Introduction

Mouth ulcers are a common complaint in UK medical and dental hospitals. These are small sores that cause discomfort upon eating or talking. They usually heal in 10 to 14 days and require topical gels for better healing, pain relief, and prevention of further infection.

According to the NHS UK, a pharmacist can recommend topical gels for mouth sores. These include over-the-counter (OTC) antimicrobial, anaesthetic, anti-inflammatory, and protective barrier gels. They do not require a prescription. You can also buy OTC painkillers, mouthwashes, and lozenges for your ulcer symptom relief.¹

Topical gels are a popular first-line treatment for mouth ulcers. They provide instant coolness and pain relief over the affected area. In this article, we will review the types of topical gels for mouth sores available in the UK, their application, benefits, and potential side effects.

What are mouth ulcers?

Mouth ulcers or small sores present with a white or grey middle that is surrounded by a red halo. They are painful and sometimes swollen. These ulcers cause difficulty in daily life activities such as eating, drinking, talking, or sometimes breathing (depending on their location in the mouth). They occur on the borders of the tongue, gums, lips, cheeks, and palate. Mouth ulcers can be single or present in clusters, depending on their type.^1,2

Types of mouth ulcers

Common types of mouth ulcers are:

Aphthous ulcers (Canker sores)

These are the most common types found in children and adolescents. Aphthous ulcers can be minor (most common and small in size), major (large in size), or herpetiform (pinpoint ulcers present in clusters of 5-10). Some people frequently get aphthous ulcers, while others do not. Common factors include minor trauma (cheek and tongue biting), vitamin B12 (cobalamin) and B9 (folic acid) deficiencies, and stress. Minor and herpetiform ulcers are present on the inner borders of the tongue and lips. They typically heal within 1-2 weeks. Major ulcers are frequently found on the palate and take 2-3 weeks to heal, leaving a scar.³

Oral thrush

Ulcers with a creamy white covering are mostly of fungal origin, caused by Candida albicans. The whitish covering can be removed by scraping, leaving a reddish, ulcerated area underneath. Oral thrush occurs when a person’s immune system is weakened from a disease or after a prolonged antibiotic course.

Traumatic ulcers

These are caused by ill-fitting dentures, cheek and tongue biting habits, fractured teeth, or rough margins of fillings. They heal in a week or two after the removal of the cause.²

Oral lichen planus

Lichen planus is a systemic disease that causes lacy white ulcers in the corners of the lips or cheeks. It causes red rashes and occurs on both sides of the mouth. Lichen planus affects more females than males, typically those aged 50 or older.

Leukoplakia

Leukoplakia is a white or grey covering surrounding both sides of the cheeks in the mouth. It is caused by excessive cell growth but is not cancerous. Chronic smoking and chewing tobacco may cause leukoplakia. Always visit a doctor if it lasts for more than 3 weeks.

Erythroplakia

Unlike leukoplakia, erythroplakia is a pre-cancerous condition. It occurs as a red ulcer behind the front teeth and is often caused by smoking and the use of tobacco.

Oral cancer

Any ulcer that lasts for more than 3 weeks, bleeds immediately on touching, and is painless can be of cancerous origin. Oral cancer is caused by chronic irritation of the gums in the mouth. They commonly occur in people who have a prolonged history of smoking and drinking alcohol. Oral cancers cause firm and swollen lymph nodes in the lower jaw and sides of the neck.

What are the causes of mouth ulcers?

Common causes of mouth ulcers include:²

• Minor trauma from a hard-bristle toothbrush
• Chronic stress
• Vitamin and mineral deficiencies such as vitamin B9, B12, iron, and zinc
• Ill-fitting dentures
• Rough margins of crowns and fillings
• Systemic diseases: lichen planus, pemphigus vulgaris, bullous pemphigoid, and erythema multiforme
• Chronic inflammatory bowel disease: Behçet’s disease
• Oral cancer

What types of topical gels are available in the UK for mouth ulcers?

Topical gels for mouth ulcers in the UK provide instant coolness and pain relief. They promote healing as they are applied directly to the ulcer surface. The types depend on the ingredients present. They work on the ulcer surface by numbing pain (lidocaine in Anbesol), reducing inflammation (Bonjela), and providing antimicrobial action (chlorhexidine). Some are also applied to promote healing of damaged cells, such as Gengigel. Others form protective barriers (Orajel and Iglu) and prevent irritation from food and saliva.^3,4

Types of topical gels used for mouth ulcers in the UK

Anaesthetic gels

Orajel and Anbesol are commonly used anaesthetic gels for mouth sores in the UK. Their main ingredient is benzocaine, which provides temporary pain relief and numbs the area.

Antimicrobial gels

Antimicrobial gels contain chlorhexidine (a powerful antiseptic), which reduces the bacterial load in the mouth. This prevents further gum infection and promotes healing. Chlorhexidine-containing gels are: Corsodyl, Covonia, and Dermol.^4,6

Anti-inflammatory gels

Anti-inflammatory gels contain the active ingredient choline salicylate, which is a non-steroidal anti-inflammatory drug (NSAID). It helps alleviate pain and reduce inflammation. Common gels are Bonjela Adult Gel and Gengigel. These gels work effectively for mouths inflamed by braces, ill-fitting dentures, cold sores, and ulcers.

Protective barrier gels

Protective barrier gels form a barrier over the ulcer surface, which soothes pain. It reduces irritation and helps the area heal. Commonly used gels are: Iglu and Aloclair. Aloclair contains hyaluronic acid and aloe vera that form a protective bioadhesive film over the mouth sores.⁵

How to use mouth ulcer gels correctly?

Follow these steps to use the gel correctly:

1. Gently clean your mouth
2. Take a pea-sized amount on a cotton bud or your fingertip
3. Apply the gel over the ulcer surface. It may sting a bit
4. Do not eat or drink for 30 minutes for maximum effect

You may apply the gel 3 to 4 times a day or as instructed by the doctor. If you have a sensitive stomach, your doctor may advise you to avoid eating spicy food and citrus fruits such as oranges, limes, pineapples, and strawberries (they may irritate your ulcer). Use a soft toothbrush to maintain good oral hygiene. Stay hydrated as it keeps your mouth and gut healthy.²

How do I know if my mouth ulcer is healing?

A healing ulcer shrinks in size and has decreased redness. Within a few days, you will also notice a reduction in pain and a return to normal tissue appearance.

Benefits of using topical gels on mouth ulcers

• It provides instant coolness
• It numbs the area, providing pain relief
• It provides maximum benefit as it is applied directly over the ulcer surface
• Easy to use
• Readily available
• Cost-effective

Side effects of topical gels

Mouth ulcer gels may cause mild stinging. Allergic reactions to mouth ulcer gels are uncommon. Always ask your physician before using it on a child or a pregnant woman.

When to see a GP or dentist

Always visit a doctor if an ulcer lasts for more than 3 weeks (it may be cancerous). Look out for associated symptoms such as fever, bleeding ulcer, weight loss, ulcers present anywhere else in the body, and swollen lymph nodes in the face.¹

Summary

Mouth ulcers are small sores that occur in the lips, cheeks, gums, and palate. They cause discomfort upon eating, drinking, or talking. They typically heal in one to two weeks. Topical gels for mouth ulcers include over-the-counter (OTC) anaesthetic, antimicrobial, anti-inflammatory, and protective barrier gels. Mouth ulcers can be caused by minor trauma, loose dentures, nutritional deficiencies such as vitamins (B12 and B9), iron, and zinc. Systemic diseases that cause ulcers include lichen planus, erythroplakia, leukoplakia, Behçet’s disease, erythema multiforme, and oral cancer. Topical gels are applied to the ulcer surface. They provide instant coolness and pain relief, and protect the ulcer from irritation. You can use these gels 3 to 4 times a day or as prescribed by your physician. Always consult a doctor if your ulcer does not heal after three weeks.