How do you manage a red to white ulcer on the inner lip?

Hello,

Welcome to icliniq.com.

I can understand your concern.

Based on your description, you are experiencing a white and red mouth ulcer on the inner lip area, present for the last ten days. From the picture, the ulcer on your inner lower lip appears to be a classic minor aphthous ulcer (canker sore).

As per the image (removed to hide the patient’s privacy), I can tell that a canker sore (aphthous ulcer) on the inner side of the lower lip, which is less than 5 mm (typical minor aphthous ulcer) and is a single, round, white ulcer with a red border with no pus or severe surrounding infection. Usually, these aphthous ulcers heal within 10 to 14 days.

Causes:

1. Traumatic lip bite (minor injury).

2. Stress.

3. Poor sleep.

4. Hormonal changes.

5. Nutritional deficiency (B12, folate, iron, zinc).

6. Acidic or spicy foods.

Treatment plan:

1. Topical application: Apply one of the following two to three times per day. Mucopain gel (can apply this) or Triamcinolone dental paste (e.g., Kenacort Orabase at night).

Instructions:

Wash your hands, dry the ulcer gently with a tissue.

Apply a thin layer directly over the ulcer.

Avoid food or drink for 30 minutes after.

2. Oral vitamin support: Take for 10 to 14 days. Becosules (multivitamin) capsule - one daily after food (contains B-complex, zinc, iron). Helps if the ulcer is linked to a nutritional deficiency.

3. Saltwater rinses: One glass of warm water with half-tablespoon salt. Rinse gently two to three times per day.

4. Avoid:

1. Spicy, citrus, or very hot foods.

2. Brushing directly over the ulcer.

3. Picking or biting the ulcer area.

5. Dietary support: Avoid spicy, salty, and acidic foods (e.g., pickles, tomatoes, citrus fruits).

6. Eat more:

1. Bananas.

2. Curd or yogurt.

3. Iron-rich foods (palak, dates).

4. Soft, bland foods (khichdi, oats, soft chapati).

When to see a doctor:

1. The ulcer still has not healed after 14 days (even after following the above-mentioned measures).

2. Multiple ulcers or ulcers keep recurring.

3. Weight loss, fever, or swollen lymph nodes.

4. Very large, deep, or bleeding ulcers.

As you have also mentioned your height and weight, your BMI (body mass index) is low. I suspect that nutritional deficiency could be a possible factor, including the use of multivitamin tablets. If it persists for so long, I advise you to take basic blood tests-

1. CBC (complete blood count).

2. Vitamin B12.

3. Iron profile.

Follow this oral care routine:

After meals (two to three times per day)-

1. Rinse mouth with salt water (half a tablespoon in warm water).

2. Apply Mucopain gel (Benzocaine 20%) with a clean finger or cotton swab.

3. Wait 30 minutes before eating.

Before bed-

1. Rinse and apply gel.

2. Avoid brushing directly over the ulcer if it’s painful.

3. Stay hydrated (eight to 10 glasses of water per day).

4. Avoid tea and coffee if it is irritating.

5. No lemon, oranges, pineapple until healing (highly acidic can sting badly at this stage).

6. Rest well; stress delays healing.

Follow-up: After two weeks.

The probable causes:

1. Stress.

2. Nutritional deficiency.

3. Minor trauma.

Investigations to be done: If persistent, routine blood work, an iron profile, and B12.

Differential diagnosis:

1. Herpetic ulcer.

2. Candidiasiss.

3. Lichen planus.

Probable diagnosis: Minor aphthous ulcer.

Treatment plan:

1. Topical application of Mucopain gel.

2. Maintain oral hygiene.

3. Good diet.

4. Salt water rinse.

Preventive measures:

1. Reduce stress.

2. Balanced diet.

3. Reduce the sharp teeth edges.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.