Dr. Tariq Jagnarine
Fam Medicine, Endocrinology/ Diabetes
A canker sore, or aphthous ulcer, is an open and painful mouth ulcer or sore. It’s also the most common type of mouth ulcer. Some people notice them inside their lips or cheeks. They’re usually white or yellow and surrounded by red, inflamed soft tissue. anker sores aren’t contagious. They usually heal within 1 to 3 weeks without treatment, although the pain normally goes away in 7 to 10 days. Serious canker sores may take up to 6 weeks to heal.
CAUSES AND RISK FACTORS
Your risk for developing canker sores increases if you have a family history of them. Canker sores have various causes, and the most common ones include:
o Viral infection
o Stress
o Hormonal fluctuation
o Food allergy
o Menstrual cycle
o Vitamin or mineral deficiency
o Immune system problem
o Mouth injury
A deficiency in certain vitamins, such as B3 (niacin), B9 (folic acid), or B12 (cobalamin), can make people more prone to getting canker sores. Zinc, iron, or calcium deficiencies can also trigger or worsen canker sores. In some cases, the cause of a canker sore can’t be determined.
Canker sores vs. cold sores
Cold sores are like canker sores. However, unlike canker sores, cold sores can appear outside of your mouth. Cold sores also appear first as blisters, not inflamed sores, and become sores after the blisters pop. Cold sores are caused by the herpes simplex virus. This virus is carried within your body and can be triggered by stress, exhaustion, and even sunburn. You can also get cold sores on your lips, nose, and your eyes.
SYMPTOMS
Canker sores can cause several symptoms, which may vary depending on the specific type.
o Minor canker sores
Minor canker sores are the most common type of canker sore. Although they can be painful, they generally heal on their own without any scarring around 1 to 2 weeks after onset. Some of the most common symptoms associated with minor canker sores include:
small, oval-shaped bumps inside the mouth
a tingling or burning sensation
pain when eating, drinking, or speaking
Major canker sores
Major canker sores are less common than minor canker sores and can also cause more severe symptoms. They can take up to 4 weeks to heal and may cause scarring. Symptoms of major canker sores include:
o Large, round bumps inside the mouth
o Tingling, burning, or inflammation
o Severe pain
o Difficulty eating, drinking, or speaking
Herpetiform canker sores
Herpetiform canker sores are very uncommon. Among people who develop canker sores, only about 5 percent are affected by this type. In rare cases, they can merge together and form clusters. If this occurs, it could take several weeks to heal and may increase the risk of scarring. Some possible symptoms of herpetiform canker sores include:
o Small, pinhead-sized bumps inside the mouth, which could form in clusters
o Tingling or burning in the mouth
o Pain, which may be worse when chewing, drinking, or talking
DIAGNOSIS
A doctor can usually diagnose a canker sore by examining it. They may order blood tests or take a biopsy of the area if there’s a severe breakout. A cancerous lesion may appear as a canker sore, but it won’t heal without treatment. Some symptoms of oral cancer are like those of canker sores, like painful ulcers and swelling in the neck. But oral cancer is often indicated by unique symptoms, including:
o Bleeding from your mouth or gums
o Loose teeth
o Trouble swallowing
o Earaches
If you experience these symptoms along with canker sore symptoms, see your doctor right away to rule out oral cancer as a cause.
TREATMENT
Canker sores usually heal without treatment. However, there are many helpful lifestyles changes to make to treat canker sores.
• Brush and floss your teeth regularly to prevent a bacterial infection and avoid spicy foods to speed up the healing process.
• Pain can sometimes be severe. Lessen the discomfort by gargling with mouthwash or salt water. It may feel uncomfortable at first, but it may help reduce pain.
• Some ingredients in over-the-counter topical products can help relieve and heal sores, including:
o Benzocaine (Orabase, Zilactin-B, Kank-A)
o Hydrogen peroxide rinses (Peroxyl, Orajel)
o Fluocinonide (Vanos)
o Antimicrobial mouth rinse, such as Listerine or mouth rinses with chlorhexidine (Peridex, Periogard)
o Antibiotics, such as mouthwashes or pills with doxycycline (Monodox, Adoxa, Vibramycin)
o Corticosteroid ointment, such as hydrocortisone hemisuccinate or beclomethasone
o Prescription mouthwash, especially one that contains dexamethasone or lidocaine for inflammation and pain
HOME REMEDIES FOR CANKER SORES
o Applying ice or tiny amounts of milk of magnesia to the sores can help relieve pain and promote healing.
o Rinsing your mouth with a mixture of warm water and baking soda (1 teaspoon per 1/2 cup of water) can also help with pain and healing.
o Honey has been shown to be effective in treating canker sores as well.
COMPLICATIONS OF CANKER SORES
If the canker sore does not resolve in a few weeks, you may experience more serious complications, such as:
o Discomfort or pain while talking, brushing your teeth, or eating
o Fatigue
o Sores spreading outside of your mouth
o Fever
o Cellulitis
See a doctor if the canker sore is causing unbearable pain or interfering with your life, and if home treatments aren’t working. Consider doing this even if the complications have developed within just a week or two of the scores developing.
Bacterial infections can spread and create more serious issues, so it’s important to stop a possible bacterial cause of a canker sore quickly.
PREVENTION
People can prevent the recurrence of canker sores by avoiding foods that may have previously triggered the outbreak. These often include spicy, salty, or acidic foods. Also, avoid foods that cause allergy symptoms, such as an itchy mouth, a swollen tongue, or hives.
If a canker sore appears due to stress, try out stress reduction methods and calming techniques, such as deep breathing and meditation.
Practice good oral health and use a soft toothbrush to avoid irritating your gums and soft tissue.
Talk with your doctor to determine whether you have any specific vitamin or mineral deficiencies. They can help design a suitable diet plan and prescribe individual supplements if you need them.
Seek medical care if you’re unable to eat or drink or the canker sore hasn’t healed within 3 weeks.
