Mouth Ulcers Every Month for Three Years

Quick answer: Recurrent mouth ulcers are common and usually benign, but "common" is not the same as "nothing to look into". Ulcers that keep returning are worth a blood test — deficiencies are found often enough to be worth checking — and any single ulcer lasting more than three weeks needs examining regardless.

The call

Adina, 29, from RBS Daled, came in expecting to be told there was nothing to do. Three years of mouth ulcers, two or three at a time, roughly monthly, each lasting ten days. She had tried every gel in the pharmacy and had come to regard it as her normal.

She had also been worried, on and off, that one of them was an abscess.

What we found

Three ulcers: two on the inside of the lower lip and one on the side of the tongue. Each 4 to 6mm, round, with a yellow-grey base and a red halo. Painful out of proportion to their size. Nothing sharp nearby to explain them.

This is recurrent aphthous stomatitis — the ordinary recurring mouth ulcer, affecting a substantial share of the population.

The distinctions that matter, because people conflate these constantly:

Aphthous ulcer. Round or oval, yellow-grey base, red rim, on the soft moving tissue — lips, cheeks, tongue, floor of mouth. Never on the hard palate or attached gum. Heals in seven to fourteen days without scarring. Comes back.

Traumatic ulcer. Matches something sharp — a broken tooth, a denture edge, a bracket. Heals within days once the cause is removed.

Dental abscess. Not really an ulcer at all. A swelling, linked to a specific tooth which is usually tender to tapping, with a lump rather than a crater. May discharge pus.

Something that needs proper investigation. An ulcer lasting more than three weeks; one with raised, rolled or hardened edges; one that is painless; one with a lump beneath it; or a red or white patch that will not wipe away. That is the list, and it is short.

Adina's ulcers were textbook aphthous. But three years of monthly recurrence deserves more than a gel.

What actually causes them. Genuine triggers include iron, folate, vitamin B12 and zinc deficiency; coeliac disease; sodium lauryl sulphate in toothpaste; trauma from brushing; hormonal cycles; stress; and — occasionally — a systemic condition. A significant minority of recurrent cases have a treatable deficiency behind them.

What we did

Blood tests, through her family doctor: full blood count, ferritin, B12, folate, and coeliac serology. Her ferritin came back at 9, which is low, with a borderline B12. The coeliac screen was negative.

Iron supplementation, managed by her doctor, with the cause of the deficiency investigated rather than just the number corrected.

Switched her toothpaste to an SLS-free brand. The evidence is mixed but the change costs nothing and a proportion of people improve.

Symptomatic treatment for the current ulcers: a topical anaesthetic gel before meals, a protective paste, chlorhexidine mouthwash, and avoiding acidic and salty food while they were active.

The outcome

Her ulcers reduced to roughly one every three or four months within six months of correcting the iron. She is not entirely free of them — most people with aphthous ulceration are not — but the pattern changed substantially.

Three years of gels had treated the symptom. One blood test found the cause.

What to do if this happens to you

1. Keep a simple diary — dates, sites, how long they last. Patterns are informative.
2. Ask for blood tests if ulcers recur regularly. Iron, B12, folate and coeliac screening.
3. Try an SLS-free toothpaste for three months.
4. Use protective and anaesthetic gels for comfort during an episode.
5. See someone about any ulcer lasting more than three weeks, without exception.
6. Do not assume an ulcer is an abscess. Abscesses are swellings tied to a tooth, not craters on the lip.

Ulcers that keep coming back? Ramat Beit Shemesh Urgent Dental Care looks for the cause. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.