Aphthous ulcers
Also known as: aphthous ulcers, recurrent aphthous stomatitis, recurrent aphthous ulcers, canker sores, minor aphthae, major aphthae, herpetiform aphthous ulcers, recurrent oral ulceration
Aphthous ulcers are painful, round or oval ulcers that develop on the non-keratinised lining of the mouth, commonly inside the lips or cheeks, beneath the tongue or on the soft palate. They are not caused by herpes and are not contagious. Minor aphthous ulcers are the most common form and generally heal without scarring within approximately one to two weeks. Major aphthous ulcers are larger, deeper, more painful and may persist for several weeks or heal with scarring. Herpetiform aphthae appear as numerous small ulcers that can merge into larger irregular lesions. The precise cause is often unclear, but episodes may be associated with local trauma, stress, hormonal changes, genetic susceptibility, illness, nutritional deficiency or certain medicines. Recurrent or severe oral ulceration may also occur with iron, folate, vitamin B12 or zinc deficiency; coeliac disease; inflammatory bowel disease; Behçet disease; immune dysfunction; blood disorders; medication reactions or other systemic illness. Aphthous ulcers should be distinguished from traumatic ulcers, herpes simplex, oral candidiasis, hand-foot-and-mouth disease, erythema multiforme, lichen planus, autoimmune blistering disease and oral cancer. An ulcer that does not heal within two to three weeks, is unusually hard, repeatedly occurs in the same location or is associated with a lump, red or white patch, bleeding, numbness, swallowing difficulty or neck swelling requires prompt dental or medical assessment. Conventional management may include removal of traumatic triggers, gentle oral care, protective pastes, topical analgesics, antiseptic rinses and topical corticosteroids when clinically appropriate. Severe or systemic disease may require specialist treatment. TCM patterns may include Heart Fire blazing upward, Stomach Fire, Yin deficiency with Empty Fire, Spleen Qi deficiency, Qi and Blood deficiency and Liver Qi stagnation transforming into Heat. Acupuncture and Chinese herbal medicine may be considered adjunctively for recurrent symptoms after appropriate oral and systemic assessment, but must not delay biopsy, dental investigation, nutritional testing or treatment of an underlying disease. [1][2][3][4][5]
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Lifestyle & Diet
- •See a dentist or doctor when an ulcer has not healed within two to three weeks.
- •Seek earlier review when ulcers are unusually large, extremely painful, frequent or associated with systemic symptoms.
- •Use a soft toothbrush and maintain gentle oral hygiene.
- •Consider a toothpaste without sodium lauryl sulfate when recurrent ulcers appear sensitive to it.
- •Rinse gently with salt water when tolerated.
- •Use prescribed topical corticosteroid, protective paste or analgesic treatment as directed.
- •Avoid placing aspirin directly against an ulcer because this can cause a chemical burn.
- •Avoid very spicy, acidic, salty, sharp or excessively hot foods during painful episodes.
- •Choose soft, cool or room-temperature foods when chewing is painful.
- •Maintain hydration and seek help if pain prevents adequate fluid intake.
- •Avoid tobacco, vaping, betel nut and excessive alcohol.
- •Reduce trauma from cheek biting, sharp teeth, braces or poorly fitting dentures.
- •Attend dental treatment to correct repeated mechanical irritation.
- •Keep a record of ulcer frequency, duration, location, medicines, foods and associated symptoms.
- •Do not unnecessarily eliminate major food groups without medical or dietetic guidance.
- •Seek testing for iron, folate, vitamin B12 or other deficiencies when recommended.
- •Follow medical assessment for coeliac disease, inflammatory bowel disease, immune disease or Behçet disease when indicated.
- •Do not begin a gluten-free diet before coeliac testing unless advised, because it may affect diagnostic accuracy.
- •Review recently started medicines with the prescriber.
- •Manage stress and sleep disruption, which can contribute to recurrence in some people.
- •Use separate oral-care items when infection is suspected, although typical aphthous ulcers are not contagious.
- •Seek urgent help for breathing difficulty, throat swelling, inability to swallow or severe dehydration.
Cautions & Contraindications
- •Do not treat a persistent oral ulcer as routine aphthous stomatitis without examination.
- •Do not delay biopsy or specialist referral for a hard, irregular, bleeding or non-healing ulcer.
- •Do not apply caustic herbal powders, undiluted essential oils, acids, alkalis or corrosive substances to the oral mucosa.
- •Do not puncture, cut, scrape or burn an ulcer.
- •Do not place aspirin directly onto oral tissue.
- •Do not advise stopping prescribed medicines without consultation.
- •Do not diagnose herpes, candidiasis, autoimmune disease or oral cancer solely through TCM pattern differentiation.
- •Do not use oral herbal rinses containing unsafe alcohol concentrations on inflamed mucosa.
- •Do not swallow topical products unless specifically formulated and prescribed for oral use.
- •Mù Tōng must be botanically verified and free of aristolochic acid.
- •Xì Xīn, if considered in any associated formulation, requires botanical verification and aristolochic-acid safeguards.
- •Huáng Lián and other strongly bitter-cold herbs require pregnancy, liver, medicine-interaction and digestive review.
- •Dāng Guī, Chuān Xiōng and other Blood-moving herbs require pregnancy and bleeding-risk review.
- •Gān Cǎo may worsen hypertension, fluid retention and hypokalaemia.
- •Rén Shēn may interact with warfarin, diabetes treatment and stimulant medicines.
- •Avoid mineral products without heavy-metal and contamination testing.
- •Screen all herbs for allergy, pregnancy, breastfeeding, liver or kidney disease and concurrent medicines.
- •Do not interpret persistence, enlargement, bleeding or induration as detoxification or a healing crisis.
Frequently Asked Questions
What is an aphthous ulcer?+
An aphthous ulcer is a painful, non-contagious ulcer that usually develops on the soft lining inside the mouth [6].
Are aphthous ulcers caused by herpes?+
No. Recurrent aphthous stomatitis is different from herpes simplex and is not contagious [6].
How long does a minor aphthous ulcer usually last?+
Most minor ulcers heal without scarring within approximately one to two weeks [6].
When should a mouth ulcer be checked?+
An ulcer that persists beyond two to three weeks, repeatedly occurs in one location or has hard, irregular or bleeding features requires assessment [6].
What can cause recurrent mouth ulcers?+
Possible contributors include trauma, stress, medicines, iron or vitamin deficiency, coeliac disease, inflammatory bowel disease, Behçet disease and immune disorders [6].
Can aphthous ulcers be contagious?+
Typical aphthous ulcers are not infectious and cannot be passed to another person [6].
How are aphthous ulcers treated?+
Treatment may include avoiding trauma, gentle oral care, protective or analgesic products and prescribed topical corticosteroids [6].
Can acupuncture cure recurrent aphthous ulcers?+
No cure can be guaranteed. Acupuncture may be considered adjunctively after dental and medical causes have been assessed [6].
Which TCM patterns may be considered?+
Patterns may include Heart Fire, Stomach Fire, Yin deficiency, Spleen Qi deficiency, Qi-Blood deficiency and Liver constraint transforming into Heat [6].
Can herbs be placed directly on an ulcer?+
Only products specifically formulated and professionally recommended for oral use should be applied. Caustic powders and undiluted oils can burn the mucosa [6].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- Healthdirect Australia · 2025
Australian information on aphthous ulcers, likely triggers, expected healing, symptom relief and indications for medical review.
- Healthdirect Australia · 2024
Australian guidance on persistent oral ulcers, lumps, red or white patches, bleeding, numbness and swallowing symptoms requiring investigation.
- MSD Manual Professional Edition · 2026
Professional clinical overview of minor, major and herpetiform recurrent aphthous stomatitis, differential diagnosis and treatment.
- Cambridge University Hospitals NHS Foundation Trust · 2026
Clinical information noting that recurrent aphthous ulcers are not infectious and that ulcers persisting longer than three weeks require assessment.
- National Health Service · 2026
Guidance on ulcers lasting more than three weeks and associated lumps, patches, pain, swallowing or speech changes.
- World Health Organization · 2008
Standard acupuncture-point nomenclature and anatomical-location methodology.
- World Health Organization · 2020
International benchmarks for acupuncture competence, clinical safety and professional practice.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.