Why do Mouth Ulcers Keep Coming Back?

Mouth ulcers are the loss of tissue lining in the mouth. They are usually painful and disturbing and can occur in any part of the mouth. They can be quite uncomfortable and disrupt normal eating and drinking.

Usually, they disappear in a week or two, but if they are not resolved, then it is necessary to visit a Dentist.

Your mouth, including the lips, tongue, palate, cheeks and gums, are lined by a soft tissue layer. The function of this layer is to protect the structures in your mouth and keep them moist at all times. Certain conditions can cause a disruption in this layer and that is how mouth ulcers erupt.


Types of Mouth ulcers

causes mouth ulcers
causes mouth ulcers

They usually appear like small blisters and may be red, white or yellow in colour. Based on their appearance, there are four types of mouth ulcers.

  • Minor ulcers
  • Major ulcers
  • Herpetic ulcers
  • Non-healing ulcers


Minor Ulcers: They are usually small (<1 cm in diameter). They typically present as a solitary ulcer, but may sometimes also present in clusters of 3 to 5 ulcers. They are the most common type of ulcer noticed in the mouth and tend to disappear on their own within a week or two. They are painful yet bearable.

Major Ulcers: They are quite big (>1 cm diameter) and can take a longer time to heal, ranging from a few weeks to even months. They are extremely painful and heal with a scar. Even the consumption of regular food becomes difficult.

Herpetic Ulcers: They are rare and show up as a cluster of small pinhead sized ulcers. They can occur inside the mouth or sometimes at the corner of the mouth. They usually are not very painful and they heal fast.

Non-Healing Ulcers: Certain ulcers do not heal after a few days, weeks or even months. Usually, they are painless and hard to touch. These ulcers can be signs of malignancy and should never be ignored.


mouth ulcers home remedies
mouth ulcers home remedies

Causes for mouth ulcers


This type of ulcer is most commonly caused by a sharp tooth, hot foods or accidental biting of the lips or cheeks. If this keeps happening repeatedly for a long time, it can turn a simple traumatic ulcer into a non-healing malignant one. Sometimes, a large tongue can also make one predisposed to frequent tongue biting, and hence ulcers. Improper brushing or handling sharp objects with your mouth can also cause such ulcers.


Stress Induced

Stress can be a major factor for mouth ulcers. It is proved that constant stress, anxiety, illness and fatigue can cause a particular type of ulcer called Aphthous Ulcer. They can be minor or major depending on the size.


Antibiotics or Vitamin Deficiency

Prolonged consumption of antibiotics can deplete the body of its normal balance of vitamins and minerals. This can predispose a person for mouth ulcers. These types of ulcers usually disappear after discontinuing the antibiotics.

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Smoking clearly has a deleterious effect on the mouth mucosa. Constant heat from the cigarette can cause minor or major ulcers. Also, healing of ulcers is very slow in case of smokers and there is a high risk of these minor ulcers turning into non-healing malignant ones. Smoking can also cause white patches in the inner part of the cheeks and other parts of the mouth. These are called Leukoplakia and have been linked to oral cancer.


mouth ulcers types
mouth ulcers types

Spicy Food

Prolonged consumption of spicy food by individuals can also cause mouth ulcers as they make the mouth mucosa fragile. This makes them extremely prone to local insults, which otherwise a normal mucosa would have tolerated well. Even a small accidental bite can turn out to become a major ulcer.


Viral Infection

Certain viral infections like Herpes simplex or Herpes Zoster can cause a cluster of ulcers in and around the mouth. They are mostly accompanied with viral fever and other related symptoms. They usually heal as soon as one recovers from the viral infection.


Allergy to toothpastes

Some people are allergic to certain ingredients in the toothpaste. This type of ulcer is very commonly seen right after changing to a new toothpaste and they disappear as soon as the toothpaste is discontinued. This can happen with certain mouthwashes too.


Ulcers related to dentures

It is not uncommon to have ulcers associated with dentures. Immediately after receiving a new denture, the mouth takes time to adapt to the same. This is associated with soreness, redness and a burning sensation in the site of friction.


Ulcers related to braces

Immediately after receiving dental braces, it is again quite common to have some ulcers as the mouth treats the braces as a foreign body. Again, it takes time for the mouth to adapt to the new environment.


Associated with other diseases

Certain diseases like Celiac disease, Crohnโ€™s disease, Infectious mononucleosis, Chicken pox, HIV, Anemia and Hand foot and mouth disease have mouth ulcers as their symptoms. Identifying these ulcers early can actually help in diagnosing these diseases.


mouth ulcers cure
mouth ulcers cure


How to Cure Mouth Ulcers with Natural Home Remedies ?

  • Salt water gargling: Mix salt in lukewarm water and gargle for at least 60 seconds.
  • Gargling with baking soda: Add in 1 teaspoon of baking soda to half a cup of water and gargle for 60 seconds.
  • Milk of magnesia: It can be directly applied over the ulcer for temporary relief.
  • Butter or clarified butter can also provide similar relief.
  • Ice application over the ulcer can reduce the burning sensation and provide a soothing sensation.
  • Topical anesthetic gels containing Benzocaine or Lignocaine can reduce the irritation, and when applied minutes before food can enable undisturbed eating.
  • Cool chamomile tea can also provide some relief.
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What are the precautions to take during mouth ulcers?

  • Avoid oily and spicy foods.
  • Avoid acidic foods and aerated drinks.
  • If Possible also avoid hot tea and coffee.
  • Consume a soft and bland diet.
  • Include calcium rich foods such as milk, cheese and yogurt.
  • Avoid toothpastes and mouthwashes that can cause an allergy.
  • Avoid smoking and alcohol consumption.
  • Use soft bristled toothbrushes.


What are best practices to avoid mouth ulcers?

  • Diminish emotional stress.
  • Practice relaxation techniques and get adequate rest.
  • Maintain good oral hygiene.
  • Keep yourself well hydrated always.
  • Include a lot of healthy foods like vegetables and fruits.
  • Ask your physician for vitamin and mineral supplements if you are on antibiotic therapy.
  • Change ill-fitting or old dentures


Why do mouth ulcers keep coming back?

  • Recurrent oral ulcers are called recurrent aphthous stomatitis.
  • In many cases, frequent ulcers are due to toothbrush trauma. Ensure you are not brushing too vigorously and damaging your tissues in the process. Also avoid walking around and doing other tasks while brushing.
  • Consult your doctor to rule out vitamin and iron deficiencies.
  • They may be due to another underlying health issue. So, watch out for other seemingly unrelated symptoms. Let your dentist know if you have ulcers in other regions of your body, especially the eyes or genital area.


How long do mouth ulcers take to heal?

  • Mouth ulcers usually resolve by themselves in one or two weeks. However, the major variety can take longer to heal, even up to 6 weeks. It is only when a painless ulcer lasts for three weeks or more, it must be immediately attended to.
  • In that case, your dentist will refer you to a specialist who will then advise a biopsy.


When to approach a Dentist?

  • When the ulcers do not heal even after a couple of weeks.
  • Consider visiting a dentist when they are extremely painful and disrupt your everyday routine.
  • If there is a sharp tooth or filling that is hurting you.
  • Repeated lip or cheek biting.
  • When there are white patches in the cheeks or any other parts of the mouth.
  • If you have recently started braces treatment, and have developed sores, do check with your dentist and he/she will cover the sharp edges with a small piece of wax to make you feel more comfortable.
  • When the ulcer is hard and painless.
  • When new ones keep appearing before the old ones heal.
  • If you find that it is associated with fever.


Can mouth ulcers turn into cancer?

  • Although 8 in 10 oral ulcers are minor and go away on their own, there is a small possibility of an oral ulcer turning into a malignant one if not identified and treated at the right time.
  • This is especially true in smokers, drinkers and high-risk individuals. A non-healing painless ulcer can always be a red signal and it has to be addressed immediately.
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Are mouth ulcers contagious?

Only mouth ulcers caused by viruses like Herpes are contagious. This type of ulcer is highly infectious and spreads through saliva and by touch.


Do mouth ulcers spread by kissing?

Major and minor ulcers do not spread through kissing. But herpetic ulcers definitely can spread through kissing. The virus thrives in saliva and can even spread through sharing glasses, plates, and oral sex.


Difference between cold sores and mouth ulcers?

Cold sores are ulcers caused by the Herpes simplex virus. They start with a burning and tingling sensation around the lips and cause blisters on the lips. You will find that they are filled with clear fluid. They burst, exposing the underlying red area, and start healing by forming crusts on the lips. They are contagious during the blister stage.


Can mouth ulcers be the reason for an upset stomach?

Not necessary. There can be instances of mouth and stomach ulcers occurring simultaneously, but there is no scientifically proven connection between a mouth ulcer and an upset tummy.




Mouth ulcers are quite common and most of the time, they can be taken care of at home. But never hesitate to approach a dentist if they are severe or they fail to heal on their own. Early diagnosis is the key and makes it easy to treat the same easily.

Dr. Vasantha Sugavanam
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