The short version
- Ordinary ulcers heal on their own within seven to fourteen days.
- Anything unhealed after three weeks must be examined — painless does not mean harmless.
- Tobacco, paan, gutkha, areca nut and regular alcohol all raise the risk substantially.
Almost everyone gets mouth ulcers. The overwhelming majority are harmless and heal on their own. A small number are not, and telling them apart is mostly a question of time rather than appearance.
Ordinary ulcers
Common aphthous ulcers are small, round, painful, with a pale centre and a red rim. They usually appear inside the lips or cheeks or under the tongue, and heal by themselves in seven to fourteen days.
They are often triggered by minor trauma — a cheek bite, a sharp filling, a toothbrush slip — or by stress, hormonal changes, or deficiencies in iron, folate or vitamin B12. Recurring crops of them are worth a blood test rather than repeated ointments.
For comfort: avoid spicy, salty and acidic food while they heal, rinse with warm salt water, and use a topical gel if the pain interferes with eating.
The three-week rule
This is the single most important rule in oral cancer detection, and it is simple enough to remember: any ulcer or sore patch that has not healed within three weeks should be examined.
It applies whether or not it hurts. This is the part that catches people out, because many serious lesions are painless — the absence of pain is not reassurance, and waiting for it to start hurting is exactly the wrong strategy.
Other signs worth acting on
A white patch (leukoplakia) or red patch (erythroplakia) that will not rub off. A lump or thickening anywhere in the mouth, or a lump in the neck. Unexplained bleeding or numbness. A persistently hoarse voice or difficulty swallowing. A loose tooth with no dental explanation.
And one that is often missed: progressively reducing mouth opening, particularly with a burning sensation when eating spicy food. This suggests oral submucous fibrosis, a pre-cancerous condition strongly linked to areca nut and gutkha use — very common in this region and very treatable when caught early.
Who should be especially careful
Anyone who uses tobacco in any form — smoked or chewed — or who chews paan, gutkha or areca nut, or drinks alcohol regularly. Combining tobacco and alcohol raises the risk more than either alone.
Oral cancer is one of the most common cancers in India, and one of the most survivable when caught early. Early lesions are typically treated straightforwardly; advanced disease needs major surgery. The difference is very often just how long someone waited.
What a screening actually involves
It takes a few minutes and is completely painless. We examine the tongue including its edges and underside, the floor of the mouth, cheeks, palate and gums, and feel the neck for lumps. If anything looks suspicious we take a biopsy, because that is the only way to know with certainty.
Most of the time the answer is reassuring, and that reassurance takes minutes to obtain. If you have an ulcer that is three weeks old, that is not something to keep an eye on for another month.
Worried about any of this?
An article cannot examine your mouth. Call and describe the problem — we will tell you honestly whether you need to be seen urgently or whether it can wait.
