Question

Is there any connection between recurrent mouth ulcers and ME? I have always had them since childhood and have been told that they can be stress-related, and that there is no underlying infection present.

Last year I had quite a few nasty mouth ulcers and was prescribed antibiotics because I had a secondary infection in the ulcers. Since then the ulcers have become more regular and persistent.

Answer

Mouth ulcers are common and normally clear up on their own within a week or two. They are  rarely a sign of anything serious, but may be uncomfortable to live with. Whilst there is no firm research evidence of a link between mouth ulcers and ME/CFS, they do seem to be reported quite frequently by people with the condition. However, mouth ulcers do occur quite commonly in the normal population as well.

Mouth ulcers are sometimes caused by things you can try to avoid. These include:

• biting the inside of your cheek.
• having badly fitting dentures, braces, rough fillings or a sharp tooth.
• cuts or burns while eating hard food or drinking hot drinks.
• food intolerance or allergy.
• damaging your gums with a toothbrush or irritating toothpaste.
• feeling tired, stressed or anxious.

Sometimes they are triggered by things you cannot always control, such as:

• hormonal changes – as during pregnancy.
• your genes – some families get mouth ulcers more often.
• a long-term medical condition – such as an inflammatory bowel disease (IBD), coeliac disease or Behçet’s disease.
• vitamin B12 or iron deficiency.
• medicines – including some non steroidal anti-inflammatory dugs/NSAIDs, beta blockers or nicorandil.
• stopping smoking – people may develop mouth ulcers when they first stop smoking.

Mouth ulcers need time to heal and there’s no quick fix. Avoiding things that irritate your mouth ulcer should help to speed up the healing process, reduce pain and lessen the chance of recurrence. Useful self-help remedies include:

• Using a soft-bristled toothbrush,
• Drinking cool drinks through a straw,
• Eating softer foods,
• Avoiding spicy, salty or acidic foods or rough and crunchy food like crisps,
• Having regular dental check-ups,
• Not using toothpaste containing sodium laurel sulphate.

There are various over-the-counter treatments available at pharmacies that can help to reduce the discomfort. On a personal basis I find Iglu ointment, which forms a protective barrier over the ulcerated area, very helpful. Other treatments include antimicrobial mouthwashes, painkilling tablets, mouthwashes, gels or sprays and corticosteroid lozenges. Finally, you should see your doctor or dentist if a mouth ulcer:

• lasts longer than three weeks.
• keeps coming back.
• grows bigger than usual or is near the back of your throat.
• bleeds or becomes more painful and red – this may be a sign of an infection.

Although most mouth ulcers are harmless, a long-lasting mouth ulcer is sometimes a sign of mouth cancer. So it’s best to get it checked.

More information

• The ME Association has a detailed leaflet about dental problems and dental hygiene in ME/CFS, written by Dr Richard Cantillon (Hon. Dental Adviser).
• Please let us know if you have any other tips for dealing with mouth ulcers: feedback@meassociation.org.uk