Mouth ulcers are a common cause for general people to seek medical/dental advice. At various times of life, most people are affected with breach of oral mucosa or an uncomfortable blister within the lips. These are also known as 'apthous ulcers'.
These ulcers are small, oval and red in colour, which develop inside the mouth. They are commonly found in the inner part of the cheeks, inside the lips, under the tongue or on the soft palate. Luckily are non-contagious (i.e. they do not spread usually) and disappear after a couple of weeks.
Both men and women are affected, but the ratio among women is more. Teenagers are most prone to developing such ulcers as it is the result of stress, poor diet or lack of sleep.

There are three types of mouth ulcers:
! Minor ulcers
! Major ulcers
! Herpetiform ulcers

Minor ulcers
Around 80 percent of all mouth ulcers are the minor type. They are oval or round in shape and are no bigger than 10mm in size. They are usually not painful and last for a week or two and disappear without scarring.

Major ulcers
This type of ulcer is bigger and deeper than a minor ulcer and tends to occur in about 10 percent of cases. This ulcer lasts from ten days to several months but in some cases, they can remain for a year or two. They are painful in nature and usually leave a scar after disappearance.

Herpetiform ulcers
These tiny ulcers are no bigger than 3mm in size and appear as clusters. In some cases they can combine together to form large, irregular shaped groups of ulcers. This type of ulcer appears in rare 10 percent of cases. Also known as 'pinpoint' ulcers, they usually disappear in ten days and don't result in scarring.

Causes of mouth ulcers
Mouth ulcers do not have any specific cause; there can be various reasons, such as:
! Poor diet–Diet lacking in certain vitamins, iron or folic acid
! Mouth injury–excessive use of toothbrush (that doesn't mean you will stop brushing) or injury from uncomfortable dentures. Accidental biting also causes mouth ulcers.
! Hereditary–If either of your parents are prone to persistent mouth ulcers, chances are that you will develop them too.
! Hormonal changes–changes in hormonal level, especially in women, may cause mouth ulcers. Onset of period, during pregnancy, or menopause, triggers development of mouth ulcers.
! Diseases–Crohn's disease, ulcerative colitis, immune system disorders etc are some underlying medical causes of mouth ulcers.
! Irritant diet–It is believed that highly acidic diet such as coffee, pineapple, eggs etc may cause mouth ulcers.
! Medications--Some medications such as hypertensive drugs, painkillers etc are also responsible for these ulcers, but they are temporary, and soon subside without harm.
! Toothpaste–many brands of toothpaste can cause mouth ulcers in some individuals, hence one should keep that in mind if one is suffering from persistent mouth ulcers.
Whatever the causes, there can be nothing more miserable than developing a mouth ulcer. They can make it difficult to eat or drink as normal and can even affect speech.

Treatment
Mouth ulcers usually disappear without any need for treatment but if they become worse or last for longer than a couple of weeks then speak to your GP. He or she will be able to recommend a suitable course of treatment.

Generally the treatment includes-
! Corticosteroids- They help to reduce inflammation. Available in ointment form such as 'Apthasol'
! Antibacterial/anti fungal mouthwash- They act as local anesthetic, reducing pain, and clear the infection, if present, helping in the quick recovery of the ulcer.
! Vitamin supplements- Vitamin B12, Folic acid or iron supplements are prescribed to those whose diet seems insufficient, causing mouth ulcers.
! Hormones- These are prescribed to female patients who are experiencing recurring mouth ulcers.
** Mouth ulcers are not transmitted from kissing or sharing food with someone with a mouth ulcer, unless the person is suffering from ulcers caused by herpes virus.

The writer is a Research Physician of CCAH  International centre for Diarrheal Disease Research, Bangladesh (icddr'b)