Gum Ulcer: Every Potential Cause Explained

Have you ever looked in the mirror and noticed a sudden, painful white or red spot on your gums? This might be a gum ulcer.

While gum ulcers are not very common, they can still occur due to various reasons. These can range from infections and allergies to injuries or even a simple canker sore. Understanding the cause is key to taking the right steps for treatment.

In this article, we'll explore all the potential causes of gum ulcers, how to identify them, and most importantly, how to ensure a smooth and speedy recovery.

1. Is it a painful single ulcer? It's probably a Canker Sore.

If you've suddenly noticed a painful single sore in your mouth and can't figure out where it came from, there's a good chance it's a canker sore.

Canker sores are common, and most people will get at least one in their lifetime. If this is your first time, you're lucky—some people get them several times a year.

They can show up anywhere inside your mouth, like on the inner lips, cheeks, under the tongue, and the roof of your mouth.

Canker sores rarely appear on the gums because they’re protected by a layer called keratin. Think of keratin as a shield that protects your gums.

When canker sores do affect the gums, it’s usually on the part without keratin, near the base and away from your teeth.

Symptoms

Recognizing canker sores is quite easy. They can show up as a single sore or in small groups of up to five. They're surrounded by a red circle and have a whitish or yellowish coating. These sores are usually round and measure just a few millimeters in size.

Causes

The exact cause of canker sores is still a bit of a mystery. However, there are a few likely factors that might contribute:

• Genetics: If others in your family have had these, you might be more prone to them.


• Nutrition: Your diet could play a role – a lack of certain nutrients might make you more susceptible.


• Stress: Yes, stress affects your mouth too. If you've been through a difficult period (work overload or illness), mouth ulcers may appear.


• Hormones: Hormonal changes can trigger these sores, just like they can affect other things in your body.


• Allergies: Have you eaten anything unusual lately? Your mouth may be sensitive to certain foods like chocolate, tomatoes, nuts, and strawberries.

The 4 Stages of Canker Sores

Canker sores go through four distinct stages as they develop:

1. The Prodromal Stage: This early phase lasts 24 hours. You might start feeling a tingling or burning sensation in the area where the sore is about to appear.
2. The Macule Stage: From 18 hours to 3 days, you'll see a red or pink spot in the area involved.
3. The Ulcer Stage: You'll notice a shallow, round ulcer with a whitish or yellowish coating. This is when the pain can be at its peak.
4. The Healing Stage: Canker sores eventually heal on their own. The sore gradually becomes smaller and begins to flatten.

How are Canker Sores Treated?

Unfortunately, there's no magic treatment to make canker sores disappear instantly. The good news is they usually heal on their own within 8 to 10 days and typically don’t leave any scars.

What you can do is speed up the healing process, manage the pain, and prevent infections or future flare-ups. There are several over-the-counter solutions that can help:

• Numbing Agents: These can provide instant relief by numbing the sore, making it less painful. One over-the-counter numbing product is Orajel.


• Mouthrinses: These help keep the area clean, reducing the risk of infection and promoting healing. You can opt for a natural approach with a saltwater rinse multiple times a day or consider using an over-the-counter mouthwash.


• Topical Corticosteroid Treatment: These are usually needed for severe cases. If your sore is large and very painful, your dentist may prescribe a product that includes cortocisteroids.

Prevent Canker Sores

Knowing what triggers your flare-ups will help you prevent or reduce episodes. Here are a few things to consider:

• Stress: If you believe stress is causing the issue, it's a good idea to find ways to relax and engage in activities that can help you handle it better.


• Diet: Think back to what you ate about three days before the sore popped up. Certain foods could be the culprit.


• Nutritional Deficiencies: If you're lacking certain vitamins and minerals in your diet, addressing these deficiencies can help prevent future outbreaks. B12, B9 and iron supplements have been shown to minimize recurrence.


• Avoid Injury or Trauma: Remove any sources of injury or trauma in your mouth. For example, if your teeth have sharp edges, they can rub against the lining of your mouth and cause ulcers.


• Oral Hygiene: Keeping your mouth clean and healthy by treating cavities, gums disease, and infections can also help prevent canker sores.

2. Traumatic Ulcer (caused by injury to the gum)

If you brush your teeth too hard, use an aggressive mouthwash or burn your mouth with something too hot, a type of sores called traumatic ulcers can appear.

These ulcers are essentially the result of an injury. They happen when the lining of your mouth gets damaged, and the sore appears exactly where the injury occurred.

Traumatic ulcers usually show up as whitish or yellowish spots, without the red border often seen in canker sores.

Unlike canker sores, the shape of traumatic ulcers is less predictable. They tend to be irregular, and their appearance depends on the type of injury that caused them.

Treatment of Traumatic Ulcer on the Gum

Traumatic ulcers almost always heal on their own once the cause of the injury is removed.

The key to treatment is addressing the root cause. Once the irritant is gone, these ulcers typically heal naturally within 8 to 10 days.

Your dentist may recommend using a topical antiseptic, mouthwash, or a numbing agent for relief.

3. Multiple Gum Ulcers due to Viral Infection

The most common viral infection affecting the mouth is oral herpes. It causes the appearance of multiple sores, commonly known as fever blisters.

Ulcers caused by viral infections often come with additional symptoms such as fever, fatigue and swollen lymph nodes under the lower jaw.

These infections can affect any part of the mouth, including the gums.



About 67% of people worldwide carry the Herpes simplex virus-1 (HSV-1), which causes oral herpes sores. Typically, the virus stays dormant and doesn’t cause any symptoms.

However, the virus can reawaken at any time under certain conditions, like stress, fever, a common cold, or even trauma to the mouth.

Cold sores usually start with an itchy or burning feeling, followed a day or two later by clusters of fluid-filled blisters. These blisters eventually break open, leaving behind small ulcers.

While the lower lip is the most common spot for cold sores, any area of the mouth can be affected.

HIV infection can also cause mouth symptoms, including ulcerations. In people with HIV, these mouth sores are often more severe. They tend to be deeper, more painful, and can grow several centimeters in size. They also heal more slowly and may leave scars behind.

What Steps to Take Next?

Mouth ulcers caused by viral infections heal once the infection has cleared up. For example, cold sores from herpes typically heal in 5 to 10 days as the body fights off the infection.

To speed up the healing process, your dentist or doctor may recommend:

• Antiviral medication
• Using an antiseptic mouthwash
• Following a soft diet
• OTC Painkillers

4. Necrotizing Ulcerative Gingivitis

Necrotizing ulcerative gingivitis (NUG) is a severe form of gum disease that requires immediate attention due to its aggressive and rapid nature. One of its telltale signs is the appearance of ulcers in the triangular area of the gums, between the teeth.

The gums between the teeth become ulcerated and covered with a whitish-grey layer, which is a sign of necrosis (tissue death).

Fortunately, necrotizing ulcerative gingivitis (NUG) is rare compared to other forms of gum disease. It mainly affects young people with weakened immune systems. Common risk factors include:

• Inadequate oral hygiene
• Stress
• HIV infection
• Tobacco use
• Malnutrition

Once NUG has set in, it often causes intense pain, bad breath, and bleeding gums. Some people may also have fever, fatigue, and swollen lymph nodes. Daily activities like eating, swallowing, and speaking can become difficult.
Without treatment, the infection can continue to destroy gum tissue and lead to extensive damage.

Treating Necrotizing Ulcerative Gingivitis

Prompt treatment is essential to reverse the damage before it's too late to recover lost gum tissue.

• Prioritize Oral Hygiene: Keeping your mouth clean is essential for treatment. Start gently due to sensitivity—use mouthwashes and an extra soft toothbrush.


• Professional Cleaning: It’s important to see a dentist for a professional cleaning, also known as scaling. This procedure will help remove dead tissue, debris and bacteria, creating a healthier environment for healing.


• Antibiotics if Needed: In severe cases, antibiotics may be necessary to fight the infection.


• Lifestyle Changes: If you’re at risk for necrotizing ulcerative gingivitis or any type of gum disease, making a few changes to your daily habits and oral care routine can help. This includes quitting smoking, managing stress, eating a healthier diet, and taking supplements if needed.

When Should a Gum Ulcer Raise Concern?

In most cases, an ulcer on your gums or anywhere else in your mouth should not be a cause for concern. Usually, it's a harmless occurrence that tends to resolve on its own.

However, even if your oral health is excellent, there are certain signs you shouldn’t ignore. These can point to something more serious than a simple canker sore or minor injury — such as a possible malignancy or oral cancer.

So, can a mouth ulcer be a sign of cancer? It can, but it’s extremely rare. And when it comes to the gums, it’s even rarer, since the tongue and lips are the areas most commonly affected.

When mouth ulcers do turn out to be cancerous, they often come with these warning signs:

• You're a heavy smoker and drinker.
• The ulcer doesn't show signs of healing after 2 weeks.
• The ulcer feels firm and hard to the touch.
• The edges of the ulcer are irregular and prominent.
• The ulcer tends to bleed easily, even with the slightest touch.
• The affected area extends beyond the ulcer itself.
• Your lymph nodes in the neck are swollen.

If you notice a few of these signs along with your mouth ulcer, please get it checked as soon as possible. If the sore looks highly suspicious, further tests like a biopsy may be needed to remove any doubt.