Persistent Oral Ulcer: Causes, Treatments, and Next Steps

Oral issues

Hello! I have an ulcer under my right sublingual area, approximately 0.5 cm in diameter, which has persisted for over a year.
I have visited several hospitals and clinics for treatment, but none have been effective.
However, I have not undergone further examinations (such as blood tests or cultures).
My daily routine is normal; I sleep for about 7 hours each night, and I do not smoke or chew betel nut.
I also tend to avoid overly spicy foods.
Currently, I am at home recovering from a miscarriage and not working.
What should I do about this?

xiao, 20~29 year old female. Ask Date: 2001/07/19

Dr. Wu Jinjun reply Dentistry

Generally, oral mucosal ulcers heal within 1 to 2 weeks.
Therefore, it is important to clarify whether the ulcer you mentioned has been persistent for over a year or if it heals but keeps recurring.
If it is the latter, there is no need to worry too much; it may simply be caused by irritation from dentures or sharp teeth, and addressing this issue is necessary for resolution.
If it is the former, further examination is required, and I recommend that you visit a specialized oral and maxillofacial surgery clinic for evaluation.

Reply Date: 2001/07/19

More Info

Persistent oral ulcers can be a frustrating and painful condition, especially when they last for an extended period, as in your case. Given that you have had this ulcer under your tongue for over a year without improvement despite seeking treatment, it is essential to consider several factors regarding its potential causes, treatment options, and next steps.

Causes of Persistent Oral Ulcers
1. Chronic Conditions: Conditions such as autoimmune diseases (e.g., lupus, Behçet's disease), inflammatory bowel diseases (e.g., Crohn's disease), or even vitamin deficiencies (like B12, folate, or iron) can lead to persistent oral ulcers.
2. Infections: Viral infections (like herpes simplex virus) or fungal infections (such as oral thrush) can cause ulcers that may not heal properly if the underlying infection is not addressed.

3. Trauma: Continuous irritation from dental appliances, sharp teeth, or even habitual cheek biting can lead to chronic ulcers.

4. Stress and Hormonal Changes: Stress can exacerbate ulcer formation, and hormonal changes, particularly after events like pregnancy loss, can also affect your oral health.

5. Malignancy: Although less common, persistent ulcers can sometimes be a sign of oral cancer, especially if they are not healing and have been present for an extended period.

Treatment Options
1. Topical Treatments: Over-the-counter topical anesthetics (like benzocaine) can help relieve pain. Prescription medications such as corticosteroid ointments may also reduce inflammation and promote healing.

2. Oral Rinses: Antiseptic mouthwashes or medicated rinses can help keep the area clean and reduce irritation. Rinses containing dexamethasone or other anti-inflammatory agents may be prescribed.

3. Nutritional Support: If a vitamin deficiency is suspected, consider taking supplements or increasing dietary intake of vitamins B12, folate, and iron. Foods rich in these vitamins include leafy greens, nuts, seeds, and fortified cereals.

4. Avoid Irritants: While you mentioned that you do not consume overly spicy foods, it is crucial to avoid any known irritants, including certain toothpaste or mouthwashes that may contain sodium lauryl sulfate.

5. Stress Management: Since stress can exacerbate oral ulcers, engaging in stress-reducing activities such as yoga, meditation, or gentle exercise may be beneficial.

Next Steps
1. Seek Further Evaluation: Given the duration of your ulcer, it is advisable to undergo further evaluation. This may include blood tests to check for nutritional deficiencies, autoimmune markers, or infections. A biopsy of the ulcer may also be warranted to rule out malignancy or other serious conditions.

2. Consult a Specialist: If you have not already, consider seeing an oral medicine specialist or an ear, nose, and throat (ENT) doctor. They can provide a more in-depth evaluation and tailored treatment plan.

3. Monitor Symptoms: Keep a record of any changes in the ulcer's appearance, size, or associated symptoms (like pain or swelling). This information can be crucial for your healthcare provider in determining the next steps.

4. Consider Psychological Support: If you are experiencing significant stress or emotional distress due to your health concerns, speaking with a mental health professional may help you cope better.

In conclusion, while persistent oral ulcers can be challenging, a systematic approach to diagnosis and treatment can lead to improvement. It is essential to follow up with healthcare professionals who can provide the necessary tests and treatments tailored to your specific situation. Remember, early intervention can often lead to better outcomes.

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