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Mouth ulcers (aphthous stomatitis)

Stomatitis aphthosa recurrens · Afty (aftózní stomatitida)

What it is

Round painful ulcers inside the mouth that come and go; triggers include stress, injury, SLS toothpaste and low iron, B12 or folate.

Symptoms & signs

  • Round white-yellow ulcer with a red rim
  • stinging pain when eating or speaking
  • heals in 1–2 weeks
  • recurs several times a year

🚩 Get help if…

  • see a doctor soon An ulcer lasting over 3 weeks
  • see a doctor soon Ulcers with fever, rash or sore eyes or genitals
  • see a doctor soon Ulcers with diarrhoea, weight loss or tiredness
  • see a doctor soon Too painful to eat or drink

Where it strikes

Medical treatment

  • Antiseptic or benzydamine mouthwash
  • hydrocortisone pellets or steroid mouthwash
  • check iron, B12, folate and coeliac disease if frequent
  • biopsy for an ulcer lasting over 3 weeks
  • apremilast for Behçet's mouth ulcers — FDA-approved 2019

Natural & lifestyle

  • SLS-free toothpaste
  • avoid sharp, spicy and acidic food
  • soft toothbrush

Emerging & experimental

  • Laser therapy for pain

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Vitamin B12 1 000 µg daily under the tongue — a small 2009 trial cut recurrences whatever the blood level early / small studies
  • Honey on the ulcer — small trials heal faster early / small studies
  • Aloe vera gel — small trials early / small studies
  • Salt-water or baking-soda rinses — soothing; untested anecdotal / traditional

ICD codes