MOUTH ULCERS

Minor mouth ulcers- Most people get minor mouth ulcers. These are round or oval, and usually less than 5 millimetres (a little less than one-fifth of an inch) across. They tend to be greyish-white, with redness around them, and are usually on the inside of your lips or cheeks, or on the floor of your mouth. People usually get one to five ulcers at a time.

Major mouth ulcers- Major mouth ulcers are less common than minor mouth ulcers, and they are oval and larger. They may be 1 to 3 centimetres (nearly one-half to one-and-a-quarter inches) across. They often happen on the lips or towards the back of the roof of your mouth (the soft palate), but they can be anywhere in your mouth. People usually get one to 10 ulcers at a time.

Herpetiform ulcers- Some people get lots of small, painful ulcers called herpetiform ulcers. These ulcers can occur anywhere in the mouth.You may have as many as 100 at a time, each measuring 2 to 3 millimetres (about one-eighth of an inch) across. Some join together to form large, irregularly-shaped ulcers.

SYMPTOMS-The main symptom you'll notice with mouth ulcers is that your mouth gets very sore on and around the ulcers. How bad the pain is will depend on where the ulcers are, and how many you have.

You may find that eating or talking makes the pain worse. If it's really bad, you may try to avoid eating or talking altogether. If you often having difficulty eating because of mouth ulcers, you need to be careful not to lose too much weight.

If your mouth ulcers keep coming back, or if you have an ulcer that takes more than a week to heal, your dentist or doctor should take a look.

Your dentist or doctor will examine your mouth and ask you:

• How often you get mouth ulcers

• How quickly they go away

• If anything seems to trigger them or make them worse

• Whether you can eat when you get them and, if not, whether you've lost weight as a result.

TREATMENTS-There's no one treatment that works for everyone with recurrent mouth ulcers.You may need to try a few treatments to see what works best for you.

• Mouthwashes and gels containing an antiseptic called chlorhexidine may make your ulcers less painful and go away faster

• Mouthwashes, lozenges, pastes, or sprays containing steroids also may be helpful.

• You can also buy painkilling sprays and rinses, gels, and pastes that protect the ulcer.

• There are some things you can try yourself that may help you avoid mouth ulcers. To learn more, read Self-help to avoid mouth ulcers .

Chlorhexidine and similar antiseptics :

Chlorhexidine (brand names Chlorohex, Corsodyl) is an antiseptic. It's available as a mouthwash, gel, or mouth spray to use every day. It probably works by keeping away germs that could infect your mouth ulcers and make them worse. If you use chlorhexidine antiseptic, your mouth ulcers may be smaller and less painful, and they may go away faster. But chlorhexidine probably won't affect how often you get mouth ulcers. We found four good-quality studies ( randomised controlled trials ) of antiseptic mouthwashes or gels for recurrent mouth ulcers. They included a total of 203 people.The studies compared chlorhexidine or similar products with dummy mouthwashes or gels ( placebos ). They showed:

• People using chlorhexidine had mouth ulcers for fewer days over four to six weeks

• Using chlorhexidine made mouth ulcers less painful

• Mouth ulcers went away more quickly when people used chlorhexidine or a similar product, but in most studies the average difference was less than a day

• One of the studies showed that people got fewer new mouth ulcers when they used chlorhexidine gel. But there were problems with the way this study was done, so we can't rely on it. The other four studies didn't show this result.

The disadvantage of chlorhexidine is that it has a bitter taste and may make you feel sick. If you use it every day, it can stain your teeth and tongue brown. This discoloration should go away when you stop using it.

Another antiseptic mouthwash is called hexetidine (brand name Oraldene).There hasn't been much high-quality research on hexetidine as a treatment for mouth ulcers.We only found one small study, which included 40 people with recurrent mouth ulcers. People who used hexetidine did not feel any better than those who were using a placebo (dummy) treatment.

Another antiseptic is called thymol. It's found in Listerine mouthwash. But there hasn't been much high-quality research on thymol for mouth ulcers. One study found it worked no better to reduce the symptoms of mouth ulcers than a dummy treatment (placebo).

Painkilling mouthwashes, lozenges, sprays, and gels - There isn't very good research on lozenges, sprays, and gels that contain a local anaesthetic or painkiller, but they may help to take away some of the pain caused by mouth ulcers. However, the effect may not last very long and you have to keep reapplying them. There are lots of different painkilling treatments for mouth ulcers that you can buy from the pharmacy. Common ones include

• Benzydamine. This is a type of painkiller called a non-steroidal anti-inflammatory drug (or NSAID for short). It comes as a mouthwash and spray under the brand name Difflam. But the mouthwash should not be used by children under 12.You may need to dilute the mouthwash .

• Choline salicylate. This is another painkiller. One brand name is Bonjela. This treatment isn't recommended for anyone under 16. There's a theoretical risk of a serious illness called Reye's syndrome for young people who use this type of painkiller.

• Lidocaine. This is an anaesthetic that is often used to numb areas of skin before minor operations, such as on the skin or in the mouth. It comes as lozenges, sprays, and gels. Some brand names include Iglu, Anbesol, and Xylocaine.

We found just one study that looked at benzydamine mouthwash for mouth ulcers. It found that benzydamine mouthwash did not help to reduce pain or reduce the number of mouth ulcers. More studies are needed for us to know whether painkilling mouthwashes, gels, and sprays help to reduce the pain of mouth ulcers.

@somkaushal group