Mouth sores

Causes

Mouth sores may be caused by irritation from:

• A sharp or broken tooth or poorly fitting dentures
• Biting your cheek, tongue, or lip
• Burning your mouth from hot food or drinks
• Braces
• Chewing tobacco

Cold sores are caused by the herpes simplex virus . They are very contagious. Usually, you will have tenderness, tingling, or burning before the actual sore appears. Cold sores usually begin as blisters and then crust over.  The herpes virus can live in your body for years. It only appears as a mouth sore when something triggers it, such as:

• Another illness, especially if there is a fever
• Hormone changes (such as menstruation)
• Stress
• Sun exposure

Canker sores are not contagious. They may look like a pale or yellow ulcer with a red outer ring. You may have one, or a group of them. Women seem to get them more than men. The cause of canker sores is not clear. It may be due to:

• A weakness in your immune system (for example, from the cold or flu)
• Hormone changes
• Stress
• Lack of certain vitamins and minerals in the diet, including vitamin B12 or folate

Less commonly, mouth sores can be a sign of an illness, tumor, or reaction to a medication. This can include:

• Autoimmune disorders (including systemic lupus erythematosus)
• Bleeding disorders
• Cancer of the mouth
• Infections such as hand-foot-mouth disease
• Weakened immune system -- for example, if you have AIDS or are taking medication after a transplant

Drugs that may cause mouth sores include aspirin, beta-blockers, chemotherapy medicines, penicillamine, sulfa drugs, and phenytoin.

Home Care

Mouth sores often go away in 10 to 14 days, even if you don't do anything. They sometimes last up to 6 weeks. The following steps can make you feel better:

• Avoid hot beverages and foods, spicy and salty foods, and citrus.
• Gargle with salt water or cool water.
• Eat popsicles. This is helpful if you have a mouth burn.
• Take pain relievers like acetaminophen.

For canker sores:

• Apply a thin paste of baking soda and water to the sore.
• Mix 1 part hydrogen peroxide with 1 part water and apply this mixture to the sores using a cotton swab.
• For more severe cases, treatments include fluocinonide gel (Lidex), anti-inflammatory amlexanox paste (Aphthasol), or chlorhexidine gluconate (Peridex) mouthwash.

Over-the-counter medications, such as Orabase, can protect a sore inside the lip and on the gums. Blistex or Campho-Phenique may provide some relief of canker sores and fever blisters, especially if applied when the sore first appears.

To help cold sores or fever blisters, you can also apply ice to the sore.

When to Contact a Medical Professional

Call your doctor if:

• The sore begins soon after you start a new medication
• You have large white patches on the roof of your mouth or your tongue (this may be thrush or another type of infection)
• Your mouth sore lasts longer than 2 weeks
• You have a weakened immune system (for example, from HIV or cancer)
• You have other symptoms like fever, skin rash, drooling, or difficulty swallowing

What to Expect at Your Office Visit

The doctor or nurse will examine you, and closely check your mouth and tongue. You will be asked questions about your medical history and symptoms.

Treatment may include:

• A medicine that numbs the area such as lidocaine to ease pain. (Do not use in children.)
• An antiviral medication to treat herpes sores. (However, some experts do not think medicine makes the sores go away sooner.)
• Steroid gel that you put on the sore.
• A paste that reduces swelling or inflammation (such as Aphthasol).
• A special type of mouthwash such as chlorhexidine gluconate (such as Peridex).

Prevention

You may reduce your chance of getting common mouth sores by:

• Avoiding very hot foods or beverages
• Reducing stress and practicing relaxation techniques like yoga or meditation
• Chewing slowly
• Using a soft-bristle toothbrush
• Visiting your dentist right away if you have a sharp or broken tooth or misfitting dentures

If you seem to get canker sores often, talk to your doctor about taking folate and vitamin B12 to prevent outbreaks.

To prevent cancer of the mouth:

• Do not smoke or use tobacco.
• Limit alcohol to two drinks per day.
• Wear a wide-brimmed hat to shade your lips. Wear a lip balm with SPF 15 at all times.

Alternative Names

Aphthous stomatitis

References

Daniels TE. Diseases of the mouth and salivary glands. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 433.

Update Date: 11/6/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.