Mouth Ulcers

What are the key symptoms of this condition?

• Small (<1 cm), round or oval ulcers

• Grey-white base with a raised red rim

• Painful – pain is the main presenting symptom

• Shallow ulcers, occurring singly or in small crops (≤5)

• Rarely affect gingiva

• Heal within 7–14 days, with recurrence every 1–4 months

What are the treatment options available?

Treatment is symptomatic, as ulcers are self-limiting:

• Topical corticosteroids (e.g. hydrocortisone buccal tablets)

• Choline salicylate gel for pain relief

• Benzydamine mouthwash/spray for short-term analgesia

• Local anaesthetic gels (e.g. lidocaine, benzocaine)

• Protectorant pastes to reduce irritation

• Chlorhexidine mouthwash to reduce severity and recurrence

Who is eligible to take these treatments?

• Adults and children ≥12 years: most treatments including corticosteroids, benzydamine, chlorhexidine,benzocaine

• ≥16 years: choline salicylate

• Local anaesthetics: age-dependent (e.g. lidocaine ≥7 years)

• Pregnant and breastfeeding patients: most topical treatments are safe

• Children <10 years: routine treatment not recommended → consider referral

What are the main differential diagnoses to consider?

• Major aphthous ulcers – larger (>1 cm), multiple, slow healing

• Traumatic ulcers – irregular borders, clear history of injury

• Herpetiform ulcers – numerous pinpoint ulcers, posterior mouth

• Herpes simplex infection – systemic symptoms, gingival involvement

• Oral thrush – creamy white plaques

• Oral carcinoma – painless, persistent solitary ulcer (>3 weeks)

When should the patient be referred?

Refer if any of the following are present:

• Ulcer lasts longer than 14 days

• Ulcer >1 cm in diameter

• More than 5–10 ulcers present

• Painless ulcer

• Associated eye involvement or systemic symptoms

• Children under 10 years

• Suspicion of trauma without clear cause

What condition is this?

Minor Aphthous Ulcer

What condition is this?

Ulcer caused by trauma

What condition is this?

Major aphthous Ulcer

What condition is this?

Herpetiform Ulcer