Ayurvedic medicine for mouth ulcers

A recurring mouth ulcer is usually innocent and usually worth investigating, in that order. The medicine settles the ulcer; the reason it keeps coming back is a blood test, a tooth, a toothpaste or a disease.

What the common ulcer is

• Recurrent aphthous stomatitis: a round, shallow, yellow-grey ulcer with a red rim on the loose lining of the mouth, inside the cheek, under the tongue, on the soft palate.
• It is not a cold sore. Cold sores sit on the lip skin, are caused by herpes, and behave differently.
• It burns for a few days, peaks, and heals in one to two weeks without scarring.
• It is not contagious, and it is not caused by a fungus.
• The triggers are tiredness, stress, a minor bite, a sharp tooth edge, the cycle, and certain foods. The predisposition is largely inherited.

What we prescribe for the ulcer itself

• A triphala mouth wash, cool, several times a day. It is the most useful single thing in this list: it keeps the ulcer clean, reduces the sting, and shortens the healing by a day or two.
• Licorice chewed or as a rinse, for its coating effect on the raw surface.
• Turmeric and honey applied to the ulcer, which is the traditional remedy that has enough support behind it to keep recommending.
• Ghee or a mild medicated oil applied to the sore, which does nothing to the cause and a great deal to the pain of eating.
• Cooling preparations for the burning, and avoiding anything heating: chilli, vinegar, dry roasted snacks, alcohol-based mouthwash and undiluted essential oils, all of which make an ulcer worse and are the reason some people feel their treatment is failing.
• A short course where the ulcers are frequent, and a topical application for each individual ulcer rather than systemic medicine for every one.

What actually stops them recurring

• A blood count with ferritin, vitamin B12 and folate. Deficiency in one of these is the commonest findable cause of recurrent ulcers, it is cheap to test, and correcting it works better than any topical. Zinc too, where the diet is thin.
• A toothpaste without sodium lauryl sulphate. For a subset of people this is the whole answer, and it takes two weeks to find out.
• The sharp tooth edge, the chipped filling, the denture clasp or the brace bracket that bites the same spot of cheek every week. Ulcers that always appear in the same place are almost always mechanical, and no medicine outworks a sharp edge.
• Coeliac disease, which presents as recurrent ulcers in adults more often than it presents as gut trouble. If there is bloating, loose stools, iron deficiency or a family history, that gets tested before anything else.
• Inflammatory bowel disease, Behcet disease, and in anyone at risk, HIV. Each has its own pattern alongside the mouth, and each is why a persistent ulcer is not simply prescribed around.
• Stress and sleep, which is the least satisfying trigger to be told about and the most common one.

What medicine will not do

• It will not clear an ulcer that is being caused by a sharp tooth, a denture or a habit of cheek-biting.
• It will not correct a deficiency, and a B12 or iron deficiency needs its own treatment for months, not days.
• It will not treat a fungal infection, which looks nothing like an aphthous ulcer and is common after antibiotics, in inhaler users, in denture wearers and in anyone with uncontrolled diabetes.
• It will not treat the ulcers of a drug reaction, of chemotherapy, or of a blood disorder, all of which need their own management.

When an ulcer is not an aphthous ulcer

• Any ulcer that has not healed in three weeks. That is the single most important rule on this page, and it is how oral cancer gets found late.
• An ulcer that is painless, firm or indurated at the base, has raised or rolled edges, or is growing rather than settling.
• A patch that is red, white, or red-and-white and will not rub off, particularly on the side of the tongue or under the tongue.
• Numbness of the lip or tongue, a tooth that has become loose without gum disease, difficulty swallowing, an ear pain on one side, or a lump in the neck.
• Anyone who smokes, chews tobacco or pan masala, or drinks heavily, in whom the threshold for referral should be very low indeed. Betel nut and gutka are major causes of oral cancer in India and of a white, tight mouth that cannot open fully.
• Ulcers with fever, or with ulceration of the eyes or genitals, or with a rash and joint pain. Those are systemic and need a physician.
• Ulcers in someone on chemotherapy, on immunosuppressants, or with neutropenia, where a mouth ulcer can be the first sign of a dangerous infection risk.

The daily part

• A soft brush, and brushing that does not slip and catch the cheek.
• Avoiding the foods that sting on the day: chilli, citrus, pineapple, vinegar, salt on dry snacks, hot coffee.
• Water through the day, because a dry mouth heals badly. Some tablets, some antihistamines and mouth-breathing at night all do this.
• Not eating to the point of biting the same cheek, and chewing slowly when tired.
• A diary of where and when, kept for two or three cycles. It tells you whether these are aphthous, mechanical, or cyclical, and it is more useful to a physician than a description.

How we judge it

• Days to heal, number of ulcers per month, and how much eating is affected.
• Whether the deficiency, once found, has actually been corrected and re-tested.
• Whether the toothpaste, the tooth edge or the denture was the answer, because that is the version of this problem that gets solved permanently.
• And above all, whether anything that has not healed in three weeks has been looked at properly rather than given another week.