Mouth sores

Mouth sores are a colloquial term for various pathological changes that appear on the mucous membrane of the cheeks, tongue, palate, gums, or lips. They can take the form of blisters, erosions, ulcers, nodules, or purulent changes. Their etiology is diverse, ranging from harmless traumatic aphthae, through viral and bacterial infections, to manifestations of systemic diseases, including autoimmune disorders. Due to the rich vascularization and innervation of the oral cavity, these lesions are often painful and can hinder eating, speaking, and hygiene. Clinical assessment should consider the duration, location, nature of the lesion, and the presence of general symptoms.

Lesions in the oral cavity – causes

The causes of changes in the oral cavity can be divided into several main etiological groups:

1. Local causes (traumatic and mechanical)

microtrauma caused by orthodontic appliances or a sharp tooth edge,
accidental biting of the mucous membrane,
thermal and chemical burns,
irritation from a dental prosthesis.

These most often lead to the formation of erosions or traumatic ulcers.

2. Viral infections

herpes simplex virus type 1 (HSV-1) – causes painful blisters that progress to erosions,
varicella-zoster virus (VZV),
Coxsackie viruses (hand, foot, and mouth disease).

Viral changes often have a vesicular nature and are accompanied by a low-grade fever.

3. Fungal infections

Most commonly caused by Candida albicans. They occur in:

immunocompromised individuals,
patients taking antibiotics,
diabetics,
people using inhaled steroids.

The clinical picture includes white patches with a erythematous base (thrush).

4. Autoimmune diseases

oral lichen planus,
mucous membrane pemphigoid,
pemphigus vulgaris,
recurrent ulcers with an immunological basis.

The changes are chronic, painful, and require specialist diagnostics.

5. Deficiencies and systemic diseases

Bumps and ulcers may be a symptom of:

vitamin B12 deficiency,
iron deficiency,
folic acid deficiency,
inflammatory bowel diseases (e.g., Crohn's disease),
celiac disease.

6. Neoplastic changes

A chronic, non-healing ulcer (>3 weeks), hard, and painless, may suggest a neoplastic process and requires urgent diagnostics.

Mouth sores – how to treat

Treatment depends on the cause and should be preceded by a proper diagnosis. Management includes:

1. Local Treatment

anesthetic preparations (lidocaine),
protective gels with hyaluronic acid,
chlorhexidine rinses,
anti-inflammatory preparations (benzydamine).

For aphthae and erosions, preparations that accelerate epithelialization are used.

2. Antiviral Treatment

In herpes:

acyclovir locally or orally,
valacyclovir in more severe cases.

Most effective when initiated within 24–48 hours of symptom onset.

3. Antifungal Treatment

nystatin,
miconazole,
fluconazole (generally in more severe cases).

Simultaneous removal of the predisposing factor is necessary.

4. General Treatment in Autoimmune Diseases

local or systemic corticosteroids,
immunosuppressive drugs (in selected cases).

5. Supplementing Deficiencies

In case of confirmed deficiency:

vitamin B12 supplementation,
iron preparations,
folic acid.

6. Supportive Measures

avoiding spicy and acidic foods,
gentle oral hygiene,
using a toothbrush with soft bristles,
proper hydration.

When to see a doctor?

Urgent dental or medical consultation is indicated when:

the lesion persists for more than 2–3 weeks,
it is accompanied by enlarged lymph nodes,
there is difficulty swallowing,
the changes are recurrent,
the lesion is hard and painless.

In clinical practice, diagnostics may include laboratory tests, microbiological swab, and in case of suspected neoplastic changes – biopsy.