What is a Canker Sore?
These common ulcers are painful, white or yellow, sores with a bright red surrounding area. They range in size from 1-2 mm to 1 cm. they may occur alone or in groups anywhere on the inner surface of the mouth including the gums, tongue, and throat. Twice as common in women than men, canker sores typically first appear between the ages of 10 and 40 in about 20 to 25 percent of the population. They may recur at any time. Canker sores do not occur on the skin outside of the mouth. Cold sores (fever blisters) on the lips are a different problem caused by the herpes virus. Canker sores are also known as Aphthous Ulcers.
What causes them?
We don’t know what causes a canker sore, but we do know that they are not an infection caused by a virus or bacteria. Canker sores are probably due to an attack of your mucous membrane by your own body’s immune system. The tendency to develop a canker sore may be inherited. If your parents had canker sores, you have a 90% chance of developing them too. Since they are not caused by infection, you do not become immune to them, and they are not contagious.
Frequently, canker sores first appear when a person is under physical or emotional stress (for example, during college exams). Possible causes include:
- trauma from dental procedures
- aggressive tooth cleaning
- accidentally biting your tongue or cheek
- head colds
- a deficiency in iron, folic acid, or vitamin B12
- menstrual periods and other hormonal changes
- food allergies
- sodium lauryl sulfate found in some toothpaste
People with celiac disease also tend to get canker sores more frequently.
Less common causes of canker sores include:
- cancer (rare)
- drug allergies
- viral infections
- a genetic condition called Behcet’s Syndrome (very rare)
What does a canker sore feel like?
You will first feel a tingling or burning sensation followed by a red spot or bump that develops into a painful ulcer. Depending on how large they are, the pain may continue for seven to fourteen days. In children, canker sores will heal on their own in 7-10 days without any treatment. Any acidic drinks or food (for example colas and orange juice) increase the pain. Just before the ulcer heals, it may have a gray membrane. Occasionally, with a severe occurrence, you may have a fever and tender swollen lymph nodes. You may also have a general, vague feeling that you are not well. It is common that canker sores recur in different places in the mouth and they may continue for years.
When should you call your doctor or dentist?
Most of the time you can diagnose and treat a canker sore yourself. Once you have had one or two, what they are will become obvious. Come see the doctor if the sore lasts for more than two weeks or recurs more than two or three times per year.
How do you treat canker sores?
Since we do not know the cause of canker sores, we don’t know the best treatment for them. There are no specific drugs for canker sores, but the following may be helpful:
Over-the-counter mouthwashes and medications applied directly to ulcer
- Benzocaine for pain available as Anbesol®, Num-Zit® and Zilactin-B®
- Carbamide peroxide (Gly-Oxide®, Orajel®) for antisepsis
- Amlexanox (Aphthasol®) and hydrocortisone (OrabaseHCA®) for inflammation
Prescription medications
- Chlorhexidine gluconate (Peridex®, Periogard®)
- Klax (or Klack) solution
- Kenalog in Orabase.
- Liquid Carafate, an anti-ulcer preparation
- Silver Nitrate to cauterize the ulcer, killing the nerve endings and relieving the pain
In very severe cases, your doctor may prescribe oral prednisone, a steroid pill.
How do you prevent canker sores?
Dental work: Irritation from poor-fitting dentures, rough fillings, or braces can aggravate canker sores and should be treated by a dentist.
Sodium lauryl sulfate (SLS): SLS, a component of most toothpaste, is a potential cause of canker sores. SLS seems to attack the upper layers of the mucous membrane. Try an SLS-free toothpaste for several months to see if such a change helps.
Good oral hygiene: Flossing teeth daily and brushing teeth and gums for at least two minutes two to three times daily may help prevent canker sores.
Dietary changes: Food sensitivities or allergies may aggravate canker sores. These are hard to figure out and you need to try various diet changes to see if something you are eating is aggravating the problem. In a 1990 study, oranges, tomatoes, nuts, eggplant, tea, and cola were the dietary allergens found to trigger ulcer formation. Other foods anecdotally associated with aphthous ulcers are pineapple and cinnamon oil or flavoring.
Some nutritional supplements and lifestyle changes may be helpful in treating or preventing canker sores. There is no proven evidence for these, but people have reported relief with the following:
- B vitamins
- Lactobacillus acidophilus
- Aloe (Aloe vera)
- Licorice (DGL) (from Glycyrrhiza glabra)
- Chamomile (Matricaria recutita)
If you have any questions about canker sores or any other oral health concerns, don’t hesitate to contact us today!
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