Mouth ulcers are small sores that develop on the soft tissues inside the mouth.
They can be painful, particularly when eating, drinking, brushing your teeth or talking, but most ordinary mouth ulcers are harmless and heal without treatment.
A common type is the aphthous ulcer, also called an aphthous ulcer or canker sore.
These typically appear as round or oval sores with a white, yellow or greyish centre surrounded by a red border.
Most minor aphthous ulcers heal within approximately one to two weeks.
However, ulcers that are unusually large, repeatedly return or do not heal should be properly assessed.
Where Do Mouth Ulcers Develop?
Mouth ulcers can occur on several areas inside the mouth, including:
- inside the lips,
- inside the cheeks,
- on or underneath the tongue,
- on the floor of the mouth,
- and on other soft tissues.
Their location can sometimes help distinguish an ordinary aphthous ulcer from other mouth conditions.
What Does a Mouth Ulcer Look Like?
A typical minor aphthous ulcer is:
- round or oval,
- shallow,
- white, yellow or greyish in the centre,
- surrounded by a red border,
- and painful or tender.
Some people experience a burning or tingling sensation shortly before the ulcer becomes visible.
You may have only one ulcer or several at the same time.
Are Mouth Ulcers Contagious?
Ordinary aphthous mouth ulcers are not contagious.
You cannot pass a canker sore to another person by:
- kissing,
- sharing food,
- sharing cups,
- or being physically close to them.
This is an important difference between aphthous ulcers and certain infections that can cause sores around the mouth.
Mouth Ulcer vs Cold Sore
Mouth ulcers and cold sores are not the same thing.
A canker sore or aphthous ulcer usually develops inside the mouth and is not contagious.
A cold sore is usually caused by herpes simplex virus, commonly HSV-1. Cold sores generally develop on or around the lips and are contagious.
Cold sores commonly begin with tingling, itching or burning before fluid-filled blisters develop.
Because different conditions can cause mouth sores, an unusual or persistent lesion should be professionally assessed rather than self-diagnosed.
What Causes Mouth Ulcers?
There is no single cause of every mouth ulcer.
A single ulcer is often associated with minor injury or irritation.
Possible triggers include:
- accidentally biting the cheek or lip,
- brushing too aggressively,
- a sharp or broken tooth,
- rough dental fillings,
- braces,
- poorly fitting dentures,
- burns from hot food or drinks,
- hard or abrasive foods,
- stress,
- tiredness,
- and certain foods in susceptible people.
For recurrent aphthous ulcers, the exact underlying cause is often unknown.
Can Stress Cause Mouth Ulcers?
Stress is reported as a trigger for recurrent aphthous ulcers in some people.
However, stress should not automatically be blamed whenever someone develops a mouth ulcer.
Someone experiencing frequent ulcers may need assessment for other contributing factors.
Managing stress may support general wellbeing, but it does not guarantee that mouth ulcers will disappear.
Can Hormonal Changes Trigger Mouth Ulcers?
Hormonal changes may be associated with recurrent mouth ulcers in some people.
Individual responses vary considerably.
If mouth ulcers repeatedly occur alongside other unusual symptoms, discuss the pattern with a healthcare professional.
Can Vitamin or Mineral Deficiencies Cause Mouth Ulcers?
Recurrent mouth ulcers can sometimes be associated with nutritional deficiencies.
These may include deficiencies involving:
- iron,
- vitamin B12,
- folate,
- and certain other nutrients.
This does not mean everyone with a mouth ulcer should automatically start taking vitamin supplements.
If ulcers are frequent, severe or persistent, a healthcare professional may recommend blood tests to look for anaemia or nutritional deficiencies.
A confirmed deficiency can then be treated appropriately.
Should You Take Folic Acid or B Vitamins for Mouth Ulcers?
Not automatically.
Vitamin supplements are most useful when there is an identified deficiency or another clinical reason for taking them.
Taking unnecessary high-dose supplements is not a substitute for finding the cause of recurrent ulcers.
Can Certain Medical Conditions Cause Mouth Ulcers?
Sometimes recurrent or unusual mouth ulcers can occur alongside other medical conditions.
Examples include:
- coeliac disease,
- inflammatory bowel disease such as Crohn's disease,
- Behçet disease,
- certain immune disorders,
- and some blood or nutritional disorders.
This does not mean that having an occasional mouth ulcer indicates a serious disease.
Most mouth ulcers are not caused by these conditions.
However, repeated ulcers combined with symptoms elsewhere in the body deserve further assessment.
Can Medicines Cause Mouth Ulcers?
Some medicines can contribute to oral ulceration in certain people.
Examples may include particular:
- anti-inflammatory medicines,
- blood-pressure medicines,
- medications affecting the immune system,
- and other drugs.
One medicine particularly associated with oral ulceration is nicorandil, which is used to treat angina in some countries.
Never stop prescribed medication because you develop a mouth ulcer without first discussing it with the healthcare professional responsible for your treatment.
Does Smoking Cause Mouth Ulcers?
Smoking causes substantial harm to oral and general health and increases the risk of oral cancer and many other diseases.
However, the relationship between smoking and ordinary recurrent aphthous ulcers is unusual.
Some people actually develop recurrent aphthous ulcers after stopping smoking.
This is not a reason to continue smoking or restart smoking.
The health benefits of quitting tobacco greatly outweigh this temporary problem.
If ulcers develop after stopping smoking, discuss symptom-relief options with a healthcare professional or dentist rather than returning to tobacco.
Types of Aphthous Mouth Ulcers
Recurrent aphthous ulcers are commonly divided into several types.
Minor Aphthous Ulcers
These are the most common.
They are generally:
- small,
- shallow,
- painful,
- and self-limiting.
They usually heal within approximately 7–14 days and generally do not leave scars.
Major Aphthous Ulcers
Major aphthous ulcers are:
- larger,
- deeper,
- more painful,
- and slower to heal.
They may persist for several weeks and can sometimes leave scarring.
Large or persistent ulcers should be professionally assessed.
Herpetiform Aphthous Ulcers
Despite the name, herpetiform aphthous ulcers are not caused by the herpes virus.
They consist of numerous tiny ulcers that can sometimes merge into larger irregular areas.
They are less common than minor aphthous ulcers.
What Symptoms Can Mouth Ulcers Cause?
Pain is the most common symptom.
Pain may become worse while:
- eating,
- drinking,
- speaking,
- or brushing the teeth.
Hot, spicy, salty or acidic foods can irritate an existing ulcer.
Severe ulcers may make eating or drinking difficult.
Does Bad Breath Mean You Have a Mouth Ulcer?
Bad breath is not a defining symptom of an ordinary aphthous ulcer.
Bad breath can have many causes, including:
- dental plaque,
- gum disease,
- dry mouth,
- certain foods,
- smoking,
- dental infections,
- and other oral or medical conditions.
Persistent bad breath deserves appropriate dental assessment rather than being attributed automatically to a mouth ulcer.
How Long Do Mouth Ulcers Last?
Most minor mouth ulcers improve by themselves within approximately one to two weeks.
Larger aphthous ulcers can take longer.
The important warning sign is a sore that does not heal normally.
An ulcer persisting for approximately three weeks or longer should be examined by a dentist or healthcare professional.
How Are Mouth Ulcers Treated?
Most minor mouth ulcers do not require prescription treatment.
The main goals are to:
- reduce pain,
- minimize irritation,
- maintain oral hygiene,
- and allow the tissue to heal.
Treatment depends on the severity and cause.
Use a Soft Toothbrush
Continue cleaning your teeth even when you have a mouth ulcer.
Good oral hygiene remains important.
A soft-bristled toothbrush can make brushing more comfortable and reduce additional trauma to the ulcer.
Brush gently around painful areas.
Avoid Foods That Irritate the Ulcer
While an ulcer is healing, it may help to temporarily avoid foods and drinks that make the pain worse.
These may include:
- very spicy foods,
- highly acidic foods,
- very salty foods,
- rough or crunchy foods,
- and very hot foods or drinks.
This is mainly about reducing irritation and discomfort.
These foods are not necessarily the underlying cause of every mouth ulcer.
Salt-Water Mouth Rinse
A simple saline rinse may provide symptom relief and help keep the mouth clean.
One commonly used method is to dissolve approximately half a teaspoon of salt in a glass of warm water.
Gently rinse the mouth and then spit the solution out rather than swallowing it.
Do not use water hot enough to burn the mouth.
Over-the-Counter Treatments
Depending on what is available in your country, a pharmacist may recommend treatments such as:
- pain-relieving oral gels,
- protective pastes,
- mouth sprays,
- antiseptic mouthwashes,
- or other products intended for oral ulcers.
Follow the product instructions carefully.
Products suitable for adults may not always be appropriate for young children.
Corticosteroid Treatment
For recurrent, painful or more severe aphthous ulcers, healthcare professionals may sometimes recommend topical corticosteroids.
These may come as:
- mouth rinses,
- sprays,
- pastes,
- or dissolving preparations.
They can reduce inflammation and may help ulcers heal more quickly, particularly when treatment begins early.
Stronger treatment should be used under appropriate professional guidance.
Should You Put Aspirin Directly on a Mouth Ulcer?
No.
Do not place an aspirin tablet directly against an ulcer or gum.
Aspirin can chemically irritate or burn oral tissue.
Pain relief should be used according to product instructions and individual medical circumstances.
Should You Use Alcohol-Based Mouthwash?
Alcohol-containing mouthwashes can irritate painful mouth ulcers in some people.
If a mouthwash makes the ulcer sting or worsens discomfort, stop using it and ask a dentist or pharmacist about an alternative.
Can Mouth Ulcers Be Prevented?
Not every mouth ulcer can be prevented.
For people who repeatedly develop ulcers, identifying personal triggers may help.
Useful measures can include:
- using a soft toothbrush,
- correcting sharp teeth or rough fillings,
- ensuring dentures fit properly,
- managing irritation from braces,
- eating a balanced diet,
- maintaining good oral hygiene,
- and avoiding foods that consistently trigger or aggravate your ulcers.
A dentist can help identify repeated mechanical trauma.
Should You Floss When You Have a Mouth Ulcer?
Flossing is an important part of oral hygiene for many people, but it is not a specific treatment for aphthous ulcers.
Continue appropriate dental hygiene while being careful not to injure the ulcer.
If flossing repeatedly damages a particular area, ask a dental professional to check your technique or investigate other causes.
Can Mouth Ulcers Be a Sign of Oral Cancer?
Most mouth ulcers are not cancer.
However, oral cancer can sometimes appear as a persistent ulcer or other abnormal area that does not heal.
That is why a mouth ulcer lasting longer than approximately three weeks should not simply be ignored.
Other possible warning signs include:
- an unexplained lump,
- persistent red or white patches,
- unexplained bleeding,
- persistent mouth pain,
- difficulty swallowing,
- persistent hoarseness,
- or an unexplained neck lump.
These symptoms do not automatically mean cancer, but they warrant professional assessment.
When Should You See a Dentist or Healthcare Professional?
Arrange an assessment if a mouth ulcer:
- lasts for around three weeks or longer,
- is unusually large,
- repeatedly returns,
- is different from ulcers you normally experience,
- becomes increasingly painful,
- becomes very red or appears infected,
- bleeds unexpectedly,
- interferes significantly with eating or drinking,
- or occurs together with other unexplained symptoms.
Also seek medical advice if you have mouth ulcers along with:
- genital ulcers,
- unusual skin lesions,
- swollen or painful joints,
- persistent digestive symptoms,
- unexplained weight loss,
- fever,
- or significant fatigue.
When Is More Urgent Care Needed?
Seek prompt medical care if mouth sores are accompanied by:
- severe difficulty swallowing,
- difficulty breathing,
- severe dehydration,
- inability to drink enough fluid,
- rapidly increasing facial or mouth swelling,
- or a rapidly worsening overall condition.
Contact your local emergency medical service if symptoms appear life-threatening.
Mouth Ulcers in Children
Children can develop ordinary aphthous ulcers, but mouth sores can also occur with infections such as hand, foot and mouth disease and other illnesses.
A child with mouth sores should receive medical advice if they:
- cannot drink adequately,
- show signs of dehydration,
- have significant fever or illness,
- develop a widespread rash,
- or have persistent or recurrent ulcers.
Avoid giving children medicines or oral gels unless they are suitable for the child's age.
Recurrent Mouth Ulcers
Someone who repeatedly develops mouth ulcers may have recurrent aphthous stomatitis.
In many cases, no underlying disease is found.
However, depending on the history, a healthcare professional may consider:
- blood tests,
- nutritional deficiencies,
- gastrointestinal conditions,
- immune-related disorders,
- medications,
- and other possible causes.
Occasionally, a biopsy or specialist oral-medicine assessment may be required for an unusual persistent lesion.
Mouth Ulcer vs Stomach Ulcer
A mouth ulcer is not the same condition as a stomach ulcer.
A stomach or peptic ulcer develops in the stomach or upper part of the small intestine and has completely different causes, investigations and treatments.
Mouth ulcers should therefore not be treated as a form of stomach ulcer.
The Bottom Line
Mouth ulcers are common and are usually harmless.
Most minor aphthous ulcers heal naturally within approximately one to two weeks.
Simple measures such as:
- avoiding irritating foods,
- using a soft toothbrush,
- maintaining oral hygiene,
- using a saline rinse,
- and appropriate pain-relieving treatments
can make healing more comfortable.
Recurrent ulcers can sometimes be associated with nutritional deficiencies or underlying medical conditions and may need further investigation.
Most importantly, do not ignore a mouth ulcer that persists for around three weeks or longer.
Persistent, unusual, recurrent or worsening mouth ulcers should be examined by an appropriate dentist or healthcare professional.
Medical Disclaimer
This article provides general oral-health information for an international audience and is not a substitute for examination, diagnosis or treatment by a dentist, doctor or other appropriately qualified healthcare professional. Treatment options and medicine availability vary between countries. Persistent, unusual or severe mouth ulcers should be professionally assessed.
Sources and Further Reading
National Institute of Dental and Craniofacial Research — Fever Blisters & Canker Sores
https://www.nidcr.nih.gov/health-info/fever-blisters-canker-sores
NHS — Mouth Ulcers
https://www.nhs.uk/conditions/mouth-ulcers/
University College London Hospitals — Aphthous Ulcers
https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/aphthous-ulcers
Cambridge University Hospitals — Recurrent Oral Ulceration
https://www.cuh.nhs.uk/patient-information/recurrent-oral-ulceration/
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