Samarth Institute of Pharmacy, Belhe, Maharashtra, India.
Mouth ulcers, also known as aphthous stomatitis, are common, painful lesions that affect the mucosal surfaces of the oral cavity. Their pathophysiology is complex, involving genetic, immunological, and environmental factors. Although the exact cause remains unclear, dysregulation of the immune system plays a central role. Inflammatory responses are triggered by the activation of T lymphocytes, which lead to the release of cytokines, resulting in epithelial cell damage and ulcer formation. Genetic predisposition, stress, trauma, nutritional deficiencies (especially of B vitamins, folic acid, and iron), and microbial factors have all been implicated as contributing factors. The local tissue response is characterized by an imbalance between pro-inflammatory and anti-inflammatory mediators, with the upregulation of cytokines such as interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-?), and interferon-gamma (IFN-?). This results in increased vascular permeability, edema, and neutrophil infiltration, which further exacerbate the lesion. Treatment strategies often focus on symptomatic relief, while ongoing research aims to elucidate the precise molecular mechanisms involved to develop more targeted therapies. Understanding the pathophysiology of mouth ulcers is critical for improving treatment outcomes and minimizing recurrence.Treatment options include over-the-counter pain relievers, topical medications, and avoiding irritants. In most cases, mouth ulcers will heal on their own within a week or two. However, if they persist or are accompanied by other symptoms, it is important to seek medical attention. The diagnosis and treatment of oral lesions are often challenging due to the clinician’s limited exposure to the conditions that may cause the lesions and their similar appearances. This review aims at a systematic approach towards the diagnosis of oral ulcers based on their clinical and histopathological features while eliminating unrelated factors. Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases characterized by recurrent and painful ulcerations on the movable or nonkeratinized oral mucosae. Clinically, three types of RAS, namely minor, major, and herpetiform types, can be identified. RAS more commonly affects labial mucosa, buccalmucosa, and tongue. Previous studies indicate that RAS is a multifactorial T cell-mediated immune-dysregulated disease.
There are several potential causes of mouth ulcers, including stress, hormonal changes, food sensitivities, and certain medical conditions. They can also be triggered by injury to the mouth, such as biting the inside of the cheek or brushing too aggressively. While most mouth ulcers will heal on their own within a week or two, they can be treated with over-the-counter medications or home remedies to help alleviate pain and speed up the healing process. If mouth ulcers persist or are accompanied by other symptoms, it's important to seek medical attention to rule out any underlying health issues. Mouth ulcers are also common in patients converted to mTOR inhibitors. Again, such ulcers usually resolve spontaneously, but they can be problematic. In one prospective randomized study in which renal transplant recipients were converted at 1 year from a steroid-free regimen of tacrolimus and MMF to sirolimus and MMF, oral ulceration occurred in 9 of 15 converted patients. (. Eur J Oral Sci. et .al. 2018 Dec12)
Pathophysiology of Mouth Ulcers
Aphthous ulcerations are initially and primarily the result of T cell-mediated immune dysfunction but also may involve neutrophil and mast cell-mediated destruction of the mucos mucosal epithelium. Mouth ulcers, also known as aphthous ulcers, are small, painful sores that develop inside the mouth. They are a common condition that affects most people at some point in their lives. The exact cause of mouth ulcers is unknown, but they are thought to be triggered by a combination of factors, including:
Trauma: Injury to the mouth, such as biting the inside of your cheek or brushing your teeth too hard, can cause mouth ulcers.
Stress: Stress can also trigger mouth ulcers.
Certain foods: Some foods, such as acidic fruits, spicy foods, and nuts, can irritate the mouth and cause ulcers.
Hormonal changes: Women may experience mouth ulcers during their menstrual cycle or during pregnancy.
Certain medications: Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can cause mouth ulcers as a side effect.
Underlying medical conditions: Certain medical conditions, such as Crohn's disease, celiac disease, and vitamin deficiencies, can also cause mouth ulcers. Mouth ulcers typically heal on their own within 1 to 2 weeks. However, there are a number of things you can do to relieve the pain and promote healing, such as:
Avoid irritants: Avoid foods and drinks that irritate your mouth, such as acidic fruits, spicy foods, and nuts.
Use a mouthwash: Use a mouthwash that is designed for mouth ulcers.
Apply a topical medication: Apply a topical medication, such as a corticosteroid cream or gel, to the ulcer.
Over-the-counter pain relievers: Take over-the-counter pain relievers, such as ibuprofen or acetaminophen, to relieve the pain.
Causes of mouth ulcers: -
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There’s no definite cause behind mouth ulcers, but certain risk factors and triggers have been identified People assigned female at birth, children, adolescents, and those with a family history of mouth ulcers have a higher risk of developing them.
Triggers Include:
Mouth ulcer symptoms
Symptoms of mouth ulcers may vary depending on their cause, but they typically include:
Mouth ulcers are not usually contagious unless they’re caused by an infection such as hand, foot, and mouth disease. Canker sores are the most common type of mouth ulcer, with 20% of people having a canker sore at least once. There are thre main types of canker sores:
Minor canker sore
Minor canker sores are small oval or round ulcers measuring under 5 millimeters (mm). They heal within 1 to 2 weeks and don’t cause scars. According to Derm Net New Zealand, 80% of people with canker sores have minor canker sores, making them the most common type.
Major canker sore
Major canker sores are larger and deeper than minor ones. They often measure over 10 mm.They have irregular edges and can take weeks or months to heal. Major canker sores can result in long-term scarring.
Herpetiform Canker Sore
Herpetiform canker sores are pinpoint-sized, occur in clusters, and often appear on the tongue. Sometimes the clusters can merge to form one large sore. Herpetiform canker sores have irregular edges and often heal, without scarring, within 1 month. They’re called “herpetiform” because they may resemble the sores caused by herpes. Herpetiform canker sores are not otherwise associated with herpes infection.
|
Sr.no |
Common name |
Scientific name |
family |
Chemical constituents |
uses |
|
1 |
Guava leaves |
Psidium guajava |
myrtaceae |
Flavonoid, tennin |
Antimalarial, antiulcer, analgesic |
|
2 |
Indian cherry leave |
Cardia dichotoma |
boranginaceae |
Flavonid alkaloid |
Headache and ulcer |
|
3 |
Liquorice |
Glycurrhia glabral |
Leguminoseae |
Saponin ,fiavonoid |
Expectorant,Antiinflamatory |
|
4 |
Turmeric |
Curcuma loga |
zingiberaceae |
curcumine |
Anti arthritic,antiulcer |
|
5 |
Pomegranate flower |
Punica M L |
punicaeae |
Gallic acid, ellagic acid |
Peptic ulcer, oral and anal ulcer |
|
6 |
Betel leave |
Piper bette L |
piperaceae |
Alkaloid, amino acid |
Antifungal ,anti oxident |
|
7 |
Aloe vera |
Aloe barbadensis miller |
liliaceae |
Antroquinones, vitamin, lignins |
Anticancer, antidiabetic |
|
8 |
Capsicum |
Capsicum annuuml |
Solanaceae |
Capsaicin, paprika,aloe resin |
Stomach pain, mouth ulcer |
|
9 |
Noni fruit |
Morindacitrifolia linn |
rubiaceae |
Flavonoid, phenolics |
Abnormal menstruatin acene, fever, blood pressure |
Diagnosis Of Mouth Ulcers
Your doctor will be able to diagnose mouth ulcers through a visual exam. You might be tested for other medical conditions if you have frequent, severe mouth ulcers.
1. Pain or discomfort in the mouth, particularly when eating, drinking, or talking.
2. Redness or swelling in the affected area.
3. White or yellowish sores or lesions inside the mouth.
4. Difficulty in chewing or swallowing.
5. Tingling or burning sensation before the appearance of the ulcer.
6. Fever or swollen lymph nodes in severe cases.
7. Bad breath or a foul taste in the mouth.
8. Difficulty opening the mouth fully.
9. Feeling generally unwell or fatigued.
10. Recurrent outbreaks of mouth ulcers.
11. Sores that do not heal or continue to grow in size.
12. Ulcers that spread to the lips, gums, or throat.
Cold sores are also more likely to cause additional symptoms beyond the lesions, including:
Both types of lesions can cause a burning or tingling sensation on the skin that may start a few days before the lesions appear. However, this sensation is more closely associated with cold sores.( Chiang CP,et.al.2019)
Aphthous ulcers
Aphthous ulcer is another name for a canker sore. The medical term “aphtha” has a few definitions but is mostly used to refer to a small ulcer.
Mouth Ulcer Treatment
Most mouth ulcers don’t need treatment.
However, if you get mouth ulcers often or they’re extremely painful, a number of treatments and home remedies can decrease pain and healing time. These include:
Treatment Of Mouth Ulcers
The treatment for mouth ulcers is broadly divided into two categories:
Symptomatic Relief
Various OTC and prescription formulations are available for topical application to provide relief and promote faster healing of the mouth ulcers:
REFERENCES
Deshmane Pranav*, Jadhav Siddharth, Wavhal Vinayak, Datkhile Sachin, Lokhande Rahul, Pathophysiology of Mouth Ulcers, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 5, 263-268 https://doi.org/10.5281/zenodo.15332374
10.5281/zenodo.15332374
