'I thought my mouth ulcer was stress, but I really had tongue cancer'

They can scupper your sleep, make mealtimes miserable and turn your favourite hot drink into an instrument of torture.

Even holding a simple conversation can often be agony.

Mouth ulcers, it’s fair to say, punch way above their weight when it comes to dragging down our health and mood.

It’s estimated that one in five people in the UK – about 14million – are affected by mouth ulcers at various points throughout their lives. Not only are they disproportionately painful for their size, but the worst thing for many is that the lesions keep coming back.

Worryingly, experts also warn that, in rare cases, what appears to be an ulcer can, in fact, be mouth cancer (see panel below).

It’s not always clear why some people get ulcers time and again. Constant stress may be a factor, as can lacking in certain vitamins and minerals – such as B12 and iron.

An unfixed broken or jagged tooth that keeps causing injury to the tongue, the lips or the lining of the cheek, can also lead to ulcers.

Last week Dr Ellie Cannon, The Mail on Sunday’s GP columnist, gave her advice on how to banish ulcers. In response, we received a flood of emails and letters from readers keen to share their own remedies.

It’s estimated that one in five people in the UK – about 14million – are affected by mouth ulcers at various points throughout their lives
One woman claimed red wine was behind her long-standing mouth ulcer problems

One woman told how a century-old spot cream rid her of the painful lesions for good. Another claimed that a little-­known vitamin supplement was the answer to stop them returning.

Others explained that cutting out certain foods or drinks made a massive difference to their frequency. One man said ditching Marmite ended his ulcer agony, while a woman said she realised red wine was behind her long-standing problem.

So what’s the best way to deal with mouth ulcers? What treatments really do work?

And, crucially, when should you worry that it might be something more sinister?

The vitamins that can keep ulcers at bay

Lacking in certain vitamins and minerals can, some studies suggest, put you more at risk of regular ulcer outbreaks.

Most common is vitamin B12 deficiency. It’s vital for healthy red blood cells, and foods rich in it include meat, fish, eggs and dairy goods – as well as fortified breakfast cereals.

Cutting out certain food and drinks has been beneficial for some patients, with one man saying ditching Marmite helped end his ulcer agony

But when we don’t get enough, it can lead to anaemia, where there are not enough healthy red blood cells to carry oxygen around the body – including to the mouth.

One sign of anaemia can be recurrent mouth ulcers. Taking B12 supplements (available as drops or mouth spray) could combat this, according to a 2015 study from Taiwan.

Similar studies have found that folic acid supplements, iron tablets and zinc pills may also combat recurrent ulcers. Zinc, for example, is known to accelerate wound healing.

And one reader swears by a supplement called Coenzyme Q10, often taken by those on cholesterol-­lowering statins as a way to prevent the muscle pain the pills can sometimes cause.

Coenzyme Q10 is a nutrient that occurs in the body that protects cells against damage.

The long-time sufferer said ulcers stopped when she started taking the vitamin supplement 20 years ago. ‘I have been taking it every day since,’ she says. ‘I can honestly say I have not had a single ulcer. I am a pharmacist and have recommended it to many of my patients.’

Beware – toothpaste might be a trigger

Most toothpastes contain a chemical called sodium lauryl sulphate, or SLS. It’s what makes it foam up in your mouth.

But in some people, it can cause mouth ulcers, or make existing ones worse, according to Stephen Porter, professor of oral medicine at University College London’s Eastman Dental Institute.

This is because SLS can sometimes irritate the tissue in the gums, cheeks and tongue, and strip away the protective layer of mucus that covers them.

But Prof Porter adds: ‘Strong flavourings – such as mint – in toothpastes can also irritate existing ulcers, so it can be a good idea to switch to ones with little or no flavourings.

‘If you get lots of ulcers you might want to try OraNurse, as it’s completely free of flavourings and SLS.’

Foods and drinks that can make them worse

Chocolate-lovers, look away now. Studies show it can be a trigger for mouth ulcers, because it’s rich in theobromine – a compound found in cocoa beans which can irritate the lining of the mouth, almost like an allergic reaction.

Read More

I thought pain in my mouth was a harmless ulcer - in fact it was the first and only sign of cancer

Peanuts, too, can be a problem. They contain high levels of an amino acid called L-arginine which has a similarly aggravating effect on soft tissue in the mouth, creating the ideal conditions for ulcers to form.

Other known culprits include spicy foods, or acidic treats such as strawberries, tomatoes and even cheese.

One reader told us that red wine – which is known for its acidity – was the source of her ulcer problems for many years. ‘I used to suffer from mouth ulcers for years and then I found out that I was allergic to red wine,’ she said. ‘I stopped the wine and have not had any further trouble.’

And another insists the lesions disappeared as soon as he stopped eating Marmite.

‘My wife read an article about yeast extract products being a possible cause,’ he said. ‘I was a Marmite lover but I gave it up and now rarely get an ulcer at all. It’s changed my life.’

Blood pressure pills increase the risk

Several prescription medicines increase the risk of mouth ulcers.

They include beta blockers – used to treat high blood pressure and abnormal heart rhythms – nicorandil, a drug used to control angina or chest pain, and even the widely used anti-inflammatory painkiller ibuprofen.

It’s not clear why they raise the risk of ulcers.

One theory is that the tablets themselves – rather than the medicines they contain – can inflame the tissue inside the mouth.

‘Lots of drugs can do this,’ says Prof Porter. ‘Usually, the ulcers disappear when the drug is stopped.’

He warns that it is important that patients do not stop taking prescription medicines without speaking to their GP first. In some cases, it might be possible to switch to an alternative. However, he adds: ‘Sometimes the benefits of the medication are far more important to the patient than the mouth ulcers.’

A dab of honey to clear them up

When ulcers do occur, applying a blob of honey could hasten its departure, according to research. One 2009 Turkish study found applying it every few hours speeds up the healing process.

They argued this was possibly because it provides a natural protective barrier from food, bacteria, sharp teeth and anything else that could aggravate an ulcer.

However, a more common remedy is washing the mouth with warm, salty water. And there is some evidence that this may actually help heal the lesion.

A 2021 Indonesian study looked at what happened to skin wounds generally when exposed to a solution made with 7 per cent salt. The results showed it significantly accelerated the rate at which wounds heal.

But whether that applies to mouth ulcers too is still not clear.

One traditional technique that has been roundly rejected is apple cider vinegar.

Typically, patients will rinse their mouth with a combination of the vinegar and water. However, there is no ­evidence that it works.

Moreover, it can sting – and possibly even aggravate the mouth further.

Interestingly, one MoS readers believes that Germolene may effectively deal with ulcers. The over-the-counter antiseptic cream was invented 100 years ago as a treatment for blemishes, minor cuts, grazes, burns and blisters.

‘I had a spot forming on my face one day and coincidentally was getting a mouth ulcer in the exact same spot but on the inside of my cheek,’ says Elaine Taylor, 75, from Oldham ‘The spot cleared up, and after a couple of days I realised so had the mouth ulcer.

‘That was over 30 years ago and I’ve been using Germolene for my mouth ulcers ever since and it has worked every single time.’

Prof Porter says he isn’t aware of any evidence that Germolene helps with ulcers – but says that doesn’t necessarily mean patients shouldn’t use it.

‘As long they seem to work and have no adverse side effects, then carry on using them,’ he says.

Drug treatment that can help

Most ulcer treatments are designed to dull the pain rather than provide a cure. However, there are ­p­­rescription medications that, in rare circumstances, can be given to quickly heal ulcers.

Over-the-counter treatments include Bonjela and Iglu, which dull the pain and act as a protective barrier to prevent infection.

Experts suggest that over-the-counter painkillers such as paracetamol can often be just as effective at managing uncomfortable symptoms.

In most cases, doctors will not prescribe medicines to treat ulcers as they usually go away on their own.

But when severe ulcers do not go away – and other causes, such as cancer or an infection have been ruled out – then GPs may prescribe a drug called fluticasone. This is a steroid that dampens down inflammation, calms surrounding tissue and should help ulcers heal.

The ­treatment tends to come as drops, a mouthwash or a spray that is applied to the inside of the mouth.

However, steroid treatments can also trigger uncomfortable side effects, including burning or stinging. They can also raise the risk of oral thrush – a fungal mouth infection.

For this reason, experts says that the majority of patients who develop an ulcer are best served by simply taking painkillers, waiting for it to heal and – if they can bear it – avoiding chocolate.

My 'harmless' sore turned out to be cancer 

When civil servant Grace Brand felt a sore patch on the side of her tongue, she thought nothing of it.

The 30-year-old assumed it was just a stubborn mouth ulcer brought on by stress after a house move and long hours at work.

But six weeks later the pain was still there – and getting worse.

A trip to the pharmacist for Bonjela set off a chain of referrals and tests that ended in the news she had stage two tongue cancer.

During a 12-hour procedure, surgeons removed half her tongue and rebuilt it using skin from her left forearm. Now she faces radiotherapy and months of speech therapy to relearn how to talk, swallow and eat.

She says: ‘I realised after six weeks that I had a painful ulcer on my tongue, and I didn’t do anything about it. I want to get people to look at their tongues. I’m very lucky it was painful – [in many cases] unless you see it, you wouldn’t know it was there.’

She is one of the around 11,000 people a year in the UK who are diagnosed with mouth cancer.

‘If an ulcer is still there after two weeks, then get it looked at,’ says Prof Porter.