Mouth Ulcers/Aphthous Ulcers (Mukha-paka)


Mouth ulcers, also known as aphthous ulcers, are common painful sores that form on the mucous membranes of the mouth. This article provides a comprehensive overview of mouth ulcers, including their epidemiology, types, underlying mechanisms, risk factors, signs and symptoms, diagnostic methods, treatment options, and preventive measures.


Mouth ulcers are a prevalent condition characterized by the development of small, round or oval sores in the mouth. These ulcers can cause discomfort, pain, and difficulty in eating and speaking. Understanding the causes, symptoms, and effective management of mouth ulcers is essential for promoting oral health and overall well-being.

Epidemiology of Mouth Ulcers:

Mouth ulcers are a common oral health concern affecting people of all ages. While they are generally harmless and temporary, they can be recurrent and impact daily activities.

Types of Mouth Ulcers:

Mouth ulcers can be categorized into three main types:

  1. Minor Aphthous Ulcers:

    • These are the most common type of mouth ulcers.
    • Small in size, usually less than 1 centimeter in diameter.
    • Typically appear as round or oval lesions with a red border and a gray or yellowish center.
    • Heal within 1 to 2 weeks without scarring.
  2. Major Aphthous Ulcers:

    • Larger and deeper than minor ulcers.
    • Can be more painful and take longer to heal, often several weeks.
    • May leave scars after healing.
    • Less common than minor ulcers.
  3. Herpetiform Ulcers:

    • These ulcers are not caused by the herpes virus.
    • Small, pinpoint-sized ulcers that can occur in clusters.
    • Can be very painful and tend to merge, forming larger irregular-shaped ulcers.
    • Often heal within a few weeks without scarring.

Pathophysiology of Mouth Ulcers:

The exact cause of mouth ulcers is not fully understood. However, factors such as immune system dysfunction, genetic predisposition, and local tissue trauma play a role in their development.

Risk Factors and Triggers:

Several factors can increase the risk of developing mouth ulcers:

Risk Factors for Mouth Ulcers:

  1. Age and Gender:

    • Mouth ulcers are more common in younger individuals and tend to occur more frequently in women.
  2. Underlying Health Conditions:

    • Certain medical conditions, such as inflammatory bowel disease (Crohn’s disease, ulcerative colitis), celiac disease, and Behçet’s disease, are associated with an increased risk of mouth ulcers.
  3. Immune System Disorders:

    • Disorders affecting the immune system, such as HIV/AIDS or autoimmune conditions, can make individuals more susceptible to developing mouth ulcers.

Triggers for Mouth Ulcers:

  1. Mechanical Injury:

    • Accidental trauma to the mouth, such as biting the inside of the cheek, tongue, or lips, can trigger the development of mouth ulcers.
  2. Spicy or Acidic Foods:

    • Consumption of spicy, acidic, or abrasive foods can irritate the sensitive mucous membranes in the mouth and lead to ulcers.
  3. Citrus Fruits:

    • Citrus fruits, such as oranges, lemons, and tomatoes, contain acids that may trigger or exacerbate mouth ulcers in some individuals.
  4. Nutritional Deficiencies:

    • Deficiencies in nutrients such as vitamin B12, folic acid, iron, and zinc have been linked to an increased risk of mouth ulcers.
  5. Dental Appliances:

    • Ill-fitting dental braces, dentures, or other dental appliances can cause friction and lead to the formation of mouth ulcers.
  6. Tobacco and Alcohol:

    • Smoking or chewing tobacco and excessive alcohol consumption may increase the risk of mouth ulcers.
  7. Certain Medications:

    • Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may contribute to the development of mouth ulcers in susceptible individuals.
  8. Viral Infections:

    • Certain viral infections, such as the herpes simplex virus, can trigger the development of mouth ulcers.

Sign & Symptoms of Mouth Ulcers:

Mouth ulcers present with various symptoms:

  1. Pain and Discomfort:

    • Mouth ulcers are typically painful and can cause discomfort while eating, drinking, or speaking.
  2. Red or White Lesions:

    • Mouth ulcers often appear as round or oval-shaped lesions with a red border and a white, gray, or yellowish center.
  3. Location:

    • Mouth ulcers can develop on the inner cheeks, lips, gums, tongue, and palate.
  4. Burning Sensation:

    • Some individuals may experience a burning or tingling sensation before the ulcer becomes fully visible.
  5. Swelling and Inflammation:

    • The area around the ulcer may be swollen and inflamed.
  6. Difficulty Eating:

    • Pain and discomfort from mouth ulcers can make it difficult to eat certain foods, especially spicy or acidic ones.
  7. Talking Discomfort:

    • Mouth ulcers can make speaking uncomfortable, especially if the ulcer is located on the tongue or inside the cheeks.
  8. Recurrent Occurrence:

    • Some individuals may experience recurrent mouth ulcers, with new ulcers appearing after the previous ones have healed.
  9. Healing Time:

    • Most minor mouth ulcers heal within 1 to 2 weeks without scarring.

Investigation & Diagnosis of Mouth Ulcers:

Diagnosing mouth ulcers involves:

  1. Visual Assessment:

    • The healthcare provider will visually inspect the ulcers for their appearance, size, color, and any surrounding inflammation.
  2. Biopsy (if necessary):

    • In certain cases, a small tissue sample (biopsy) may be taken from the ulcer for laboratory analysis to rule out other potential causes, such as oral cancer.
  3. Laboratory Tests (if necessary):

    • Blood tests may be ordered to check for underlying health conditions that could contribute to recurrent mouth ulcers, such as nutritional deficiencies or immune system disorders.
  4. Underlying Conditions:

    • The healthcare provider will consider the patient’s overall health and any underlying medical conditions that may contribute to the development of mouth ulcers.

Treatment of Mouth Ulcers in Modern Medical Science:

Treatment aims to relieve symptoms and promote healing:

  1. Topical Medications:

    • Over-the-counter or prescription topical gels, creams, ointments, or mouthwashes containing ingredients like benzocaine, lidocaine, or corticosteroids can provide pain relief and help reduce inflammation.
  2. Oral Rinses:

    • Antimicrobial or antiseptic mouth rinses may be recommended to promote healing and prevent secondary infections.
  3. Pain Relief:

    • Over-the-counter pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil), can help manage pain and discomfort.
  4. Corticosteroid Treatment:

    • Severe or recurrent mouth ulcers may benefit from corticosteroid treatment, which can help reduce inflammation and promote healing.
  5. Immune Modulating Agents:

    • In certain cases, medications that modify the immune response, such as colchicine or dapsone, may be considered for managing recurrent mouth ulcers.
  6. Dietary and Lifestyle Changes:

    • Avoiding spicy, acidic, or abrasive foods that can irritate the ulcers may promote healing.
    • Maintaining good oral hygiene and using a soft-bristle toothbrush can prevent further irritation.
  7. Nutritional Supplements:

    • Nutritional deficiencies may contribute to mouth ulcers. Supplements of vitamins B12, folate, iron, and zinc may be recommended under medical supervision.
  8. Oral Hygiene:

    • Practicing proper oral hygiene, including regular brushing and flossing, can help prevent secondary infections and promote healing.

Prevention & Precaution for Mouth Ulcers:

Preventive measures include:

  1. Maintain Oral Hygiene:

    • Brush your teeth gently twice a day with a soft-bristle toothbrush.
    • Use a mild toothpaste and avoid abrasive oral care products.
  2. Avoid Irritating Foods:

    • Limit or avoid consumption of spicy, acidic, and citrus foods that can trigger or exacerbate mouth ulcers.
  3. Choose Soft Foods:

    • Opt for soft, bland, and non-irritating foods if you have a tendency to develop mouth ulcers.
  4. Proper Chewing:

    • Chew food slowly and thoroughly to avoid accidentally biting the inside of your cheeks or tongue.
  5. Manage Stress:

    • Practice stress-reduction techniques, such as meditation, deep breathing, and yoga, to minimize stress-related triggers.
  6. Good Nutrition:

    • Maintain a balanced diet rich in vitamins and minerals to support overall oral health and immunity.
  7. Stay Hydrated:

    • Drink plenty of water to keep your mouth and body hydrated.

Ayurvedic Perspective on Mouth Ulcers:

In Ayurveda, mouth ulcers are known as “Mukha Pakha.” They are considered a result of aggravated Pitta dosha and impaired digestion (Agni). The accumulation of excess heat (Ushna) in the body, combined with poor dietary habits and stress, can lead to the formation of ulcers. Ayurveda aims to balance Pitta, strengthen Agni, and promote oral health.

Ayurvedic Treatment Principles for Mouth Ulcers:

Ayurvedic treatments for mouth ulcers focus on restoring Pitta balance, improving digestion, and soothing the inflamed mucous membranes. Some treatment principles include:

  1. Dietary Modifications: Emphasizing cooling and Pitta-pacifying foods like cucumber, coconut, and leafy greens. Avoiding spicy and acidic foods.
  2. Herbal Remedies: Using herbs like Aloe Vera, Yashtimadhu (Licorice), and Neem for their anti-inflammatory and healing properties.
  3. Herbal Mouthwashes: Gargling with herbal decoctions or infusions made from herbs like licorice (Yashtimadhu) or triphala can help reduce inflammation and promote healing.

  4. Herbal Applications: Paste or powder made from herbs like neem (Azadirachta indica), turmeric (Curcuma longa), and licorice can be applied directly to ulcers for their antimicrobial and anti-inflammatory properties.

  5. Triphala Rinse: Gargling with a solution of triphala (a blend of three fruits: amla, haritaki, bibhitaki) mixed in warm water can help maintain oral hygiene and support healing.

    Ayurvedic Lifestyle Recommendations for Mouth Ulcers:

Ayurveda suggests lifestyle practices to manage and prevent mouth ulcers:

  1. Stress Management: Practicing relaxation techniques like meditation and deep breathing to reduce stress and Pitta accumulation.
  2. Hydration: Drinking cool and soothing herbal teas to maintain hydration and balance internal heat.
  3. Oral Care: Using natural mouthwashes or coconut oil pulling to cleanse the oral cavity.

The Role of Ayurveda in Mouth Ulcers Prevention:

Ayurveda plays a role in preventing mouth ulcers by promoting balanced digestion, supporting oral hygiene, and reducing Pitta imbalances. Following Ayurvedic guidelines can help prevent the recurrence of mouth ulcers.

Ayurvedic Researches on Mouth Ulcers:

While Ayurvedic texts discuss herbal remedies and lifestyle practices for oral health, scientific research on Ayurvedic treatments for mouth ulcers is limited. More studies are needed to explore the effectiveness of Ayurvedic interventions.

Challenges and Future Directions:

Integrating Ayurveda into mainstream healthcare for mouth ulcers management requires addressing challenges such as evidence-based research, standardization of treatments, and collaboration between traditional and modern medical systems. Future research can contribute to a deeper understanding of Ayurveda’s potential in promoting oral health.


Ayurveda offers a holistic approach to managing mouth ulcers by addressing doshic imbalances, improving digestion, and promoting oral well-being. While further research is necessary, Ayurvedic principles, herbal remedies, and lifestyle adjustments can complement modern medical approaches and contribute to healthier oral hygiene.

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