Description

Mouth sores, also called aphthous ulcers, are small, shallow lesions that develop on the soft tissues of the mouth or at base of the gums. Unlike cold sores, canker sores don't occur on the surface of your lips, and are not contagious. They can be painful, however, and can make eating and talking difficult.

Most canker sores go away in a week or two. Check with your doctor or dentist if you have unusually large or painful canker sores or canker sores that don't seem to heal.

Symptoms

Most canker sores are round or oval with a white or yellow center and a red border. They form inside your mouth or on your tongue, the inside of the cheeks or lips, at the base of the gums, or in the soft palate. You might notice a tingling or burning sensation that a day or two before the sores actually appear.

There are several types of canker sores, including minor, major, and herpetiform sores.

Minor canker sores

Minor canker sores are the most common and:

  • Are usually small
  • They are oval in shape with a red border
  • Heal without scarring in one to two weeks

Major canker sores

Major canker sores are less common and:

  • They are larger and deeper than the lesser of canker sores
  • They are usually round with defined boundaries, but they can have jagged edges when very large
  • It can be very painful
  • It can take up to six weeks to heal and can leave large scars

Herpetiform canker sores

Herpetiform canker sores are rare and usually develop later in life, but are not caused by infection by the herpes virus. These canker sores:

  • Are to identify the size of the
  • They often occur in groups of 10 to 100 lip, but can be combined into one large ulcer
  • They have irregular edges
  • Heal without scarring in one to two weeks

When to see a doctor

Consult your doctor if you experience:

  • Unusually large canker sores
  • Recurrent labial, with new ways of development before the old ones heal, or frequent outbreaks
  • Persistent sores, with a duration of two weeks or more
  • Ulcers that extend into the lips themselves (vermilion border)
  • Pain that cannot be controlled with self-care measures
  • The extreme difficulty eating or drinking
  • High fever, along with canker sores

See your dentist if you have sharp tooth surface or dental appliance that seem to trigger the appearance of sores.

Causes

The exact cause of canker sores is not yet clear, although researchers suspect that a combination of factors that contribute to outbreaks, even in the same person.

Possible triggers for canker sores are:

  • A minor injury in your mouth from dental work, overzealous brushing, sports mishaps or accidental cheek bite
  • Toothpastes and mouth rinses containing sodium lauryl sulfate
  • Sensitivity to foods, particularly chocolate, coffee, strawberries, eggs, nuts, cheese, and spicy or acidic foods
  • A diet poor in vitamin B-12, zinc, folate (folic acid) or iron
  • An allergic response to certain bacteria in your mouth
  • Helicobacter pylori, the same bacteria that causes peptic ulcers
  • Hormonal changes during menstruation
  • The emotional stress

Canker sores can also occur due to certain diseases and conditions, such as:

  • Celiac disease, a serious intestinal disease caused by a sensitivity to gluten, a protein found in most grains
  • Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis
  • Behcet's disease, a rare disorder that causes inflammation throughout the body, including the mouth
  • A defective immune system that attacks healthy cells in your mouth instead of pathogens, such as viruses and bacteria
  • HIV/AIDS, which suppresses the immune system

Unlike cold sores, canker sores are not associated with herpes virus infections.

Risk factors

Any person can develop a canker sore. But they occur more frequently in adolescents and young adults, and is most common in women.

Often people with recurrent canker sores have a family history of the disease. This can be due to heredity or to the same factor in the environment, such as certain foods or allergens.

Prevention

Canker sores tend to be repeated, but you may be able to reduce their frequency by following these tips:

  • Careful with what you eat. Try to avoid foods that seem to irritate your mouth. These may include nuts, potato chips, pretzels, certain spices, salty foods, and acidic fruit, such as pineapple, grapefruit and oranges. Avoid foods to which you are sensitive to or are allergic to.
  • Choose healthy foods. To help prevent nutritional deficiencies, eating lots of fruits, vegetables and whole grains.
  • Follow good oral hygiene habits. Brushing after meals and flossing once a day can keep your mouth clean and free of food that can trigger a pain. Use a soft brush to help prevent irritation of the delicate mouth tissues, and avoid toothpastes and mouth rinses that contain sodium lauryl sulfate.
  • Protect your mouth. If you have braces or other dental appliances, ask your dentist about orthodontic wax to cover the sharp edges.
  • Reduce stress. If your canker sores seem to be related to stress, learn and use stress-reduction techniques, such as meditation and guided visualization.

Diagnosis

The tests are not needed to diagnose canker sores. Your doctor or dentist can identify with a visual examination. In some cases, you may have tests to rule out other health problems, especially if your canker sores are severe and ongoing.

Treatment

The treatment generally is not necessary for minor canker sores, which tend to clear on their own in a week or two. But large, persistent or unusually painful sores often need medical attention. A number of treatment options that exist.

Mouthwashes

If you have multiple sores in the mouth, the doctor may prescribe a mouth rinse that contains the steroid dexamethasone (dek-suh-METH-uh-sown) to reduce pain and inflammation or lidocaine to relieve the pain.

Topical products

Over-the-counter and prescription products (pastes, creams, gels or liquids) can help relieve the pain and speed up healing if it applies to certain wounds as soon as they appear. Some products have active ingredients, such as:

  • Benzocaine (Anbesol, Kank-A, Orabase, Zilactin-B)
  • Fluocinonide (Lidex, Vain)
  • The hydrogen peroxide (Orajel Antiseptic mouth Sore Rinse, Peroxyl)

There are many other topical products for canker sores, including those without the active ingredients. Ask your doctor or your dentist for advice on which may work best for you.

Oral medications

Oral medications can be used when canker sores are severe or do not respond to topical treatments. These may include:

  • Medicines are not designed specifically for canker sores treatment, such as intestinal ulcer treatment with sucralfate (Carafate), used as a coating agent, and colchicine, which is usually used for the treatment of gout.
  • Oral steroid medications when severe ulcers do not respond to other treatments. But due to serious side effects, usually a last resort.

Cauterization of wounds

During the cauterization, an instrument, or chemical substance that is used to burn, sear, or destroy the tissue.

  • Debacterol is a topical solution designed to treat mouth sores and gum problems. By chemically cauterizing canker sores, this drug may also reduce the healing time of about a week.
  • Silver nitrate — another option for chemical cautery of canker sores — it has not been shown to speed the healing, but it can help relieve canker sore pain.

Nutritional supplements

Your doctor may prescribe a nutritional supplement, if you consume low amounts of important nutrients, such as folate (folic acid), vitamin B-6, vitamin B-12 or zinc.

Health-related problems

If your canker sores refer to a more serious health problem, your doctor will recommend the treatment of the underlying condition.

Lifestyle and home remedies

To help alleviate the pain and speed up healing, keep these tips in mind:

  • Rinse out your mouth. The use of salt water or baking soda rinse (dissolve 1 teaspoon of baking soda in 1/2 cup of warm water).
  • Apply a small amount of milk of magnesia on your canker sore a few times a day.
  • Avoid abrasive, acidic or spicy foods that can cause further irritation and pain.
  • Apply ice to your canker sores, allowing ice chips to slowly dissolve over the sores.
  • Brush your teeth gently, using a soft brush and foam-free agent of the toothpaste as Biotene or Sensodyne ® ProNamel™.

Preparing for your appointment

Your doctor or dentist can diagnose a canker sore on the basis of their appearance. Here's some information to help you prepare for your appointment.

Collection of information

Before your appointment, make a list of:

  • Your symptoms, including when they started and how they may have changed or worsened with time
  • Of all your medications, including otc medicines, vitamins, or other supplements, and dosage
  • Any other medical condition, to see if any relate to your symptoms
  • Key personal information, including any recent changes or emotional stressors in your life
  • Questions to ask your doctor or dentist to make your visit more efficient

Here are some basic questions to ask:

  • I have a canker sore?
  • If so, what factors may have contributed to its development? If not, what else could it be?
  • Do I need any tests?
  • What treatment approach do you recommend, if any?
  • What self-care steps can I take to relieve the symptoms?
  • Is there anything I can do to speed healing?
  • How soon do you expect that my symptoms improve?
  • Is there anything I can do to help prevent a recurrence?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor or dentist

Be prepared to answer questions of your doctor, or dentist, such as:

  • What are your symptoms?
  • When did you first notice these symptoms?
  • How severe is your pain?
  • Has had similar sores in the past? If so, have you ever noticed if there is something in particular that seemed to trigger them?
  • We have tried similar sores in the past? If so, what was the most effective treatment?
  • Has recently had some dental work?
  • Have you recently experienced a major stress or major life changes?
  • What is the typical daily diet?
  • Have you been diagnosed with any other medical condition?
  • What medications are you taking, including prescription and over-the-counter medications, vitamins, herbs and other supplements?
  • Do you have a family history of canker sores?
Symptoms and treatment of Canker sores