When to worry about those pesky mouth ulcers

Many of us are guilty of brushing aside those “harmless” painful bumps as “heatiness”. But are you missing an important health warning?


You know that blister on your tongue, cheek or gums that feels like you’ve got a cut or burn. And the pain can make it hard to eat, swallow and speak, not to mention put you in a foul mood. Yup, we’re talking about those all-too-familiar, irritating mouth ulcers.

In Singapore, mouth ulcers tend to be most commonly associated with two things: Hand, Foot and Mouth Disease, and heatiness due to excessive consumption of things like deep-fried food and chocolate. Because they’re so common and tend to go away quickly, often without any treatment, most of us don’t pay much attention to them.

But did you know that these little inconvenient bumps could also be a tell-tale sign of something more serious?


The difference between mouth ulcers and mouth cancer

With cancer being one of the most common critical illnesses in Singapore, it’s not unusual to wonder if the nagging blister in your mouth is cancerous.

Ulcers, sores and red and white patches that do not go away are some of the usual signs of pre-cancerous growths and oral cancers. While you should get any growth on your body investigated, oral cancer is rare.

According to Dr Paul Mok, from My ENT Specialist Clinic at Mount Elizabeth Novena Specialist Centre and a member of the MHC Asia Group, recurrent ulcers, recurrent sore throat and a bony lump in the roof of the mouth (called torus palatinosus) are often mistaken for mouth cancer.

However, recurrent ulcers are usually not due to cancer. Their causes can range from accidentally biting yourself while eating to nutritional deficiencies or they could be a side effect of taking certain medications. “They could also be from stress, autoimmune conditions or viral infections such as herpes,” Dr Mok says.

So how do you tell if an ulcer is cancerous? The two main differences between common ulcers and ulcers from early stage oral cancer have to do with pain level and persistence. While common ulcers tend to appear flat, feel sore and uncomfortable and clear up within two weeks, Dr Mok says oral cancers are often raised, painless, bleed when contracted and don’t heal within two weeks.


Home remedies for common ulcers

Unless mouth ulcers are non-healing or accompanied by other symptoms such as fever – which could be a sign of Hand, Food and Mouth Disease – you don’t have to rush to the nearest medical clinic.


Common quick fixes for ulcers include:

  • Drink lots of water
  • Avoid spicy, hot food
  • Apply a steroid-based paste to the ulcer to reduce pain and promote healing
  • Use analgesic mouth spray to reduce pain

If these don’t alleviate symptoms and the ulcers don’t heal after two or three weeks, there’s a chance they may be cancerous.


Is it possible to have oral cancer even if you don’t smoke?

Oral cancer can affect the lips, gum, tongue, cheek lining, roof of mouth and throat. And while lifestyle habits such as smoking and alcohol consumption can increase the risk of oral cancer, it is possible to contract this type of cancer even if you do not smoke or drink excessively. 

“Other causes of oral cancer are betel nut chewing and constant trauma or irritation from a sharp edge of teeth,” says Dr Mok. Sources of such chronic irritation can include ill-fitting dentures or faulty dental restoration or implants.


Diagnosing and treating oral cancer

If you have recurrent, non-healing mouth ulcers, see a specialist for evaluation. A biopsy may be necessary to determine if the lesion is indeed cancerous.

And rather than hold off since you’re not in pain and can go about your daily activities as usual, it’s best to have it examined early as early stage treatment has been shown to have substantially better outcomes and higher survival rates.

Depending on the stage of the cancer and the patient’s age and general state of health, treatment options can include surgery which may be complemented with post-surgical radiotherapy and/or chemotherapy. Patients may also have to undergo rehabilitative speech and swallowing therapy.

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