Many people with MDS and CMML have poor immune systems which can mean that they can suffer with frequent and long-lasting mouth ulcers. In the context of other more serious symptoms that people with these diseases have to cope with, mouth ulcers can seem a trivial ailment to deal with or complain about, but they can be very bothersome, painful and spoil enjoyment and ease of eating. We hope the information and tips below will be of help.

What are mouth ulcers?

A mouth ulcer is defined as the loss or erosion of the delicate lining tissue of the mouth (mucous membrane). The most common cause is injury, such as accidentally biting the inside of your cheek. In most cases, mouth ulcers are harmless and resolve by themselves in 10 to 14 days without the need for treatment.

Prevention

Avoiding damage is very important, especially as treatments are not always effective, so focus on “careful and mindful eating” and try the following:

• Avoid eating foods which are “scratchy” and likely to cause grazing/damage in the mouth as even minor damage can escalate if your immune system is compromised (e.g. Crisps, tortilla chips, any rough snacks, crusty rolls, baguettes, breakfast cereals)
• Avoid eating food which is too hot and could burn your tongue/inside your cheeks
• Avoid talking whilst eating - can lead to loss of focus leading to tongue/cheek biting incidents

• Avoid foods that can irritate the mouth, such as acidic fruits like oranges, lemons, or anything spicy
• Choose whole grains and alkaline fruits and vegetables
• Eat a healthy, well-balanced diet with multivitamins
• Reduce stress and anxiety by getting adequate sleep and rest
• Maintain a good oral hygiene by performing daily interdental cleaning.

As well as avoiding damage, it is understood that some substances used in the mouth may cause mouth irritation and soreness and make people more prone to ulcers. This includes some toothpastes and mouthwashes which contain:

• Sodium lauryl sulphate (SLS/SLES) (foaming agent / detergent used in most proprietary toothpastes).
  From Dentistry.co.uk [i] “Patients with a delicate oral mucosa are more likely to find SLS-containing toothpastes less suitable. Especially those with aphthous ulcers.”  
  “SLS toothpaste can increase the frequency of repeated mouth ulcers” (Herlofson and Barkvoll, 1994). 
  According to Which  “A 2019 systematic review found that SLS-free toothpastes reduced the number and duration of mouth ulcers so if you suffer from these, you may want to choose a toothpaste without SLS.”