Mouth ulcers are the worst. Here's what to do about them.

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There are many things in life that hurt far more than you expect them to: stubbed toes, paper cuts, ingrown hairs. But all these ailments combined have nothing on the agony caused by mouth ulcers.

It seems ridiculous that something so tiny and well-concealed can inflict such horror, but if you’ve ever suffered from a mouth ulcer even the memory is enough to make your eyes water:

Those nasty little f***ers sores make it near impossible to talk, eat, sneeze, smile, breathe, or even simply exist without wincing. And oh God, don't even get me started on the unique pain of eating citrus fruits, balsamic vinegar or even chocolate when your mouth being terrorised by ulcers. It's the only time chocolate has ever made me cry.

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We can all agree that life is better without mouth ulcers, so here's what you need to know about them.

Um... what are they?

"An ulcer is a lesion characterised by a loss of surface epithelium (the outer layer of skin/gum/mucosa). It usually appears as a whitish to yellow circular or ovular shape often surrounded by a red halo," explains Sydney-based dentist Dr Jenna Cutting.

Ulcers can pop up anywhere in your mouth - your gums, tongue, the roof of your mouth, or inside your lips and cheeks. Regardless of location, they hurt like hell.

What causes ulcers?

Dr Cutting says mouth ulcers can be caused by several factors or events, which fall into four broad categories.

The first is local causes. These can be viral (the cold sore virus and shingles can both trigger mouth ulcers), or related to simple traumas - for instance, accidentally biting your inner cheek, brushing a little too vigorously, or a chemical burn.

There can also be systemic causes, like a reaction to certain drugs, immunosuppression, or gastrointestinal, skin and immune diseases. Certain oral cancers can also manifest as non-healing ulcers on the lower lip.

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The fourth major culprit is Recurrent Apthous Stomatitis (RAS), a common condition that causes episodes of mouth ulcers, and is believed to be related to immune process and genetics. There are 3 forms of this condition, the most common being RAS Minor.

"Usually a [RAS Minor] sufferer will have 2-5 ulcers that are less than one centimetre and heal within 10-14 days with no scar - they have a whitish yellow base with a red halos. Generally this will start in childhood/adolescence and recur into adulthood," Dr Cutting explains. Stress, fatigue, physical trauma, nutritional deficiencies and food allergies are common triggers for the ulcer episodes in people with RAS.

What can I do?

The annoying thing about having a sore inside your mouth is that you can't simply whack a Band-aid on it and go about your life. You've got to live with it as it heals. Ulcers can heal themselves within a few days - in that time, keeping your mouth clean, brushing your teeth gently, drinking lots of fluids and avoiding spicy or acidic foods can help you manage the symptoms (and minimise the pain).

Also - where possible, avoid accidentally sinking your teeth into your ulcer. I learned that one the hard way. Good times.

Treatment-wise, Dr Cutting says the best approach is to address any factors that predispose you to ulcers in the first place.

"In some cases, zinc and vitamin B12 /iron supplements can help, and in traumatic ulcers a salt water or saline mouth rinse can help," she explains. Mouth rinses containing chlorhexidine or benzydamine can also be used short-term, but they do have side effects.

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In really severe cases, topical corticosteroids can be used - but you'll need a prescription for these. Dr Cutting says as corticosteroids have a long list of side effects, so it's better to consider them a last resort.

Prevention strategies

Prevention is better than eye-watering pain, friends. Maintaining your oral hygiene (you know the drill - brushing twice a day, flossing, regularly rinsing out your mouth...) is an important step in keeping your mouth clean, happy and hopefully ulcer-free. It'll also ensure there aren't any food particles hanging around in your mouth that might trigger a sore.

Also, if you know there are foods that irritate your mouth - like particularly spicy or acidic items - it's a good idea to avoid them where you can.

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 See a doctor if...

Although mouth ulcers are generally harmless and will usually heal within a week or two, Dr Cutting says they can require medical attention in some circumstances.

"Ulcers that persist for longer than three weeks need proper medical examination and testing for oral cancer," she recommends. Similarly, if ulcers are accompanied by symptoms like fever, malaise, diarrhoea or abdominal pain, or they're appearing in other parts of the body like the eyes, skin or genitals, it's important to see a doctor. These symptoms could indicate a systemic condition.

"Another reason to see the dentist or doctor is if the mouth ulcers are large or are interfering with eating or swallowing," Dr Cutting adds.

Do you suffer from mouth ulcers? How do you treat them?