Oral ulcers — when a mouth sore needs a specialist.

An oral ulcer is a sore or open wound in the soft tissue lining the mouth — the cheeks, lips, tongue, gums, palate, or floor of the mouth. Some heal in days. Others linger for weeks. A few keep coming back, in cycles.

The cause matters more than the symptom. Aphthous ulcers (the common, recurrent kind) are inflammatory in nature, often triggered by stress, hormonal change, or minor trauma. Other ulcers can be caused by viral infections, autoimmune disease, drug reactions, vitamin deficiencies, or — less commonly — early signs of malignancy.

• An ulcer that has not healed in two weeks
• Multiple ulcers appearing at the same time
• Recurrent ulcers more than six times a year
• An ulcer that is unusually large, deep, or painful
• An ulcer in an unusual location (floor of mouth, lateral tongue, palate)
• Ulcers accompanied by skin lesions, eye changes, or systemic symptoms

A non-healing ulcer is one of the more important clinical findings in oral medicine — it warrants prompt assessment regardless of age or other risk factors.

The first consultation includes a thorough examination of the entire mouth, a review of your medical history, current medications, and any systemic symptoms. Most ulcers can be diagnosed on clinical grounds alone.

Where the diagnosis is uncertain, or where we want to rule out a more serious cause, a small biopsy is taken under local anaesthetic. The sample goes to a pathology laboratory and results typically come back within 10 to 14 days.

Treatment depends entirely on what the ulcer is. Common approaches include topical corticosteroids for inflammatory ulcers, antimicrobial rinses for secondary infection, pain-management strategies, and addressing any underlying systemic factor (iron, B12, folate deficiency; medication review; autoimmune disease management).

For recurrent aphthous ulcers, we focus on identifying triggers and reducing both frequency and severity over time.