Patient's question:
I often get mouth ulcers, and they usually take about half a month to heal. Sometimes even after they heal, they leave scars, and they still hurt when touched. In the past, eating cooling fruits like grapefruits helped them heal quickly. If I didn’t take care of them, it would take about half a month for them to heal completely. Now, even grapefruits don’t heal them as quickly. Are there any medications that can treat this condition?Also, what type of ulcers are these, and what causes them? How can they be prevented? I am currently taking medication to prevent tuberculosis (isoniazid and glucuronic acid tablets). Does this have anything to do with it? I haven’t had any other recent check-ups.
Doctor's answer:
Canker sores (oral ulcers) are one of the most common oral mucosal diseases, with an incidence rate generally considered to exceed 10% in the population. They can occur in people of all ages, with middle-aged and young adults being the most affected.Canker sores are characterized by periodic, recurrent, localized ulcers of the oral mucosa that can heal on their own. They can appear in any part of the oral mucosa, most commonly on the lips, cheeks, and tongue. In severe cases, they may extend to the pharyngeal mucosa. Many patients experience an increase in ulcer size and number, along with worsening pain and prolonged healing periods with shorter intervals, which can affect eating and speaking.
Although there are many treatments for oral ulcers, most are symptomatic, primarily aimed at reducing pain or frequency of recurrence. They cannot completely control recurrence, so prevention is particularly important.
In daily life, it is important to maintain good oral hygiene, rinse the mouth with warm salt water, quit smoking and drinking, maintain a regular lifestyle, and ensure adequate sleep. Regular exercise, a light diet, and eating more vegetables and fruits while reducing spicy and heavy foods can help. Women should pay attention to rest before and after their menstrual period, maintain a positive mood, avoid excessive fatigue, eat lightly, and consume more fruits and fresh vegetables to reduce the occurrence of canker sores.
It is important to note that long-lasting ulcers in the mouth, due to constant irritation from chewing and speaking, may develop into cancer over time. This is especially true in areas close to teeth, such as those with retained, damaged teeth or poorly fitted dentures, where sharp edges continuously irritate the mucosa, causing ulcers. If the irritant is not removed, the ulcers may not heal and worsen. Such long-lasting ulcers may also be precancerous lesions and are highly likely to transform into cancer. If you frequently suffer from oral ulcers, you should pay attention to these issues.
Do not take oral ulcers lightly. If you have any doubts, seek medical attention promptly, and undergo a pathological examination if necessary to confirm the diagnosis before receiving appropriate treatment. Do not delay treatment due to negligence.
14 Simple Remedies for Oral Ulcers
1. Eggs: Beat an egg into a paste and soak an appropriate amount of green beans in cold water for over 10 minutes. Boil the green beans in a pot over low heat for about 1.5 minutes (do not overcook, as they should still be raw). Use the green bean water to mix with the egg paste and drink it in the morning and evening. This is an effective treatment for oral ulcers.
2. Lianhua Pills: Crush one Lianhua pill (30 granules) into a powder and mix it with 2 ml of cool water to form a thin paste. Clean the patient's mouth before use, then apply the paste to the ulcer with a thin cotton swab. The best time to use it is 1–15 minutes before meals. Use it 3 times a day, with an additional dose at bedtime. Pain relief usually occurs within 5 minutes of application. Small ulcers can heal in 1–2 days, while larger ulcers take about 5 days.
3. Yunnan Baiyao: Apply Yunnan Baiyao externally to the oral ulcer site twice a day. Most ulcers heal within 2–3 days.
4. Whole Milk Powder: Use whole milk powder, 2–3 times a day, with one tablespoon each time. Add a little sugar and mix with warm water. Taking it before bedtime is more effective. Symptoms usually disappear within 2 days.
5. Watermelon: Cut a half of a watermelon and squeeze out the flesh. Hold the juice in your mouth for about 2–3 minutes, then swallow it. Repeat this process several times.
6. Vitamin C: Crush 1–2 vitamin C tablets and apply them to the ulcer. Close your mouth for a moment and repeat twice a day.
7. Cimetidine: Grind 1–2 cimetidine tablets into a fine powder and apply them to the ulcer with a cotton swab. Do not drink water for 10 minutes after application. Use it twice a day.
8. Lianhua Pill: Take Lianhua Pill 2–3 times a day, with 6–8 grams each time.
9. Strong Tea: The Ming Dynasty medical classic Bencao Gangmu states, "Tea is bitter and cold, and it is the best at reducing fire... When fire is reduced, the upper body becomes clear." Research shows that tea contains tannins, which have astringent properties. Rinsing the mouth with strong tea can promote the healing of oral ulcers.
10. Gentamicin: Use a sterile cotton swab to apply 2 ml of gentamicin (40,000 units) to the oral ulcer. Reapply after a few minutes. Use it 4 times a day—after meals and before bedtime—after rinsing the mouth. Most ulcers heal within 2–3 days.
11. Tomatoes: Hold tomato juice in your mouth for several minutes at a time, multiple times a day.
12. Shi Feng: Take Shi Feng from a persimmon and mix it with warm water or add it to porridge.
13. Banana Leaves: Collect fresh banana leaves, roast them slightly over fire, and apply them to the oral ulcer 2–3 times a day.
14. 95% Ethanol: Dip a cotton swab in 95% ethanol, gently press it against the ulcer, and rotate it lightly to remove decaying tissue on the ulcer surface. Do this 2–3 times a day, with each application lasting 20–30 seconds. Most ulcers heal within 2–3 days.
Dietary Remedies for Oral Ulcers
1. Honey Rinse: Use a 10% honey solution to rinse the mouth. It can reduce inflammation, relieve pain, and promote cell regeneration.
2. Honey Therapy: Clean the mouth thoroughly, then use a sterile cotton swab to apply honey to the ulcer. Do not eat or drink for 15 minutes after application. Swallow the honey with saliva and repeat the process several times a day.
3. Zinc Sulfate Therapy: Take zinc sulfate tablets or 12% zinc sulfate syrup, with 40–80 mg for adults, 3 times a day. Most ulcers heal within 5–7 days.
4. Black Moss Therapy: Boil 10 grams of white moss, black moss, and hawthorn together, drink the broth and eat the moss. Do this 1–2 times a day.
5. Cocoa Therapy: Mix cocoa powder with honey to form a paste and hold it in the mouth frequently. Do this several times a day to treat inflammation and ulcers.
6. Cabbage Root Therapy: Boil 60 grams of cabbage root, 15 grams of garlic sprouts, and 10 jujubes, and drink the broth. Do this 1–2 times a day.
7. Mustard Seed Therapy: Grind 30 grams of white radish seeds, 30 grams of mustard seeds, and 15 grams of scallions together, and apply them to the soles of the feet. Do this once a day.
8. Apple Therapy: Peel one apple (or pear) and place the slices in a container. Add cold water (enough to cover the fruit) and heat it to a boil. Let it cool slightly, then hold it in the mouth with wine for a moment before eating. Repeat for several days to heal the ulcer.
9. Walnut Shell Therapy: Boil 30–50 grams of walnut shells twice and drink it once in the morning and once in the evening.
Oral Ulcers May Hide Underlying Conditions—Seek Medical Attention if They Don’t Heal in Three Weeks
Most people have experienced small oral ulcers, often caused by trauma. Professor Scully from the Eastman Dental Institute at University College London notes that if oral ulcers do not heal within three weeks, it is essential to identify the underlying cause.
Approximately 20% of the population suffers from common recurrent oral ulcers, which are round or oval with clear boundaries. 80% of ulcers are less than 5 mm in diameter and heal within 7–14 days. Larger ulcers are rare and may take weeks or months to heal, leaving scars. Additionally, there are herpetic ulcers, which take about a month to heal.
According to the Medical Forum (June 7, 2001), the cause of oral ulcers is unclear, but some patients' symptoms may be related to stress, trauma, quitting smoking, menstruation, or food allergies. There are no specific diagnostic tests, and diagnosis relies on typical symptoms and medical history. However, differential diagnosis should not be neglected. Conditions such as iron, folic acid, or vitamin B12 deficiency, chronic inflammatory bowel disease, HIV infection, or neutropenia should be considered. Other systemic diseases and skin conditions, such as leukemia, lupus, or Beh?et’s disease, should also be ruled out. Additionally, anticancer drugs and antithyroid medications can cause oral ulcers.
Single chronic ulcers should be suspected as oral cancer. In children, oral ulcers may appear alongside periodic fever, pharyngitis, hand-foot-mouth disease, or infectious mononucleosis.
Professor Scully emphasizes that oral ulcers can be treated with chlorhexidine or hydrocortisone-coated tablets, used four times a day. If symptoms do not improve, systemic corticosteroids may be necessary.
14 Simple Remedies for Oral Ulcers
Although oral ulcers are not a serious condition, they can cause frequent inconvenience and pain. Here are 14 simple remedies:
1. Eggs: Beat an egg into a paste, soak green beans in cold water for over 10 minutes, and boil them for 1.5 minutes (do not overcook). Use the green bean water to mix with the egg paste and drink it in the morning and evening. This is effective for oral ulcers.
2. Lianhua Pills: Crush one Lianhua pill (30 granules) into a powder, mix it with 2 ml of cool water to form a thin paste, and store it. Clean the patient's mouth before use, then apply the paste to the ulcer with a thin cotton swab. Use it 3 times a day, with an additional dose at bedtime. Pain relief usually occurs within 5 minutes, and small ulcers heal in 1–2 days, while larger ulcers take about 5 days.
3. Yunnan Baiyao: Apply Yunnan Baiyao externally to the oral ulcer site twice a day. Most ulcers heal within 2–3 days.
4. Whole Milk Powder: Use whole milk powder, 2–3 times a day, with one tablespoon each time. Add a little sugar and mix with warm water. Taking it before bedtime is more effective. Symptoms usually disappear within 2 days.
5. Watermelon: Cut a half of a watermelon and squeeze out the flesh. Hold the juice in your mouth for about 2–3 minutes, then swallow it. Repeat this process several times.
6. Vitamin C: Crush 1–2 vitamin C tablets and apply them to the ulcer. Close your mouth for a moment and repeat twice a day.
7. Cimetidine: Grind 1–2 cimetidine tablets into a fine powder and apply them to the ulcer with a cotton swab. Do not drink water for 10 minutes after application. Use it twice a day.
8. Lianhua Pill: Take Lianhua Pill 2–3 times a day, with 6–8 grams each time.
9. Strong Tea: The Ming Dynasty medical classic Bencao Gangmu states, "Tea is bitter and cold, and it is the best at reducing fire... When fire is reduced, the upper body becomes clear." Research shows that tea contains tannins, which have astringent properties. Rinsing the mouth with strong tea can promote the healing of oral ulcers.
10. Gentamicin: Use a sterile cotton swab to apply 2 ml of gentamicin (40,000 units) to the oral ulcer. Reapply after a few minutes. Use it 4 times a day—after meals and before bedtime—after rinsing the mouth. Most ulcers heal within 2–3 days.
11. Tomatoes: Hold tomato juice in your mouth for several minutes at a time, multiple times a day.
12. Shi Feng: Take Shi Feng from a persimmon and mix it with warm water or add it to porridge.
13. Banana Leaves: Collect fresh banana leaves, roast them slightly over fire, and apply them to the oral ulcer 2–3 times a day.
14. 95% Ethanol: Dip a cotton swab in 95% ethanol, gently press it against the ulcer, and rotate it lightly to remove decaying tissue on the ulcer surface. Do this 2–3 times a day, with each application lasting 20–30 seconds. Most ulcers heal within 2–3 days.
Types of Oral Ulcers
Oral ulcers that recur repeatedly are medically referred to as "recurrent oral ulcers." The frequency of recurrence is closely related to the duration of the oral ulcer history. Shorter histories may result in attacks every few months or once a year, while longer histories may lead to monthly recurrences or alternating new and old lesions. Generally, they heal within 10 days without leaving scars.
Recurrent oral ulcers are the most common oral mucosal disease, characterized by repeated but self-limiting episodes. Clinically, they are divided into three types: mild recurrent oral ulcers, herpetic recurrent oral ulcers, and recurrent necrotizing mucosal periparotitis.
Vitamins Can Treat Oral Ulcers
Both solitary and chronic oral ulcers can be treated with vitamins B2, B6, and other B vitamins. Some people report that oral ulcers disappear completely after taking B vitamins for just one night.
A deficiency in vitamin B2 can cause angular cheilitis, eye congestion, and anal ulcers, especially on the skin and mucosa. A deficiency in vitamin B6 affects fat metabolism and can lead to seborrheic dermatitis. Additionally, pantothenic acid and biotin (excluding vitamin B1) play roles in preventing and treating oral ulcers.
Factors or Causes of Oral Ulcers
Oral ulcers most commonly occur on the oral mucosa and the margins of the tongue, appearing as white ulcers with red halos around them. They are very painful, especially when exposed to acidic, salty, or spicy foods, making it difficult to enjoy even delicious meals. Although they are minor oral issues, they can cause great distress, making it hard to sit or lie down, disrupt sleep and appetite, and lead to low mood.
Most doctors believe that oral ulcers are related to the following factors:
- Digestive system diseases and functional disorders, such as bloating, diarrhea, or constipation.
- Endocrine changes, with some women experiencing ulcers during their menstrual period, possibly due to a decrease in estrogen levels.
- Psychological factors, as some patients develop ulcers under stress, emotional fluctuations, or poor sleep, which may be related to autonomic nervous system dysfunction.
- Genetic factors, with children of both parents suffering from recurrent oral ulcers having an 80–90% chance of developing the condition. If only one parent has the condition, the risk is about 50–60%.
- Other factors, such as deficiencies in trace elements like zinc, iron, folic acid, or vitamin B12, which can weaken the immune system and increase the likelihood of recurrent oral ulcers.
Why Do Oral Ulcers Keep Recurring?
The recurrence of oral ulcers is caused by various factors, including infections from bacteria, viruses, and other microorganisms; malnutrition or vitamin deficiencies; digestive system issues such as gastric ulcers, inflammation, constipation, or diarrhea; deficiencies in trace elements like iron, folic acid, B12, or zinc; endocrine disorders; and psychological or neurological factors such as overwork, stress, emotional fluctuations, or autonomic nervous system dysfunction.
Some women experience oral ulcers before or during their menstrual period, with medication only providing temporary relief. The ulcers return with each menstrual cycle, causing severe pain. Alongside the ulcers, they may also experience dry mouth, irritability, anger, and constipation. Clinical studies suggest that oral ulcers during menstruation are primarily due to elevated progesterone levels and reduced estrogen levels.
Oral Ulcers Are Dangerous When They Occur Frequently
Oral ulcers are a common symptom in daily life, and most people encounter them at some point. Typically, oral ulcers can heal on their own with rest, dietary adjustments, and maintaining regular bowel movements. Some patients may only need local medication or a few doses of traditional Chinese medicine to recover, with no serious adverse effects on the body.
However, if one or more oral ulcers recur frequently or are accompanied by ulcers in other areas (e.g., genital ulcers), it is essential to take it seriously, as such recurrent ulcers may be a warning sign of an autoimmune disease like Beh?et’s disease.
Beh?et’s disease, also known as Beh?et’s syndrome or ocular-genital syndrome, is clinically characterized by a triad of oral ulcers, genital ulcers, and iritis. Eye symptoms can vary, including blurred vision, vision loss, eye pain, photophobia, tearing, foreign body sensation, and floaters. Severe cases may lead to blindness. Other symptoms include posterior needle-eye reactions. Without a comprehensive understanding of the disease, patients may describe different symptoms to different specialists, leading to fragmented care and missed opportunities for optimal treatment.
Beh?et’s disease has a long history and can affect both men and women of all ages, with higher prevalence after 35. Its development and progression are closely linked to immune system dysfunction. Traditional Chinese medicine refers to it as "hu huo" and notes, "When it affects the throat, it is huo; when it affects the genitals, it is hu." The disease is closely associated with deficiencies in the liver and kidneys, qi and yin deficiency, and external damp-heat. Over time, damp-heat interacts with qi and blood, leading to the stagnation of dampness, toxicity, and blood stasis, making the condition recurrent and difficult to heal.
For many years, traditional Chinese medicine has used different treatment approaches for acute and remission phases of Beh?et’s disease, based on varying patterns. Studies have shown that traditional Chinese medicine not only controls the recurrence of ulcers but also regulates immune function.
Additionally, topical applications such as Xili Powder, Bingbing Powder, and a mixture of berberine and asarum can be used externally, while decoctions of honeysuckle, licorice, wild chrysanthemum, dodder, or polygonum can be used for rinsing or bathing. Clinical practice has demonstrated that topical and oral traditional Chinese medicine treatments can reduce ulcer recurrence frequency, number, and pain within about one month. Continued treatment for several months can further control the condition.
In addition to medication, daily oral hygiene should be maintained, and a diet low in greasy, fried, or spicy foods should be followed. Avoid alcohol, tobacco, mutton, and maintain a positive mood and regular bowel movements.
Iron and Zinc Deficiencies Also Increase the Risk of Oral Ulcers
Oral ulcers are the most common disease of the oral mucosa, with a prevalence ranking third after dental caries and periodontal disease.
Deficiencies in iron and zinc can also lead to ulcers.
Recurrent oral ulcers are a polygenic genetic disorder. When the body experiences gastrointestinal dysfunction, menstrual disorders, deficiencies in iron, zinc, or other trace elements, stress, fatigue, or colds, oral ulcers may be triggered. Therefore, vitamin B2 alone is not effective. Currently, there is no cure for this condition.
If you have oral ulcers, eat more fresh foods rich in vitamins, proteins, and fiber, maintain a balance between work and rest, and remove triggers to reduce recurrence.
Small Home Remedies for Oral Ulcers
1. Take 160 grams of fresh bitter gourd (80 grams of dried) and steep it in boiling water. Drink it as tea once a day. Generally, symptoms improve within 3–5 days.
2. After rinsing the mouth with warm water in the evening, take a spoonful of honey (preferably pure honey) and apply it to the ulcer. Hold it in the mouth for 1–2 minutes, then swallow it. Repeat 2–3 times, and symptoms usually clear up within 2–3 days.
3. Boil about 10 walnut shells in water twice and drink it once in the morning and once in the evening.
4. Crush 8–9 small rosebuds with flower cups, mix with a small cup of honey to form a paste, and apply it to the oral ulcer. Generally, it heals within 3–5 applications.
5. Crush 1–2 vitamin C tablets and apply them to the ulcer. Close your mouth for a moment and repeat twice a day.
6. Use whole milk powder, 2–3 times a day, with one tablespoon each time. Add a little sugar and mix with warm water. Taking it before bedtime is more effective. Symptoms usually disappear within 2 days.
7. Take one Lianhua pill (30 granules) and crush it into a powder. Mix it with 2 ml of cool water to form a thin paste. Clean the mouth before use, then apply the paste to the ulcer with a clean cotton swab. Use it 3 times a day, with an additional dose at bedtime. Pain relief usually occurs within 5 minutes, allowing pain-free eating and improved appetite. Small ulcers heal in 1–2 days, while multiple ulcers heal in 3 days.
Avoid Oral Ulcers in the Summer
Oral ulcers are a common problem for modern people, and many believe they are more likely to occur in the summer due to increased "internal heat." However, what are the actual causes of oral ulcers? Doctors state that the causes of oral ulcers are mainly "excessive heart fire" or "stagnant heat in the spleen and stomach." In addition to medication, dietary therapy can also be effective.
Oral ulcers are more common in young and middle-aged adults and can occur year-round, especially in summer when days are longer and nights are shorter, temperatures rise, people stay up late, and modern diets often include greasy, fried foods, making oral ulcers more likely in those with a hot constitution.
In traditional Chinese medicine, oral ulcers are classified into several types, including "excessive heart fire," "stagnant heat in the spleen and stomach," "yin deficiency with fire," "spleen and stomach deficiency with cold," and "liver cold invading the stomach." In addition to medication, dietary therapy can also be used.
For "excessive heart fire" or "stagnant heat in the spleen and stomach," use bamboo leaf congee as a dietary therapy. Use 8 fresh bamboo leaves, 1 gypsum, 2 rice, and an appropriate amount of sugar. For "yin deficiency with fire," use Erdeng congee, selecting 3, 3, 3, 2 rice, and an appropriate amount of rock sugar. For "spleen and stomach deficiency with cold," use Lizhong congee, using, dry ginger, roasted licorice, poria, and glutinous rice with brown sugar.
However, in addition to medication and dietary therapy, avoiding oral ulcers still requires attention to daily habits. Avoid spicy, greasy, fried, or heavy foods, drink plenty of water, eat more vegetables, maintain regular bowel movements to avoid constipation; for severe ulcers, a soft or semi-liquid diet may be necessary.
Dietary Remedies for Oral Ulcers
1. Honey Rinse: Use a 10% honey solution to rinse the mouth. It can reduce inflammation, relieve pain, and promote cell regeneration.
2. Honey Therapy: Clean the mouth thoroughly, then use a sterile cotton swab to apply honey to the ulcer. Do not eat or drink for 15 minutes after application. Swallow the honey with saliva and repeat the process several times a day.
3. Zinc Sulfate Therapy: Take zinc sulfate tablets or 12% zinc sulfate syrup, with 40–80 mg for adults, 3 times a day. Most ulcers heal within 5–7 days.
4. Black Moss Therapy: Boil 10 grams of white moss, black moss, and hawthorn together, drink the broth and eat the moss. Do this 1–2 times a day.
5. Cocoa Therapy: Mix cocoa powder with honey to form a paste and hold it in the mouth frequently. Do this several times a day to treat inflammation and ulcers.
6. Cabbage Root Therapy: Boil 60 grams of cabbage root, 15 grams of garlic sprouts, and 10 jujubes, and drink the broth. Do this 1–2 times a day.
7. Mustard Seed Therapy: Grind 30 grams of white radish seeds, 30 grams of mustard seeds, and 15 grams of scallions together, and apply them to the soles of the feet. Do this once a day.
8. Apple Therapy: Peel one apple (or pear) and place the slices in a container. Add cold water (enough to cover the fruit) and heat it to a boil. Let it cool slightly, then hold it in the mouth with wine for a moment before eating. Repeat for several days to heal the ulcer.
9. Walnut Shell Therapy: Boil 30–50 grams of walnut shells twice and drink it once in the morning and once in the evening.