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Oral ulcers and mouth sores are a common symptom of lupus, affecting around 50% of Lupus Warriors. These ulcers may be an indication of changes in disease activity.

An oral ulcer or canker sore is a shallow injury in the cheeks, tongue, or other soft parts of the mouth. It is often surrounded by a “halo” of swollen skin. These ulcers, canker sores, and other injuries in the mouth are common, but they occur more frequently in people with autoimmune diseases like lupus.

Though not usually harmful, oral ulcers are still wounds. They can get infected and provide an entry point for bacteria. Even outside of this, they are painful and can make eating and drinking difficult and unpleasant. These symptoms are more common for children with juvenile-onset lupus (jSLE). Oral ulcers can be an obstacle to getting the right nutrition and staying hydrated.

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Why do Oral Ulcers Happen?

The most common way of getting an oral ulcer is through an injury to the mouth. This can be accidentally biting the inside of their mouth, burning the mouth on food or drink that is too hot, or eating rough-textured or sharp foods that cut the mouth. Over-enthusiastic toothbrushing and irritating mouthwashes can also cause these injuries, which then become sores as they heal. Most oral ulcers caused by injury heal in 2-3 days.

Hormone changes can also cause sores. Some hormone medications, as well as the normal menstrual cycles of women, can cause sores to appear in the mouth. Because women with lupus are more sensitive to hormone changes, they have more of these sores.

While these are the most common reasons for the development of mouth sores, they are not the only reasons that they may develop. Genetics, diets low in vitamin B12 or iron, and some medications (especially steroid medications) can lead to the appearance of oral ulcers.

Autoimmune diseases including lupus, allergies, and stress have also been linked to mouth sores. With lupus, the sores are often painful and easily irritated, and may resemble the discoid lesions of cutaneous lupus. Most doctors believe that oral ulcers are the mouth equivalent to these skin symptoms of lupus.

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What to Watch for with Oral Ulcers

20% of people – not just Lupus Warriors – have sores that come and go without injury, hormone changes, or inflammation. These recurring or aphitious ulcers can be harmless as well. However, if they don’t clear up after 10 days, then they may be related to other underlying health issues.

A few symptoms to watch out for include:

  • Shiny red tongue
  • Red, white, or distorted spots
  • Dry mouth and enlarged salivary glands

These symptoms can hint at deeper problems, including infections. This is especially likely in people with compromised immune systems, either because they have an autoimmune disease (such as lupus) or are being treated with immune system suppressing medications. There is also a risk of cancer in the mouth, tongue, or soft palate.

If you have any of these symptoms, you should talk to your lupus treatment team and see if you can get a dentist on board to make sure that all is well.

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How to Get Rid of Mouth Sores

Keeping your mouth clean of bacteria that can cause infections, and treating your mouth gently, can go a long way towards helping mouth sores go away.

Brush gently but thoroughly, floss regularly, and use non-irritating mouthwashes. Ice can help reduce the swelling surrounding the oral ulcer and make the pain less intense. Wet tea bags are also great home remedies, as they draw out moisture from the ulcer and act as an antibacterial, helping the wound heal faster.

Changing your diet can also help – make sure that you are eating a healthy balanced diet with enough vitamin B12 and iron, and try not to hurt your mouth while you eat. Avoiding foods that are high in acid can also help.

Otherwise, anything that prevents a lupus flare will also prevent oral ulcers, as they can be a part of a flare. Take medications as prescribed and avoid triggers. If your medications (such as antimalarials) are causing a lot of mouth sores to appear as a side effect, talk to your lupus treatment team about adjusting medications.

In particular, it may be useful to ask about Dapsone or topical creams —  these medications can be used to treat particularly stubborn sores.

The mouth is the beginning of the gastrointestinal tract and keeping it healthy is key. Here are a few diet tips to help keep your gut healthy and happy.

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