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Persistent or recurring mouth ulcers can be a source of significant discomfort and worry. While most mouth ulcers are benign and heal within a week or two, chronic mouth ulcers that keep returning or linger for extended periods often indicate an underlying issue that warrants specialist attention. At Melbourne Oral Medicine and Facial Pain Centre, Dr. Suhaib Alqudah, a registered Oral Medicine Specialist, provides expert assessment and guidance for patients across Australia experiencing these challenging conditions.

Understanding Chronic Mouth Ulcers

A mouth ulcer, also known as an aphthous ulcer or canker sore, is a break in the mucous membrane lining the mouth. While common, when they become chronic – meaning they recur frequently or persist for weeks at a time – it's crucial to investigate the cause. Many factors can contribute to chronic mouth ulcers, ranging from common inflammatory conditions to more complex systemic issues.

Common Causes of Recurring Mouth Ulcers

Several conditions can lead to chronic mouth ulcers:

• Recurrent Aphthous Stomatitis (RAS): This is one of the most common causes of recurring mouth ulcers. These ulcers typically appear as round or oval lesions with a white or yellowish centre and a red border. While the exact cause is unknown, factors like stress, minor injury, certain foods, and nutritional deficiencies (such as iron, vitamin B12, or folate) are thought to play a role. They usually heal on their own but can be painful and impact quality of life when they appear frequently.
• Oral Lichen Planus (OLP): As a specialist with a PhD in Oral Lichen Planus from the University of Melbourne, Dr. Alqudah has extensive expertise in this chronic inflammatory condition. OLP is an autoimmune disease where the immune system mistakenly attacks cells in the mouth lining. It can manifest in various ways, including white, lace-like patterns (reticular OLP), redness and inflammation (erythematous OLP), or painful erosions and ulcers (erosive OLP). These ulcers can be persistent and significantly impact eating and speaking. Diagnosis often requires a biopsy to confirm, as outlined in current literature (Oral lichen planus - Differential diagnoses, serum autoantibodies, hematinic deficiencies, and management · 2018; Oral Lichen Planus: An Update on Diagnosis and Management · 2024).
• Nutritional Deficiencies: As mentioned, deficiencies in iron, vitamin B12, and folate can contribute to chronic mouth ulcers. These are often easily identified with blood tests.
• Systemic Diseases: Conditions such as inflammatory bowel disease (e.g., Crohn's disease), Coeliac disease, and other autoimmune or immune-mediated disorders can have oral manifestations, including recurring ulcers.
• Reactions to Medications or Allergens: Some medications or contact with certain allergens can trigger ulceration.

When to Seek Specialist Help for Chronic Mouth Ulcers

While many ulcers are harmless, certain 'red flags' indicate that a specialist oral medicine consultation is advisable:

• Persistence: An ulcer that does not heal within two to three weeks.
• Recurrence: Ulcers that keep coming back frequently, significantly impacting your daily life.
• Unusual Appearance: Ulcers that are unusually large, irregularly shaped, or have raised, hardened edges.
• Unusual Location: Ulcers appearing in less common sites like the side of the tongue, floor of the mouth, or soft palate.
• Associated Symptoms: Ulcers accompanied by fever, swelling, difficulty swallowing, weight loss, or skin rashes.
• Lack of Clear Cause: If you or your referring GP/dentist cannot identify a clear cause for the persistent ulcers.

The Role of a Specialist Oral Medicine Consultation

Dr. Suhaib Alqudah specialises in diagnosing and managing complex oral and maxillofacial conditions, including chronic mouth ulcers. With his background at the Royal Dental Hospital of Melbourne and the Peter MacCallum Cancer Centre, he brings a wealth of experience to his practice. Through secure video (telehealth) consultations, Melbourne Oral Medicine offers specialist assessment to patients Australia-wide, providing expert guidance without the need for travel.

During an online consultation, Dr. Alqudah will conduct a detailed history of your symptoms, medical background, and lifestyle. He can also assess visual information, guiding you or your referring practitioner on necessary investigations. This might include blood tests to check for nutritional deficiencies or systemic conditions, or imaging if a deeper issue is suspected. In cases where conditions like Oral Lichen Planus or other suspicious lesions are considered, Dr. Alqudah can advise on the necessity of a biopsy and guide your local practitioner on the appropriate steps. This efficient triage process provides reassurance, helps to rule out serious conditions, and establishes a clear management plan, ensuring you receive the right care promptly.

FAQs About Chronic Mouth Ulcers

Can stress cause mouth ulcers?

While stress doesn't directly cause all types of mouth ulcers, it is a commonly recognised trigger for Recurrent Aphthous Stomatitis (RAS), one of the most frequent causes of recurring ulcers. Managing stress can sometimes help reduce the frequency of these particular ulcers.

Are chronic mouth ulcers a sign of cancer?

While most chronic mouth ulcers are benign, a persistent ulcer (one that doesn't heal within 2-3 weeks) is a key 'red flag' that warrants investigation to rule out oral cancer. This is why specialist assessment is so important for any non-healing oral lesion.

What is the difference between a cold sore and a mouth ulcer?

Cold sores, also known as fever blisters, are caused by the herpes simplex virus and typically appear on the lips or around the mouth. Mouth ulcers (aphthous ulcers) occur inside the mouth on the cheeks, tongue, or gums and are not contagious.

If you or your patient are struggling with chronic mouth ulcers, understanding the underlying cause is the first step towards effective management. Dr. Alqudah and the team at Melbourne Oral Medicine are here to help. Contact us today to book a secure online consultation and take the first step towards relief and clarity.

References

1. Xerostomia of Various Etiologies: A Review of the Literature — Advances in clinical and experimental medicine : official organ Wroclaw Medical University · 2016
2. Hyposalivation and Xerostomia and Burning Mouth Syndrome: Medical Management — Oral and maxillofacial surgery clinics of North America · 2022
3. Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review — International journal of molecular sciences · 2022
4. Temporomandibular Joint Disorders and Orofacial Pain — Dental clinics of North America · 2016
5. Burning Mouth Syndrome — Dermatologic clinics · 2020
6. Burning Mouth Syndrome — Dental clinics of North America · 2023
7. Oral lichen planus - Differential diagnoses, serum autoantibodies, hematinic deficiencies, and management — Journal of the Formosan Medical Association = Taiwan yi zhi · 2018
8. Oral Lichen Planus: An Update on Diagnosis and Management — American journal of clinical dermatology · 2024