A mouth ulcer (aphtha), or sometimes called a canker sore or salt blister, is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are painful and typically small lesions that develop in our mouth or at the base of our gums.
Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually, or multiple ulcers may appear at once (called – crop of ulcers). Once formed, an ulcer may be maintained by inflammation and/or secondary infection.
Mouth ulcers are rarely contagious and usually go away after 1 to 2 weeks, even without treatment. If a person gets a mouth ulcer that is large, is extremely painful, or lasts for a long time without healing, it could be a serious case. Mouth ulcers are not usually contagious unless they’re caused by an infection such as hand, foot, and mouth disease.
The oral lesions caused by canker sores and cold sores may appear and feel similar, but they actually have different causes.
Drug-induced
Many allopathic drugs can cause mouth ulcers as a side effect. Common examples are alendronate (a bisphosphonate, commonly prescribed for osteoporosis), cytotoxic drugs (e.g. methotrexate, i.e. chemotherapy), non-steroidal anti-inflammatory drugs, nicorandil (may be prescribed for angina) and propylthiouracil (e.g. used for hyperthyroidism). Some recreational drugs can cause ulceration, e.g. cocaine, Ice/Substance, heroin etc.
Definition
An ulcer is a break in the skin or mucous membrane with loss of surface tissue and the disintegration and necrosis of epithelial tissue. A mucosal ulcer is an ulcer which specifically occurs on a mucous membrane.
An ulcer is a tissue defect which has penetrated the epithelial-connective tissue border, with its base at a deep level in the submucosa, or even within muscle or periosteum. An ulcer is a deeper breach of epithelium compared to an erosion or excoriation and involves damage to both epithelium and lamina propria. 
An erosion is a superficial breach of the epithelium, with little damage to the underlying lamina propria. A mucosal erosion is an erosion which specifically occurs on a mucous membrane. Only the superficial epithelial cells of the epidermis or of the mucosa are lost, and the lesion can reach the depth of the basement membrane. Erosions heal without scar formation.
Excoriation is a term sometimes used to describe a breach of the epithelium which is deeper than an erosion but shallower than an ulcer. This type of lesion is tangential to the rete pegs and shows punctiform (small pinhead spots) bleeding, caused by exposed capillary loops.
Causes of mouth ulcers
There’s no definite cause behind mouth ulcers, but certain risk factors and triggers have been identified. Pathologically, the mouth represents a transition between the gastrointestinal tract and the skin, meaning that many gastrointestinal and cutaneous conditions can involve the mouth. Some conditions usually associated with the whole gastrointestinal tract may present only in the mouth, e.g., orofacial granulomatosis/oral Crohn’s disease.
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:
- minor mouth injury from dental work, hard brushing, sports injury, or an accidental bite,
- dental braces,
- toothpaste or mouthwash that contains sodium lauryl sulfate (SLS),
- an allergic response to oral bacteria,
- bacterial, viral, or fungal infections in the mouth, such as hand, foot, and mouth disease,
- sensitivities to acidic foods and beverages like strawberries, citrus fruits, pineapple, chocolate, and coffee,
- certain nutrient deficiencies, especially vitamin B9 (folate), vitamin B12, zinc, and iron,
- hormonal changes, such as those that occur during menstruation or pregnancy,
- emotional stress,
- lack of sleep.
Mouth ulcers can also be a sign of conditions that are more serious and require medical treatment, such as: 
- celiac disease,
- inflammatory bowel disease (IBD), including ulcerative colitis,
- diabetes,
- HIV,
- some autoimmune diseases, for example:
- lupus,
- oral lichen planus,
- Behçet’s disease, a rare condition that causes inflammation throughout the blood vessels.
Canker sores
Canker sores occur only in the soft tissues of the mouth, such as on your gums or inside your cheeks. They can be caused by a variety of factors, including injury to the inside of your mouth and vitamin deficiencies.
Canker sores are the most common type of mouth ulcer, with 20% of people having a canker sore at least once. There are three main types of canker sores:
- minor
- major
- herpetiform
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.
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. 
Cause of Canker sores
Some of the possible triggers can be one or a combination of the following:
- injury to the inside of your mouth,
- deficiency in nutrients such as vitamin B-12, iron, or folate,
- use of toothpastes or mouthwashes that contain sodium lauryl sulfate,
- stress,
- fluctuations in hormones, such as those that occur during menstruation,
- a reaction to foods such as chocolate, nuts, or spicy foods,
- conditions that affect your immune system, such as lupus and inflammatory bowel diseases.
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.
Cold sores
Cold sores form on and around your lips, although in some cases they can also form inside your mouth. They’re caused by infection with the herpes simplex virus (HSV).
Rarely, infants can ulcerate the tongue or lower lip with the teeth, termed Riga-Fede disease.
Cold sores are caused by infection with specific strains of HSV. HSV-1 is the strain that most commonly causes cold sores. However, HSV-2, the strain that causes genital herpes, can also cause cold sores. HSV is very contagious. The virus is most contagious when oozing cold sores are present, although it can be transmitted even if cold sores aren’t present.
HSV-1 can be spread through things such as sharing eating utensils or toothbrushes, or through kissing. Oral sex may spread HSV-2 to the mouth and lips and may also spread HSV-1 to the genitals.
After a person has contracted the infection, some factors may lead to the development of cold sores, for example:
- stress,
- fatigue,
- being sick with the flu or a cold,
- heatstroke,
- changes in hormones, such as during menstruation,
- irritation to the area where patient has cold sores, which can be due to injury, dental work, or cosmetic surgery.
Symptoms of cold sores
The symptoms of a cold sore can depend on if patient has a new infection with HSV or has had the virus for a while. 
Those with a new infection may experience:
- burning or tingling, followed by the development of painful sores on or around the lips, in the mouth, on the nose or other areas of the face,
- sore throat or pain when swallow,
- fever,
- body aches and pains,
- headache,
- nausea,
- swollen lymph nodes.
If patient had the virus for a long time, he/she may experience periodic outbreaks of cold sores. These outbreaks typically follow several phases, for example:
- warning signs in the area of the outbreak, which can include a burning, stinging, or itching sensation,
- appearance of cold sores, which are filled with fluid and are often painful,
- crusting over of the cold sores, which happens when the cold sores break open and form scabs,
- healing of cold sores, typically without a scar, in one to two weeks.
How to identify cold sores vs. canker sores
Canker sores
Canker sores occur only on the inside of mouth. They can be found in the following areas:
- gums,
- inside the cheeks or lips,
- on or below the tongue,
- soft palate.
Patient may notice a burning or tingling feeling before canker sores appear. Canker sores are typically round or oval in shape. They can appear to be white or yellow and may have a red border.
Canker sores can also vary in size from small to large. Large canker sores (major canker sores) may be quite painful and take longer to heal.
Herpetiform canker sores, a less common type of canker sore, occur in clusters and are the size of pinpricks. This type of canker sore typically develops later in life.
How do we tell the difference?
The location of the sore can often help us tell if it’s a canker sore or a cold sore. Canker sores only occur inside the mouth while cold sores often occur on the outside of the mouth around the area of the lips.
Most people are infected with HSV during childhood. After a new HSV infection, children under age 5 may have cold sores inside of their mouth that can sometimes be mistaken for canker sores.
Mouth ulcer vs. cold sore
A cold sore is another common type of oral lesion. Although mouth ulcers and cold sores share some causes and symptoms, it’s usually easy to tell the two apart:
- Mouth ulcers only appear inside the mouth.
- Although cold sores can appear inside the mouth, they mainly appear right above, below, or on the lips. They may also spread to the nose or chin. Cold sores are also fluid-filled, making them a type of blister.
Most mouth ulcers are not contagious. Cold sores are typically caused by the herpes virus and are always contagious.
Cold sores are also more likely to cause additional symptoms beyond the lesions, for example:
- fever,
- fatigue,
- malaise,
- swollen lymph nodes in the neck.
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. 
When it could be emergency?
It could be serious/dangerous sign if mouth ulcers develop any of the following:
- unusually large mouth ulcers,
- new mouth ulcers that appear before the old ones heal,
- sores that persist for more than 3 weeks,
- painless sores,
- sores that extend to the lips,
- pain that you’re unable to manage with allopathic drugs or natural home medications,
- severe problems eating and drinking,
- high fever or diarrhea whenever mouth ulcers appear.
Mouth ulcer symptoms
Symptoms of mouth ulcers may vary depending on their cause, but they typically include:
- painful sores that may be yellow, white, or red,
- sores on the inside of the mouth, such as on the tongue or the insides of cheeks or lips,
- areas of redness surrounding the sores,
- pain that worsens when patient eat, drink, or talk.
Patient may have more than one mouth ulcer at the same time.
Diagnosis of mouth ulcers
Diagnosis of mouth ulcers usually consists of a medical history followed by an oral examination as well as examination of any other involved area. The following details may be pertinent: The duration that the lesion has been present, the location, the number of ulcers, the size, the color and whether it is hard to touch, bleeds or has a rolled edge. As a general rule, a mouth ulcer that does not heal within 2 or 3 weeks should be examined by a health care professional who is able to rule out oral cancer.
In order to confirm a diagnosis of cold sores, take a sample from the sore to be tested for HSV.
If patient has canker sores that recur often, perform blood tests to check for nutritional deficiencies, food allergies, or immune conditions.
Allopathic treatment for canker sores and cold sores
Canker sore allopathic treatment
According to allopathic theory, small canker sores typically don’t require treatment and will disappear on their own within a week or two. 
For larger or more painful canker sores, there are several treatment options in allopathy, including:
- over-the-counter (OTC) creams and gels that can be applied directly to sores, especially those that contain active ingredients such as benzocaine, hydrogen peroxide, and fluocinonide,
- prescription mouthwashes containing dexamethasone (steroid), that can ease pain and swelling,
- oral steroid medications, which can help when canker sores don’t respond to other allopathic treatments,
- cautery, which involves using a chemical or instrument to destroy or burn the canker sore.
Cold sores allopathic treatment
According to allopathic theory, cold sores typically go away on their own within a few weeks. There are some allopathic treatments that can help ease symptoms and speed up healing, for example:
- OTC creams or gels containing lidocaine (anesthetic) or benzocaine (local anesthetic) to ease pain,
- OTC cold sore creams containing docosanol, which may shorten outbreak by about a day,
- prescription antiviral drugs, such as acyclovir, valacyclovir, and famciclovir.
Mouth ulcer allopathic treatment
According to allopathic theory most/all mouth ulcers don’t need treatment. However, if patient’s mouth ulcers are extremely painful, a number of treatments and Homeopathic remedies can decrease pain and healing time. These include:
- covering the ulcer with a paste made from baking soda,
- using other topical pastes,
- placing milk of magnesia on the ulcer,
- using a saline mouth rinse along with baking soda,
- using a mouth rinse that contains a steroid to reduce pain and swelling,
- applying ice to the ulcer,
- placing a damp tea bag on the ulcer,
- taking supplements if patient have deficiencies in certain nutrients, including vitamin B9 (folate), vitamin B12, zinc, and iron,
- advising over-the-counter topical products that are made with benzocaine, like Orajel and Anbesol,
- trying natural remedies, such as echinacea, myrrh, and licorice root (may come in various forms, like Homeopathic drops, syrups, teas and oils).
Homeopathic treatment for mouth ulcers
All natural remedies are rich in nutrients, minerals, antibacterial and/or antiviral effect, anti-inflammatory etc. effects that’s why every Homeopathic medicine for inflammation and for ulcers will treat any type (all types) of mouth ulcer along with their root cause(s), will restore natural tissue and functions and will boost immune system. 
According to Homeopathic theory, all diseases including mouth ulcers (any type) need urgent and full treatment to ensure safety from any future complication(s).
Here are very few of Homeopathic medicines for mouth ulcers:
Echinacea Angustifolia
A remarkable medicine as a “corrector of blood dyscrasia”. Acute autoinfection. Symptoms of blood poisoning, septic conditions generally. Diarrhea in typhoid. Gonorrhea. Boils. Erysipelas and foul ulcers. Gangrene. Goiter with exophthalmic symptoms. Tendency to malignancy in acute and subacute disorders. Last stages of cancer to ease pain. Venom infection. Cerebro-spinal meningitis. Puerperal infections. Tired feeling. Piles. Pustules. Lymphatic inflammation; crushing injuries. Snake bites and bites and stings generally. Foul discharges with emaciation and great debility.
Post-nasal catarrh with ulceration and fetor. Canker; gums recede and bleed easily; corners of mouth and lips crack; tongue dry and swollen; sores; dirty brownish. Tongue, lips, and fauces tingle. Tonsils purple or black, gray exudation extending to posterior nares and air-passages. Ulcerated sore throat. Sour belching and heartburn. Nausea; better lying down.
Recurring boils. Carbuncles. Irritations from insect bites and poisonous plants, allergies. Lymphatics enlarged. Old tibial ulcers. Gangrene. Chilliness, with nausea. Cold flashes all over back. Malarial fever.
Acts on vermiform appendix thus has been used for appendicitis, but remember it promotes suppuration and a neglected appendicitis with pus formation would probably rupture sooner under its use.
Myrica Cerifera
Marked action on the liver, with jaundice and mucous membranes. Persistent sleeplessness. Jaundice. Despondent, irritable, indifferent. Gloomy. Headache, with drowsiness; yellow sclerotia. Face yellow, Itching and stinging. Creeping sensation. Tongue furred, with bad taste in mouth, and nausea. Tenacious, thick, nauseous secretion. Tender, spongy and bleeding gums.
Mouth taste bitter and nauseous, with offensive breath. Complete loss appetite, feeling of fullness in the stomach after a hearty meal. Complete jaundice, with bronze-yellow skin; loss of appetite. Scanty, yellow, frothy urine. Sleep disturbed, bad dreams and frequent waking, insomnia.
Myristica Sebifera
A Homeopathic medicine of great antiseptic powers. Inflammation of skin, cellular tissue and periosteum. Traumatic infections. Parotitis. Fistulas. Carbuncles. Specific action in panaritium. Pain and inflammation in the fingernails. Coppery taste and burning in throat. Tongue white and cracked. Phlegmonous inflammations. Hastens suppuration and shortens its duration. Inflammation of middle ear, suppurative stage. Anal fistula.
Glycyrrhiza Glabra (also called Mulethi and Licorice root)
Glycyrrhizin has anti-viral, anti-inflammatory, hepatoprotective and anti-tumor activities for example such as herpes simplex, HIV, severe acute respiratory syndrome, influenza virus, coronavirus, enteroviruses and hepatic viruses. It works as an anti-tumor and anti-cancer. 
Mercurius Corrosive
Face swollen. Red, puffy. Lips black, swollen. Sordes. Facial neuralgia within the bones.
Mouth: Teeth loose. Gums purple, swollen, and spongy. Tongue swollen and inflamed. Salivation. Pyorrhea. Ptyalism. Taste salty and bitter.
Throat: Red, swollen, painful, intensely inflamed. Uvula swollen. Swallowing painful. Most pain in post-nasal with sharp pains to ears. Burning pain, with great swelling; worse, slight external pressure. All glands about thorax swollen.
Stomach: Incessant, green, bilious vomiting. Epigastrium very sensitive.
Mercurius Cyanatus
Mouth covered with ulcerations. Tongue pale. Free salivation. Fetor of breath. Pain and swelling of salivary glands. Astringent taste. Ulcerations of mouth have a gray membrane. Throat feels raw and sore. Mucous membranes broken down, ulcerated. Looks raw in spots. Talking is painful. Necrotic destruction of soft parts of palate and fauces. Intense redness of fauces. Swallowing very difficult. Dark blood from nose. Diphtheria of the larynx and nose. Nausea, vomiting, bilious, bloody; hiccough; abdomen painful, tender to pressure.
Mercurius Dulcis
Offensive breath; salivation; sore gums. Mouth ulcers. Tongue black. Constant flow of dark, putrid saliva; very offensive. Ulceration of throat, with dysphagia. Granular pharyngitis. Nausea and vomiting. Cyclic vomiting of infants. Phagedenic ulcers. Copper-colored eruptions.
Mercurius Iodatus Ruber
Diphtheria and ulcerated sore throats with glandular swelling. Chronic suppurating buboes. Hard chancres. Old cases of syphilis in scrofulous patients. Early stages of cold, especially in children. Faucets dark red; swallowing painful. Stiffness of muscles of throat and neck.
Boggy mucus membrane of nose and throat; closure of Eustachian tube, opening with a pop. Gums swollen; toothache; glands swollen. Scalded feeling on tongue. Aphthae. Profuse saliva. Tongue feels stiff at base, and pains on moving. Diphtheria; submaxillary glands painfully engorged, fauces dark red. Parenchymatous tonsillitis. Cough form elongated uvula, with sore throat, aphonia. Small fissures and cracks; hard papules on skin; Hunterian chancre; syphilitic ulcers. Bubo.
Mercurius Solubilis
Sweetish metallic taste. Salivary secretions increased; bloody and viscid. Saliva fetid, coppery. Speech difficult, trembling tongue. Gums spongy, recede, bleed easily. Sore pain on touch and from chewing. Crown of teeth decay. Teeth loose, feel tender and elongated. Furrow in upper surface of tongue lengthwise. Tongue heavy, thick; moist coating; yellow, flabby, teeth-intended, feels as if burnt, with ulcers, Fetid odor from mouth, can smell it all over room. Alveolar abscess, worse at night. Great thirst, with moist mouth. 
Throat: Bluish-red swelling. Constant desire to swallow. Putrid sore throat. Ulcers and inflammation appearing at every change in weather. Putrid eructation. Intense thirst for cold drinks. Weak digestion, with continuous hunger. Stomach sensitive to touch. Hiccough and regurgitation. Feels replete and constricted.
Bothrops Lanceolatus
Thrombosis, also thrombotic phenomena, as hemiplegia, aphasia, inability to articulate. septic states. Great lassitude and sluggishness; hemorrhages from every orifice of the body; black spots. Throat red, dry, constricted; swallowing difficult, cannot pass liquids. Epigastric distress. Black vomiting. Intense hematemesis. Tympanites and bloody stools.
Skin swollen, livid, cold with hemorrhagic infiltration. Gangrene. Lymphatics swollen. Anthrax. Malignant erysipelas.
Arsenicum Album
Unhealthy, easily-bleeding gums. Ulceration of mouth with dryness and burning heat. Epithelioma of lips. Tongue dry, clean, and red; stitching and burning pain in tongue, ulcerated with blue color. Bloody saliva. Neuralgia of teeth; feel long and very sore. Metallic taste. Gulping up of burning water. Throat swollen, edematous, constricted, burning, unable to swallow. Diphtheritic membrane dry and wrinkled.
Lachesis Mutus
Gums swollen, spongy, bleed. Tongue swollen, burns, trembles, red, dry and cracked at tip, catches on teeth. Aphthous and denuded spots with burning and rawness. Nauseous taste. Throat sore. Septic parotiditis. Mouth dry, intensely swollen, externally and internally. Diphtheria; membrane dusky, blackish; pain aggravated by hot drinks; chronic sore throat. Tonsils purplish.
Baptisia Tinctoria
Mouth taste flat, bitter. Teeth and gums sore, ulcerated. Breath fetid. Tongue feels burned; yellowish-brown; edges red and shining. Dry and brown in center, with dry and glistening edges; surface cracked and sore. Throat dark redness of tonsils and soft palate. Constriction, contraction of esophagus. Difficulty in swallowing. Painless sore throat, and offensive discharge. Contraction at cardiac orifice. Gastric fever. No appetite. Constant desire for water. Sinking feeling at stomach. Pain in epigastric region.
Cistus Canadensis
Scorbutic swollen gums. Mouth feels cold; putrid, impure breath. Pyorrhea. Hurts to protrude the tongue. Throat spongy feeling; very dry and cold air passing over parts causes pain. Breath, tongue, and throat feel cold. Uvula and tonsils swollen. A small, dry spot in throat; must sip water frequently. Hawking of mucus. Swelling and suppuration of throat glands. Heat and itching in throat.
Staphysagria
Toothache during menses. Teeth black and crumbling. Salivation, spongy gums, bleed easily. Submaxillary glands swollen. Colic after anger. Hot flatus. Swollen abdomen in children, with much flatus. Colic, with pelvic tenesmus.
Calendula Officinalis
A most remarkable healing agent – applied locally. Useful for open wounds, parts that will not heal, ulcers, etc. Promotes healthy granulations and rapid healing by first intention. Severe painful ulcers.
Rhus Venenata
Tongue red at tip. Fissured in middle. Vesicles mouth. Erysipelas; skin dark red. Erythema nodosum.
Lycopodium Clavatum
Dryness of mouth and tongue, without thirst. Tongue dry, black, cracked, swollen; oscillates. Mouth waters. Blisters on tongue, on lips. Bad odor from mouth. Inflammation of throat, with stitches on swallowing. Swelling, ulceration and suppuration of tonsils. Diphtheria. Ulceration of vocal bands. Tubercular laryngitis. Dyspepsia. Great weakness of digestion. 
Rhus Toxicodendrone
Teeth feel loose and long; gums sore. Tongue red and cracked; coated, except red triangular space at the tip; dry and red at edges. Corners of mouth ulcerated; fever-blisters around mouth and chin. Pain in maxillary joint. Throat sore, with swollen glands. Sticking pain on swallowing. Parotitis. Bitter mouth taste. Nausea, vertigo, and bloated abdomen after eating. Great thirst, with dry mouth and throat.
Zincum Metallicum
Teeth loose. Gums bleed. Gnashing of teeth. Bloody taste. Blisters on tongue, lips and cheeks. Difficult dentition; child weak; cold and restless feet. Throat dry. Hiccough, nausea, vomiting of bitter mucus. Burning in stomach, heartburn from sweet things. Atonic dyspepsia.
Sulphur
Herpes Zoster. Polypus and adenoids. Lips dry, bright red, burning. Bitter taste. Jerks through teeth. Swelling of gums; throbbing pain. Tongue white, with red tip and borders. Mouth ulcers. Complete loss of, or excessive appetite. Putrid eructation. Food tastes too salty. Drinks much, eats little.
P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.
For proper consultation and treatment, please visit our clinic.
Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
Location: Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.
Find more about Dr Sayed Qaisar Ahmed at:
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