Ask the GP: What are the best ways to ease mouth ulcer pain?

Recurrent mouth ulcers are a common problem

Q: MY 50-year-old son has suffered with large and painful mouth ulcers all his life and no over-the-counter remedies seem to work. He's also had ankylosing spondylitis since childhood and has a stressful job. What's the best way to get rid of these sores?


A: THIS SOUNDS like recurrent aphthous stomatitis (RAS), a common although somewhat mysterious condition that causes recurrent mouth ulcers.

At any one time up to a fifth of the population suffers from RAS. The various potential causes include vitamin deficiencies and trauma - for instance, as a result of ill-fitting dentures.

Another recent theory is that it's due to a problem with the immune cells that protect the lining of the mouth.

Indeed, recent, groundbreaking research on the 500,000 participants in the UK Biobank study (a database of genetic and general health information) has confirmed a strong association between RAS and ankylosing spondylitis, the immune condition your son has (where the spine and other parts of the body become inflamed as a result of a faulty immune system response).

According to the description in your longer letter, your son has the typical pattern of an RAS sufferer, with periods when he is ulcer-free, punctuated by times when he has several painful ulcers all at once.

There are a number of recommended treatments that are available on prescription.

An antibacterial mouthwash containing tetracycline dissolved in water is effective in treating mouth ulcers, even though there's no bacterial infection (it's not clear how it helps).

There is also dexamethasone mouthwash, which is prescription-only and contains a steroid drug to suppress painful inflammation in the mouth.

Or there is Orabase, a gel available over the counter or online that contains a different steroid, triamcinolone. This is applied to each ulcer twice daily.

Finally, a 2 per cent lidocaine local anaesthetic gel can at least make mealtimes less uncomfortable.


Swollen feet and ankles are debilitating

Q: SIX MONTHS ago, an insect bite left me with a painful and swollen right foot and ankle.

Antibiotics failed to make it any better and, despite X-rays and CT and MRI scans, doctors are baffled by why it remains inflamed.

I am 80 and hobbling around in constant pain. It's like walking on broken glass.


A: I SYMPATHISE with your frustration at not having a firm diagnosis for your condition - I suspect the problem may be lymphoedema arising from the bite itself and damage to a part of the lymphatic system.

This is the system that removes waste, bacteria and other unwanted substances from the tissues via lymphatic fluid.

This waste is then drained back into the bloodstream through tubes called lymphatic channels.

It is possible that the insect bite damaged lymphatic channels in your leg. This in turn can lead to a build-up of lymphatic fluid in the tissues, a condition known as lymphoedema.

Bacterial organisms that flourished as a result of the bite may have been resistant to the antibiotic used to treat it, and this may have exacerbated the damage.

But the X-rays and scans would not necessarily have detected this, as a specific form of imaging is required to outline the lymphatic channels of the leg.

If lymphoedema is confirmed, then wearing a compression sock right up to the knee will help with symptoms.

In some cases, specialised massage techniques are also used to disperse the fluid and ease inflammation.

I would suggest talking to your GP about further investigations.

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Dr Martin Scurr