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Painful but benign and self-healing — if they pile up, look at iron, B12, folate and coeliac disease.
Also known as: aphthous ulcers · mouth ulcers · recurrent stomatitis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Aphthous ulcers are small, round sores of the lining of the mouth with a whitish-yellow base and a red rim. They sit where the lining is movable: on the inside of lip and cheek, under the tongue, at the edge of the tongue. They hurt far more than their size suggests and usually heal by themselves within one to two weeks, without a scar. The distinction from herpes matters: that forms blisters and sits outside on the lip or, inside, where the lining is firmly bound to the bone, so on the palate and the gums. Aphthous ulcers are not catching. Why they come often stays open; triggers can frequently be found — a small injury from a toothbrush or a bite, stress, lack of sleep, the cycle, sometimes a toothpaste containing the foaming agent sodium lauryl sulfate. If they pile up, it is worth looking at iron, vitamin B12, folate and coeliac disease. And two things belong looked at by a doctor: a sore that has not healed after three weeks, and mouth ulcers together with sores in the genital area or inflamed eyes.
In some people the ulcers become less frequent with a toothpaste free of sodium lauryl sulfate. A trial over two to three months gives the answer.
An adhesive gel before eating, soft and cool food, leaving out spicy, sour and hard things for a few days. That does not heal faster, but it makes the days bearable.
Three values, one tube. In some people with recurring mouth ulcers the explanation lies exactly here — and correcting it ends them.
Recurring mouth ulcers are among the signs that can appear even without belly complaints. The order matters: test first, then leave out gluten.
A single sore in the same place that stays, hardens or bleeds belongs looked at — especially at the edge of the tongue and in smokers. Usually it is harmless, and that is precisely why the look is quickly done.
Many describe series in exactly those weeks with little sleep and much to carry. That is no proof, but a pattern that can be influenced.
Avoid spicy, acidic and hard food for a while, rinse with lukewarm salt water or sage tea, use a soft toothbrush.
Half a teaspoon of salt in 250 ml of warm water, gargle for 30 seconds, spit out, three to four times a day.
There is no drug that prevents mouth ulcers. What exists eases them: gels with a local anaesthetic for mealtimes, adhesive cortisone paste for the length of the episode, chlorhexidine against secondary colonisation. The course stays the same — a small ulcer heals in seven to ten days, a large one in up to six weeks. With frequent episodes, iron, B12, folate and coeliac disease are looked for; that is the one lever that changes the frequency.
About one in five people has recurring mouth ulcers. The small form measures under a centimetre and heals in seven to ten days without a scar; the large form over a centimetre takes up to six weeks and can leave a scar. It counts as recurring from three episodes a year — then iron, B12, folate and coeliac disease are looked for, because in some the cause is found there.
Inside of the lip, cheek, edge of the tongue, under the tongue. If it sits outside on the lip or up on the hard palate, it is usually herpes and therefore something else.
A day or two before the visible sore, the spot tingles or burns. Anyone who knows this can start early with a gel or a rinse and soften the worst day.
Several times a year, often in phases with little sleep or much tension, in women sometimes on the same days of the cycle. A simple diary finds the pattern faster than any examination.
A large, deep ulcer takes weeks and can leave a scar. It is unpleasant but not dangerous — it belongs shown once, because there are effective local treatments for it.
Mouth ulcers together with sores in the genital area, inflamed eyes or skin lumps are a picture of their own and belong assessed. The same goes for persistent diarrhoea and weight loss.
An iron shortage is among the commonest graspable causes of recurring mouth ulcers — and it often makes itself felt long before anaemia is there.
Together with folate one of the three values always checked with frequent mouth ulcers. Correcting it makes them disappear entirely in some people.
The third value of this group. It is measured together with B12, because correcting folate alone can mask a B12 shortage.
Recurring mouth ulcers can be the only visible sign of coeliac disease. Important: the value only holds while gluten is still being eaten.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Some women get mouth ulcers regularly in the second half of the cycle or just before the period. A calendar over three cycles shows the pattern — and saves the search for a food that is not the reason.
Mouth ulcers typically come after the strain, not during — in the week after the exam, not before. The same pattern as the weekend headache.
With recurrent mouth ulcers a deficiency in one of the three is found in about one case in five. Once corrected they return markedly less often in some — measure first.
Citrus, tomatoes, nuts and pineapple irritate open spots. Toothpaste without sodium lauryl sulfate reduced the number of ulcers in small studies — not diet, but it works in the same mouth.
Studied in recurring aphthae — an effect appeared in one trial even with a normal blood level.
For rinsing; the spot burns briefly and then settles. It does not act on the time to healing — mostly seven to fourteen days.
Traditionally used as a rinse. With recurrent mouth ulcers a look at iron, B12 and folate is worth more than any rinse.
The traditional application for the mouth: strongly diluted, dabbed onto the spot. It burns briefly and draws together — that is exactly what is meant.
Eugenol numbs locally — the same thing the dentist once used. One drop on a cotton bud, no more; undiluted it burns the lining.
A red tongue tip counts in TCM as “Heart heat” — the classic assignment with recurrent mouth ulcers. Today’s route runs through iron, B12 and folate.