Recurrent Oral Ulcerations are small mouth ulcers that typically last for a few days, but keep coming back every few weeks or months. These sores can be quite painful, making eating, drinking and even talking uncomfortable. It is for these reasons that people suffering from recurrent oral ulceration keep searching for information on the condition to help treat it. In this article, we are going to explain what recurrent oral ulcerations are, what causes them, the different symptoms you should look out for and finally, the best way to treat them.

Recurrent oral ulcerations are usually round or oval with a white or yellow centre and a red halo. After a while, they break down into punched out ulcers that are loosely covered with a white, yellow or greyish membrane. They may appear on;

  • The lining of lips and cheeks
  • The base of the gums
  • The tongue
  • The roof of the mouth (palates)

What Are The Main Types Of Ras (Recurrent Aphthous Stomatitis)?

Minor Aphthous Ulcers

This type of ulceration accounts for 85% of all cases. Typically, they occur at the base of the mouth, ventral and lateral tongue, pharynx and the buccal mucosa. These lesions heal within ten days without scarring.

Major Aphthous Ulcers

These ulcerations constitute about 10% of all cases. Usually, they appear after puberty. The sores are more intense, more profound, broader and longer lasting – they can last for weeks to months. These sores appear in the soft palate, lips, and throat. They may be accompanied by fever, malaise, and dysphagia, and may leave scarring.

Herpetiform Aphthous Ulcers

These account for 5% of all cases. They usually begin as multiple 1 to 3 mm crops of small, painful clusters of sores on a reddish base. They then merge to form bigger ulcers that last for about two weeks. This type of RAS is more common among women.

Symptoms of Recurrent Aphthous Ulcers

You might experience a burning or tingling sensation one or two days before the sores appear
The ulcers are painful, especially if irritated by movement or eating certain types of food like citrus fruits

Causes of Recurrent Aphthous Ulcers

Mechanical trauma

Mechanical trauma is the most common cause of oral mucosal ulceration. These ulcerations are typically caused by braces, dentures, broken teeth or too sharp teeth. It may also be as a result of tongue or cheek biting, eating rough foods or scratching with fingernails. This ulceration typically begins healing within ten days following the removal of the cause. In case it persists even after the removal of the problem, you are advised to seek a further diagnosis.

mouth ulcers mechanical trauma

Chemical injury

The most common type of chemical damage is when the oral mucosa comes into direct contact with aspirin. This results in white plaques which slough off. Bisphosphonates may also cause chemical burns when left to dissolve in the mouth instead of taking them as instructed. Your ulceration may also be caused by improperly cleaned or rinsed dentures, which are then placed in the mouth. Ulcers associated with denture usually occur in a line along the gums. This ulceration is often more painful than mechanical ulcers.

Thermal injury

This results when mucosal comes into direct contact with hot foods or liquids. Although such lesions often occur on the palate, they may also occur in the tongue, lip or oropharyngeal region.

Other causes of RAS

Genetics

About 40% of all RAS patients have a family history of the condition. Such individuals develop more severe ulcers and earlier compared to others.

Stress

Stress is a common cause of RAS. Stress induces trauma to the oral soft tissues through parafunctional habits like cheek or lip biting.

Local Trauma

Trauma to your oral mucosa that is as a result of local injection, anaesthetic injections, dental treatments, toothbrush injury or sharp teeth may lead to the development of recurrent aphthous ulceration.

Food Sensitivity

The Oral Medicine Unit at Cardiff Dental Hospital found out that certain foods and drinks can contribute to the development of RAS. These include tomatoes, chocolate, fizzy drinks, crisps, preservatives, Benzoates and Liquorice.

Cessation Of Smoking

Various studies reveal a negative link between tobacco and RAS. Smoking increases mucosal keratinisation.

Hormonal Change

In some female patients, RAS episodes seem to be related to their menstrual cycles. Still, the evidence for a hormonal basis is inconsistent.

Treatment

The treatment of RAS targets to relieve the painful symptoms, reduce and prevent secondary infections as well as encourage healing.

Topical products

Over the counter, corticosteroids are applied topically to the affected area. This treatment is adequate for most patients and is available as mouthwashes, small dissolvable pellets, and sprays. It helps to relieve pain and inflammation.

Mouth Rinses

In case of severe sores, your dentist may prescribe mouthwashes containing steroid dexamethasone, which helps to reduce pain and inflammation. Some of these mouthwashes include;

  • Anaesthetic mouthwashes, sprays or throat lozenges can also be used to treat RAS. They are mainly helpful when used before meals as they help ease the soreness
    Antiseptic mouthwash, spray or gel. These help to prevent any secondary infection as well as control plaque levels in your teeth, especially if you are having difficulty brushing
  • Hyaluronic Acid solutions: HA is one of the building blocks in skin tissue repair processes. Rinsing up to three times daily with one of these solutions promotes ulcer healing. HA is also available in gel form for single ulcers

Oral Medication

Severe cases of RAS may need treatment with oral medicines if they don’t respond to topical treatments. These treatments include;

  • Oral steroid medication: Short course of systemic corticosteroids that are taken in tablet form. Long-term treatment with these drugs is not recommended because of the potential side effects.
  • Medication not explicitly intended for the canker sores like intestinal ulcer treatment.

When to see your dentist

Although these sores can get pretty painful, they do not pose a significant risk to your health. However, if you have severe, recurring sores that keep getting worse, consult your dentist or physician. Your dentist may do some tests to look for any blood problems such as deficiencies of iron, vitamin B12, folate, or even anaemia. Treating these efficiencies can help improve the sores.

Visit your dentist if:

  • The sores are bigger than 1 centimetre
  • The recurrent rate increases
  • You have more sores than you used to
  • The ulcerations are accompanied by other symptoms like fever, diarrhoea, rash or joint pain

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Savina Clinic – Dental & Implantology Centres are friendly, state-of-the-art practices in Malta and Gozo dedicated to comprehensive quality dental care. Savina Dental is an innovative dental practice in Malta and prides itself on the high-quality customer service, low waiting room times, attention to detail and the advanced dental technology at their disposal.

Dr Joseph Xuereb
Dental & Implant Surgeon. Principal
Savina Dental Clinics

Joseph Xuereb
Joseph Xuereb
Principal Dental Surgeon & Owner of Savina Dental Clinics, Dr Joseph Xuereb BChD (Hons), MFGDP(UK), MGDS RCS(Eng), FFGDP RCS(UK), FICD is a general dental practitioner with a special interest in Implant and Restorative Dentistry. Dr Joseph & the teams' full biographical information can be found here.