Canker Sores

Canker Sores

Definition

Canker sores are small ulcers inside the mouth that are white or grayish

with red borders. They are not contagious. Canker sores should not be

confused with cold sores, which occur outside the mouth around the lips,

are caused by a virus, and are very contagious.

Description

Canker sores are small patches of raw skin on the tissues that line the

cheeks and the inside of the lips. They may also occur at the base of the

gums or below the tongue on the floor of the mouth. They may appear

as single ulcers or in clusters. Most are about three-eighths of an inch

(1 centimeter) wide, but some are larger.

Doctors classify canker sores into three groups: minor sores, which are

smaller than half an inch (1.3 centimeters) and heal by themselves in seven

to ten days; major sores, which are larger than half an inch (1.3 centimeters),

are usually deeper than minor sores, may take as long as a month

to heal, and may leave scars; and herpetiform sores, which are small, form

clusters that look like the fever blisters caused by herpes viruses, and

heal in about a week. About 80

sores, 10 percent are major sores, and 5

–85 percent of canker sores are minor–10 percent are herpetiform.

Demographics

Canker sores are most common in children over ten years of age and

young adults. They are estimated to occur in 30

population. They appear to be equally common in all races and

ethnic groups but are slightly more common in women of childbearing

age than in men. Herpetiform sores are more common in older people

than in younger patients.

Canker sores appear to run in families even though they are not contagious;

about 50 percent of people who have frequent occurrences of

canker sores have relatives with the same problem. People with certain

digestive disorders, including Crohn disease, irritable bowel syndrome,

and celiac disease, are also at increased risk of recurrent canker sores.

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Causes and Symptoms

The exact cause of canker sores is not known; however, some doctors

think that the sores develop when the person

the tissues of the mouth. There are a number of possible factors that may

trigger such a reaction:

’s immune system targets

•

is irritated by poorly fitted dentures, loose wires from orthodontic

braces, a rough tooth, or accidentally biting the inside of the

mouth. Brushing too hard or using a very stiff toothbrush have

also been associated with damage to the lining of the mouth and

canker sores.

Trauma. Canker sores sometimes develop when a person’s mouth

•

vitamin B12, iron, zinc, or folic acid in their diet are more likely

to develop canker sores.

Nutritional deficiencies. People who are not getting enough

•

stomach ulcers.

Infection by Helicobacter pylori, the same bacterium that causes

•

people with higher-than-average anxiety levels are more likely to

develop canker sores.

Stress. Researchers have noted that high-achieving people and

•

are often associated with an outbreak of canker sores.

•

immune system.

AIDS and other disorders that affect the

•

oils, benzoic acid, cinnamon, gluten, cow

milk, coffee, chocolate, potatoes, cheese,

figs, nuts, citrus fruits, and certain spices

have all been associated with canker sores

in some people.

Food allergies. Flavoring agents, essential’s

•

toothpastes and mouthwashes, particularly

sodium lauryl sulfate (SLS), a chemical

added to toothpaste to thicken it

and create a lather during brushing.

Canker sores are preceded by one or two

days of tingling or a mild pain in the area where

the sore is developing. The reddened area then

turns into a whitish patch of broken skin surrounded

by a reddish rim. The area in the

middle of the sore that looks white or grey is

actually partially destroyed. This is the reason

why anything containing acids (fruit juices,

sodas, coffee), is hot, or is heavily spiced can

cause considerable pain if it touches the sore.

Some people find it difficult to brush their teeth,

talk, or eat until the sore heals.

Sensitivity to certain chemicals found in

Diagnosis

The doctor or dentist will usually diagnose canker sores on the basis of

their appearance inside the mouth. If the sores do not heal or become

more severe, a sample of tissue may be taken to check for other possible

mouth disorders. Patients with AIDS, for example, may have an infection

in the mouth along with the canker sores. In a very few cases, a sore

that does not heal is a symptom of cancer.

Treatment

Minor canker sores will heal eventually without treatment, although

dentists frequently prescribe a mouthwash that contains a steroid medication

or a rinse that contains an antibiotic. The antibiotic rinse is not

usually given to children because it can cause their teeth to discolor.

Other treatments include pastes like Orabase, Aphthasol, or Lidex.

These can be applied directly to the sore to speed healing and protect

the sore from further irritation by food, tooth brushing, or orthodontic

braces. The dentist may also prescribe mouthwashes or gels that contain

a local anesthetic. The gels can be applied directly to the sore with a

cotton swab.

Patients can also care for canker sores at home by making a solution

of 1 teaspoon of salt in a pint of warm water and using it to rinse out the

mouth as often as desired. Other home remedies that work for some

people include making a paste of baking soda and water to be applied

to the sores; allowing small chips of ice to melt slowly over the sores;

or applying a small amount of milk of magnesia to the sores several times

a day.

Patients with severe canker sores may be treated with steroid medications

injected directly into the tissues under the sores. Some dentists have

used lasers to treat severe canker sores in patients who do not respond to

other forms of treatment. Laser therapy gives good results in treating

canker sores but is considered experimental because it requires specialized

training to use effectively.

Other treatments that are beneficial for some patients include

vitamin and mineral supplements, zinc lozenges, stress management

techniques, and avoiding foods that are likely to irritate the mouth. For

many people, these

spices, salty foods, tomatoes, and citrus fruits.

“problem foods” include nuts, chips, pretzels, certain

Prognosis

Most canker sores heal on their own in one to two weeks, although

major sores may take as long as a month to heal completely. Patients

with sores that do not respond to any treatment, take longer than a

month to heal, or do not heal at all should see their doctor or dentist

as soon as possible.

Prevention

There is no way to completely prevent canker sores in people who are

susceptible to them because of family history or an underlying disease

condition like AIDS. However, maintaining good oral hygiene, eating a

nutritious diet, using softer toothbrushes, and checking with the dentist

to be sure that braces or dentures are fitted properly can all help to lower

the risk of canker sores.

The Future

Canker sores are a common health problem that is likely to affect about a

third of the general population for the foreseeable future. Further

advances in laser therapy may offer a new treatment option for people

with recurrent or severe canker sores.

SEE ALSO

bowel syndrome

AIDS; Allergies; Celiac disease; Cold sore; Crohn disease; Irritable

For more information

BOOKS

Smith, Rebecca W.

Guide to Family Dental Care

Columbia University School of Dental and Oral Surgery’s. New York: W.W. Norton, Inc., 1997.

PERIODICALS

Brody, Jane E.

1987. Available online at http://query.nytimes.com/gst/fullpage.html?res=

9B0DE5DA1138F933A25755C0A961948260&sec=&spon=&pagewanted=

all (accessed May 13, 2008).

“Personal Health: Canker Sores.” New York Times, June 10,

WEB SITES

American Academy of Family Physicians (AAFP) Patient Information.

Sores

at http://www.aafp.org/afp/20000701/160ph.html (posted July 1, 2000;

accessed May 13, 2008).

American Dental Association (ADA).

http://www.ada.org/public/topics/mouth_sores.asp#faq (accessed May 13,

2008).

Mayo Clinic.

health/canker-sore/DS00354 (updated January 31, 2008; accessed May 13,

2008).

WORDS TO KNOW

Aphthous ulcer:

The medical term for canker sore.

Herpetiform:

Resembling blisters caused by herpes.

Stomatitis:

of the mouth.The medical term for an inflammationCanker—What Are They and What Can You Do about Them?. Available onlineCommon Mouth Sores. Available online atCanker Sore. Available online at http://www.mayoclinic.com/In women, hormonal changes during menstruation and pregnancy–60 percent of the general