What are the causes of recurrent oral ulcers (mouth ulcers)?

From the Guidelines

Recurrent oral ulcers should be managed with topical treatments, such as steroids, as the first line of treatment, according to the most recent guidelines. The management of recurrent oral ulcers involves a step-by-step approach, starting with a detailed medical history and oral examination. For mild cases, topical treatments like benzocaine gel or triamcinolone dental paste can be applied directly to the ulcers to reduce pain and prevent secondary infection 1. Rinsing with saltwater or chlorhexidine mouthwash can also help prevent secondary infection.

Key Considerations

• For moderate to severe cases, consider prescription options like dexamethasone elixir as a rinse-and-spit solution or systemic therapy with prednisone for severe outbreaks 1.
• Pain can be managed with over-the-counter analgesics like acetaminophen or ibuprofen.
• Avoid spicy, acidic, or rough-textured foods during healing.
• Most ulcers resolve within 7-14 days, but if they persist beyond 3 weeks, are unusually large (>1cm), or occur with systemic symptoms like fever, seek medical evaluation as this could indicate an underlying condition such as Behçet's disease, inflammatory bowel disease, or immunodeficiency 1.

Underlying Conditions

• Behçet's disease: characterized by recurrent oral and genital ulcers, and can be treated with topical measures, such as steroids, and systemic measures, such as azathioprine or TNF-alpha inhibitors 1.
• Inflammatory bowel disease: can cause oral ulcers, and treatment should focus on managing the underlying condition 1.
• Immunodeficiency: can increase the risk of oral ulcers, and treatment should focus on managing the underlying condition 1.

Diagnostic Approach

• A detailed medical history and oral examination are essential for diagnosing recurrent oral ulcers.
• Biopsy and histopathological examination may be necessary to rule out underlying conditions such as cancer or autoimmune diseases 1.
• Systemic diseases screening, such as blood tests, can help identify underlying conditions that may be contributing to the oral ulcers 1.

From the Research

Causes of Recurrent Oral Ulcer

• Recurrent oral ulcerations are manifestations of a heterogeneous set of both general and more-or-less specific oral diseases due to numerous potential etiologies, including infections, medications, autoimmune disease, and other systemic disease 2
• The most likely precipitating factors are local trauma and stress, while other associated factors include systemic diseases and nutritional deficiencies, food allergies, genetic predisposition, immune disorders, the use of certain medications, and HIV infection 3

Classification of Recurrent Oral Ulcer

• Recurrent oral ulceration can be classified into different types, including traumatic ulceration, chemical ulceration, recurrent aphthous stomatitis, medication-related ulceration, infectious ulceration, mucocutaneous disease, and autoimmune/systemic disease 2
• Recurrent aphthous ulcers (RAU) are classified as minor, major, and herpetiform on the basis of ulcer size and number 3

Treatment of Recurrent Oral Ulcer

• The primary goals of therapy for RAU are relief of pain, reduction of ulcer duration, and restoration of normal oral function, while secondary goals include reduction in the frequency and severity of recurrences and maintenance of remission 3
• Topical medications, such as antimicrobial mouthwashes and topical corticosteroids, can achieve the primary goals but have not been shown to alter recurrence or remission rates 3
• Systemic medications, such as levamisole, oral corticosteroids, and thalidomide, can be tried if topical therapy is ineffective 3
• Topical curcumin has been shown to have clinically beneficial effects with regard to ulcer size, pain, healing, and recurrence rate, and can be safely recommended on a long-term basis as a more appealing therapeutic agent 4

Management of Recurrent Oral Ulcer

• Hard, acidic, and salty foods and toothpastes containing sodium lauryl sulfate should be avoided, along with alcohol and carbonated drinks 5
• Antiseptic agents and local anesthetics should be tried first, and if these are ineffective, topical corticosteroids should be used 5
• In severe cases, local measures can be combined with systemic drugs, such as colchicine, pentoxifylline, or prednisolone 5
• A treatment guide for management of recurrent aphthae should be presented, including information on a spectrum of medication found useful in ulcer management 6