaine or lidocaine can numb the area and make eating and drinking more comfortable.

2. Mouth Rinses: Antiseptic mouthwashes or those containing corticosteroids can help reduce inflammation and promote healing.

3. Nutritional Supplements: If a vitamin deficiency is suspected, supplementation with B vitamins or other essential nutrients may be beneficial.

4. Pain Management: NSAIDs can help alleviate pain associated with ulcers, but it is essential to monitor for any adverse reactions.

5. Avoiding Irritants: Steering clear of spicy, acidic, or abrasive foods can help minimize discomfort.

When to Seek Medical Help
- Persistent Symptoms: If oral ulcers last longer than two weeks or recur frequently, it is essential to consult a healthcare provider. This could indicate an underlying condition that requires further investigation.

- Severe Pain or Difficulty Eating: If the pain is severe enough to prevent eating or drinking, medical intervention may be necessary.

- Associated Symptoms: If you experience other symptoms such as fever, swollen lymph nodes, or unexplained weight loss, these could be signs of a more serious condition.

Recommended Self-Monitoring and Follow-Up
- Keep a Symptom Diary: Document the occurrence of ulcers, any associated symptoms, dietary intake, and medication use. This information can be invaluable for your healthcare provider.

- Consultation with Specialists: Depending on your symptoms, you may benefit from seeing an oral surgeon, a dentist specializing in oral medicine, or an ENT specialist. They can perform more detailed examinations and recommend appropriate diagnostic tests.

- Blood Tests: Consider asking for blood tests to check for nutritional deficiencies or autoimmune markers if recurrent ulcers persist.

Conclusion
Oral ulcers can be a complex issue with multiple potential causes, including infections, medication side effects, nutritional deficiencies, and stress. Understanding these factors and seeking appropriate treatment can help manage symptoms effectively. If you experience persistent or severe symptoms, do not hesitate to seek medical advice. Early intervention can lead to better outcomes and improved quality of life.

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