There is something rather ridiculous about a mouth ulcer.
It can be smaller than your little fingernail, yet somehow it manages to make a cup of tea, a piece of toast or even brushing your teeth feel like a major event.
Most of us have had one. You bite the inside of your cheek, burn your mouth on something hot, or perhaps wake up one morning and discover a painful little white or yellow sore that wasn’t there the night before.
The good news is that most ordinary mouth ulcers are nothing to worry about. They usually clear up by themselves within one or two weeks. NHS – Mouth ulcers
But as a pharmacist, there are a few things I would want to know before simply handing over a tube of ulcer gel.
First, is it actually a mouth ulcer?
A typical mouth ulcer is a painful, shallow sore that develops inside the mouth — commonly on the inside of the cheek or lip, on the tongue or underneath the tongue.
And one useful distinction is that mouth ulcers are not the same as cold sores.
Cold sores usually occur on or around the lips and are caused by the herpes simplex virus. Ordinary mouth ulcers inside the mouth are not contagious. NHS – Mouth ulcers
That distinction matters because the treatment and advice can be quite different.
What causes them?
Sometimes the reason is obvious.
You have bitten your cheek.
A sharp tooth is rubbing against the inside of your mouth.
A filling is rough.
Your dentures don’t fit quite properly.
You have eaten something very hot and burnt the lining of your mouth.
Or perhaps you’ve been brushing your teeth rather enthusiastically.
Stress and tiredness can also be associated with mouth ulcers. The NHS lists several possible triggers, including local injury, irritating toothpaste, hormonal changes, certain medicines and nutritional deficiencies. NHS – Mouth ulcers
Then there are people who seem to get them repeatedly for no obvious reason.
This is known as recurrent aphthous ulceration.
And this is where I become a little more interested in the history.
If you keep getting them, look beyond the mouth
Repeated mouth ulcers can occasionally be associated with nutritional deficiencies, including iron, folate, vitamin B12, zinc or vitamin D deficiency. NHS – Mouth ulcers
There can also be associations with conditions such as coeliac disease or Crohn’s disease, particularly when mouth ulcers occur alongside other symptoms.
That does not mean that somebody with recurrent ulcers automatically has one of these conditions.
In fact, most people with recurrent mouth ulcers do not turn out to have a serious underlying problem. Cambridge University Hospitals notes that blood tests are often performed when recurrent ulcers need investigating, although most people have normal results. Cambridge University Hospitals – Recurrent oral ulceration
The important thing is to look at the pattern, rather than treating every ulcer as an isolated event.
Could your medicine be contributing?
This is another question I would ask at the pharmacy.
Some medicines have been associated with mouth ulcers, including certain anti-inflammatory medicines, beta blockers and nicorandil. NHS – Mouth ulcers
That doesn’t mean you should stop a prescribed medicine because you think it is responsible.
Please don’t do that.
Instead, speak to your pharmacist or doctor. We can look at your medicines as a whole and decide whether there is a possible connection and whether anything needs changing.
What can you do when one appears?
Unfortunately, there isn’t a magic cure that makes an ulcer disappear overnight.
The main aim is to make those few days more comfortable while your mouth heals.
I normally advise people to avoid foods that irritate the ulcer — particularly spicy, salty, acidic or very crunchy foods. Even something as innocent as a piece of toast can feel like sandpaper when it catches the sore spot. NHS – Mouth ulcers
Use a soft-bristled toothbrush and try not to traumatise the area further.
A simple salt-water mouthwash can also help. The NHS suggests dissolving half a teaspoon of salt in a glass of warm water, rinsing the mouth and then spitting it out rather than swallowing it. NHS – Mouth ulcers
And this is where your pharmacist can be useful.
Depending on the individual, we can recommend suitable mouthwashes, gels, sprays or other treatments to reduce pain and irritation. Some people may also benefit from corticosteroid preparations, particularly when ulcers are troublesome or recurrent and this has been assessed as appropriate. NHS – Mouth ulcers
Don’t overlook your toothpaste
This is one of those little pieces of advice that is easy to miss.
If you regularly suffer from mouth ulcers, it may be worth trying an SLS-free toothpaste.
Sodium lauryl sulphate, usually listed as SLS on the ingredients, is a foaming agent used in many toothpastes. The NHS specifically advises people prone to mouth ulcers to avoid toothpaste containing sodium lauryl sulphate. NHS – Mouth ulcers
It isn’t a miracle cure, but if changing toothpaste means fewer ulcers, that’s a pretty simple win.
And now for the important bit
Most mouth ulcers disappear.
So when should you stop waiting?
My rule of thumb is simple:
If a mouth ulcer has been there for more than three weeks, get it checked.
The NHS advises seeing a GP or dentist if an ulcer lasts longer than three weeks. NHS – Mouth ulcers
NICE guidance recommends consideration of an urgent suspected-cancer referral for unexplained ulceration in the mouth lasting more than three weeks. NICE – Suspected cancer: recognition and referral
Now, please don’t read that and immediately panic.
A persistent ulcer does not mean you have mouth cancer. The vast majority of mouth ulcers are harmless, and there are many other possible explanations.
But a persistent ulcer deserves somebody actually looking at it rather than repeatedly treating it with another tube of gel.
You should also get medical or dental advice if you notice a lump in your mouth or neck, a persistent red or white patch, unexplained mouth pain, or difficulty swallowing or speaking. NHS – Symptoms of mouth cancer
What I would say as a pharmacist
When somebody walks into the pharmacy and says, “Have you got anything for a mouth ulcer?”, it is tempting to reach straight for the treatment.
But the better conversation is often:
How long have you had it?
Is this something you get regularly?
Is it always in the same place?
Have you got more than one?
Any new medicines?
Any other symptoms?
Those few questions can sometimes tell us far more than the ulcer itself.
Most of the time, the answer will be reassuring: give it time, protect the area, treat the pain and let the mouth heal.
But occasionally the answer will be, “This has been here for five weeks.”
And that changes the conversation completely.
So next time you find yourself poking a painful little ulcer with your tongue and wondering when it will finally disappear, remember this:
Small doesn’t always mean insignificant — and anything in your mouth that refuses to heal deserves to be looked at.
Until next time…
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