Managing Oral Ulcers and Dry Mouth – Expert Guide by Dr. Pothireddy Surendranath Reddy

Introduction

Oral ulcers (“mouth ulcers”) and dry mouth (xerostomia) are two of the most common—and most uncomfortable—conditions encountered in everyday clinical practice. They may occur independently or together, and when they do coincide the symptoms can amplify each other: lack of saliva makes ulcers sting more, and painful ulcers make eating and hydrating harder, worsening dryness. This review explains causes, how to tell the common from the serious, practical treatments (self-care and medical), and when to seek specialist help. I cite clinical reviews and authoritative guidance so you can follow up on the primary sources. nhs.uk+1

Short primer: what we mean by “oral ulcers” and “dry mouth”

Oral ulcers are breaks in the mucous membrane of the mouth—round or oval sores with a red halo and yellowish base. The most common form is recurrent aphthous stomatitis (RAS) (canker sores), which affects a substantial fraction of the population at some point. Most ulcers are self-limiting, but recurrent, large, or long-lasting ulcers need evaluation. NCBI+1
Dry mouth (xerostomia) is the subjective feeling of oral dryness, usually from reduced saliva production or quality. Saliva protects mucosa, helps digestion and taste, and shields teeth against decay. When saliva is low, the mouth is more prone to ulceration, infections, dental decay and burning sensations. Causes range from medications and dehydration to autoimmune diseases and radiation therapy. Mayo Clinic+1

Why they often occur together

Saliva has protective, antimicrobial and lubricating functions. When saliva volume or composition is reduced:

The mucosal surface becomes more fragile and prone to trauma from food, teeth, or dentures.
Oral microflora balance shifts, increasing the risk of candidiasis and secondary infection in ulcerated areas.
Painful ulcers interfere with eating and drinking, reducing oral intake and sometimes worsening dehydration and xerostomia.

Conversely, chronic dry mouth (for example from Sjögren’s syndrome) is strongly linked with recurrent ulcers and other oral lesions; the literature documents frequent oral ulceration and mucosal changes in Sjögren’s patients. Recognising the two conditions as linked helps target treatment to both symptoms and underlying cause. PMC+1

Common causes of oral ulcers

Recurrent aphthous stomatitis (RAS) — the most frequent cause; minor RAS lesions are small (<1 cm), painful, and recur in cycles. RAS does not imply systemic disease in most people. NCBI
Trauma — biting, sharp tooth edges, ill-fitting dentures, or aggressive toothbrushing.
Infections — herpes simplex virus (herpetic gingivostomatitis), hand-foot-and-mouth disease, candidiasis (can erode mucosa), and bacterial ulcers in immunocompromised patients.
Nutritional deficiencies — iron, vitamin B12, folate, and sometimes zinc deficiency can produce recurrent ulcers.
Systemic diseases — inflammatory bowel disease (Crohn’s, ulcerative colitis), Behçet’s disease, systemic lupus erythematosus, and malignancies can present with oral ulceration.
Medications & therapies — certain drugs (NSAIDs, beta-blockers, chemotherapeutic agents) and head/neck radiotherapy can cause mucositis and ulcers.
Stress and hormonal factors — often reported triggers for RAS episodes. Patient+1

Common causes of dry mouth

Medications — the leading cause in adults. Anticholinergics, antihistamines, many antidepressants, some antihypertensives, and a long list of other agents reduce salivary flow.
Autoimmune disease — Sjögren’s syndrome is the classic cause: immune destruction of salivary and lacrimal glands leading to persistent xerostomia and dry eyes. Oral ulceration and rampant dental decay are common complications. PMC+1
Radiation to head & neck — damages salivary glands and frequently causes chronic xerostomia in cancer survivors.
Systemic illness — diabetes, HIV, chronic kidney disease, Parkinson’s disease and hypothyroidism can be associated with dry mouth.
Dehydration, mouth-breathing, smoking and recreational drugs — common reversible contributors. Mayo Clinic+1

Clinical features and “red flags”

Typical (benign) patterns

Small, painful, recurrent ulcers with clear healing between episodes (RAS).
Dry mouth that worsens with dehydration or medication use and improves with sips of water or sugar-free lozenges.

Red flags that need urgent attention

Any oral ulcer that persists >3 weeks despite basic care. (Rule out malignancy or chronic infection.) nhs.uk
Rapidly spreading ulceration, severe systemic symptoms (fever, weight loss), or ulcers with unusual appearance (indurated, fixed, bleeding).
Severe xerostomia with significant weight loss, rampant dental decay, or signs of systemic autoimmune disease (dry eyes, joint pains, rashes).
Recurrent ulcers plus genital lesions, eye inflammation or neurological symptoms — think Behçet’s disease or other systemic inflammatory disorders.

Diagnostic approach (practical steps)

History — onset, pattern (single vs. recurrent), associated symptoms (dry eyes, GI symptoms), medication list (including over-the-counter and herbal medicines), smoking/alcohol history, recent infections, and radiation/chemotherapy exposure.
Oral exam — size, number, location and appearance of ulcers; saliva pooling; dental status; mucosal atrophy or candidal plaques.
Basic investigations — full blood count, iron studies, B12/folate, blood glucose if diabetic symptoms, HIV test where indicated. For suspected Sjögren’s, check anti-SSA/SSB antibodies and consider referral to rheumatology and ocular tests (Schirmer test).
Special tests — swabs for viral PCR or fungal culture if infection suspected; biopsy for persistent single ulcers or suspicious lesions. Imaging or salivary-gland biopsy may be needed for complex autoimmune cases. NCBI+1

Management — practical and evidence-based

A. Self-care & symptomatic relief (first-line for most patients)

Oral hygiene: gentle brushing with a soft toothbrush; avoid toothpastes with sodium lauryl sulfate if ulcers recur (some patients report improvement). East and North Hertfordshire NHS Trust
Topical protective measures: topical emollients (gels), oral rinses with saline or bicarbonate, and protective pastes (e.g., benzocaine-based preparations for short-term pain relief). Avoid acidic, spicy and highly crunchy foods. citeturn0search0
Hydration & saliva substitutes: frequent sips of water, sugar-free chewing gum or lozenges to stimulate flow (if residual gland function exists), and over-the-counter saliva-replacement gels/sprays for lubrication. Mayo Clinic+1

B. Topical medical therapy (for ulcers)

Topical corticosteroids are first-line for symptomatic RAS (e.g., high-potency steroid gels or adhesive preparations applied to the ulcer). These reduce pain and speed healing. For many patients, topical steroid therapy (under dental or medical guidance) is effective and safe when used short term. NCBI+1
Topical antiseptics (chlorhexidine mouthwash) may reduce secondary infection but can be drying—use cautiously when xerostomia is prominent. citeturn0search12

C. Systemic therapy (for severe or refractory disease)

Short courses of systemic corticosteroids can rapidly control severe outbreaks but are not ideal for long-term use because of side effects.
Immunomodulatory agents (e.g., colchicine, dapsone, thalidomide, azathioprine, or biologics) are reserved for severe RAS or systemic inflammatory disease (e.g., Behçet’s). Evidence is evolving and specialist referral is recommended for these options. Recent literature reviews summarise new evidence for agents and recommend specialist oversight for systemic treatment. PMC+1

D. Managing dry mouth specifically

Address reversible causes: review and, if feasible, modify xerostomia-inducing medications with the prescribing clinician. Correct dehydration, reduce alcohol/tobacco, and treat candidiasis if present. NIDCR+1
Saliva stimulants: sialogogues such as pilocarpine or cevimeline can be effective if some salivary gland function remains (commonly used in Sjögren’s or drug-induced cases). These require physician prescription and monitoring for anticholinergic side effects. citeturn0search5
Topical saliva substitutes and fluoride: artificial saliva, moisturizing gels, and high-fluoride toothpaste or topical fluoride varnishes protect teeth in chronic xerostomia. Coordinate with your dentist for preventive dental care. citeturn0search13turn0search21

Special situations

Sjögren’s syndrome

Persistent dry mouth with dry eyes and systemic features requires rheumatology input: immunological testing (anti-SSA/SSB), ocular tests (Schirmer), and sometimes salivary-gland imaging or biopsy. Patients often need a combination of sialogogues, saliva substitutes, meticulous dental care and management of systemic manifestations. Oral ulceration is common in Sjögren’s and may signal severe mucosal dryness or secondary infection. PMC+1

Cancer therapy (chemotherapy / head & neck radiotherapy)

Oral mucositis can be severe and require multidisciplinary management: topical analgesia, nutritional support, oral care protocols, and sometimes growth factors or low-level laser therapy in specialized centres. Early involvement of oncology and dental teams is crucial. citeturn0search17

Prevention — practical tips

Review medications with your clinician if you develop dry mouth.
Keep well hydrated, use sugar-free gum to stimulate saliva if appropriate, and avoid tobacco/alcohol and excessive caffeine.
Good oral hygiene and regular dental check-ups; use alcohol-free mouthwashes and consider fluoride applications for long-term xerostomia.
For frequent ulcerators, identify dietary or mechanical triggers (nuts, citrus, rough foods, toothpaste ingredients) and reduce exposure. citeturn0search13turn0search12

When to see a healthcare provider

Seek prompt medical or dental attention if you have:

An ulcer lasting more than 3 weeks. nhs.uk
Severe pain or swallowing difficulty preventing adequate nutrition or hydration.
Signs of systemic illness (fever, weight loss, rash, joint pains) or multiple recurrent ulcers.
Persistent or worsening dry mouth with rapid dental decay, oral infections, or difficulty speaking/eating.

Primary care physicians, dentists, oral medicine specialists and rheumatologists (for suspected Sjögren’s or systemic disease) all play roles in diagnosis and management.

Takeaway (practical summary)

Oral ulcers and dry mouth commonly co-occur because saliva protects and lubricates the mouth; when saliva is low the mucosa is vulnerable.
Most mouth ulcers are benign and heal within 1–2 weeks with simple measures, but ulcers lasting >3 weeks or those accompanied by systemic signs require evaluation. nhs.uk
Treat the symptom (topical steroids for RAS, saliva substitutes and stimulants for xerostomia) while searching for reversible causes (medications, nutritional deficiencies, autoimmune disease). NCBI+1
For recurrent, severe or complicated cases, specialist referral (oral medicine/dentistry, rheumatology, ENT or oncology as appropriate) is essential—newer reviews and guidelines summarise evolving systemic treatment options for refractory disease. PMC+1

Selected references & useful links

NIDCR (National Institute of Dental and Craniofacial Research) — Dry Mouth. Patient and clinician resources on xerostomia and oral health. NIDCR

NHS — Mouth ulcers (patient guidance). Clear practical advice and red-flag timing (“see GP or dentist if ulcer >3 weeks”). nhs.uk

Mayo Clinic — Dry mouth (xerostomia) (Symptoms, causes, treatment). Authoritative overview of causes and therapies including sialogogues and substitutes. Mayo Clinic

StatPearls / NCBI Bookshelf — Recurrent Aphthous Stomatitis (clinical review). Good clinical summary of RAS diagnosis and treatment priorities. NCBI

Systematic / literature reviews on RAS treatments (2025 review). Recent summary of evidence for topical and systemic options for recurrent aphthous ulcers. PMC

Oral lesions in Sjögren’s syndrome — systematic review. Documents the frequent association of oral dryness and ulcers in Sjögren’s patients. PMC

Dr.Pothireddy Surendranath reddy

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