Canker Sores

Conquering canker sores

Nearly everyone has had a canker sore -- those small, painful ulcers that appear in your mouth, lip, or underneath your tongue. Canker sores are believed to be the result of a virus, bacteria, or glitch in the immune system. Accidentally biting the inside of your mouth, stress, and some ingredients in toothpaste or mouthwash have also been fingered as causes.

Additionally, canker sores have been linked to immune and nutrient deficiencies, ill-fitting dental appliances, and even menstruation.

Although canker sores are not usually serious, for the 20% of the U.S. population that suffer from them, they can be quite bothersome and annoying. Luckily, mild pain relievers, good oral hygiene, and a little time can make canker sores less bothersome and hopefully, eliminate them altogether. About one-third of all whom get them will get them recurrently.

Detailed Description

Canker sores are small ulcers with a grayish-white or yellow-white center and red outer ring that appear inside the mouth. Sores can range in size and number, usually appearing in groups of two to three, although outbreaks of 10 to 15 are not unusual. They can be very painful and, in their early stages, may even affect speech and eating. In some cases, a person will also experience swollen lymph nodes, low-grade fever, and a general feeling of malaise.

The causes of canker sores are numerous. Some of the most common include the following:

  • Stress
  • Immune deficiency
  • Nutrient deficiency
  • Virus (herpes being one common virus associated with vesicle/blister sores)
  • Poor diet
  • General illness
  • Menstruation
  • Vigorous brushing
  • Dental appliances (fillings, braces, dentures)
  • An allergic reaction to certain foods

If you have persistent canker sores, watch what you eat and how you take care of your mouth and identify any patterns that set off an outbreak so you can avoid triggers.

Medical treatment is rarely sought for canker sores unless they make it difficult to eat, speak, or sleep, or if they don't heal within two weeks. Usually they heal spontaneously in seven to 10 days. Frequent recurrences may indicate another condition or a secondary infection requiring antibiotics.

How Common Are Canker Sores?

It is estimated that at any given time, one in five people has a canker sore. Canker sores are not limited to a specific age group. However, they predominantly occur in people between the ages of 10 and 40. More women than men are affected by this condition.

What You Can Expect

Most canker sores will heal on their own in seven to 10 days, leaving no trace. Although recurring breakouts are common, it may be wise to consult a doctor to insure that you are not dealing with a secondary infection. While a sore is healing, pain-relieving gels and liquids may be used to aid in the healing process.

Established Causes

The precise cause of canker sores is unknown.

Risk Factors

Although the primary cause of canker sores is currently unknown, several risk factors have been identified with their development. These include the following:

  • Injuries from rough dentures, toothbrushes, chipped or jagged teeth, and dental work
  • Burns from hot food and drinks
  • Sensitivity to chemicals in toothpaste
  • Irritation from certain foods, including citrus fruits, pineapple, vinegar, nuts, chocolate, or highly salted foods
  • Allergy to airborne allergens or irritants
  • Sharing utensils with individuals who have canker sores
  • Physical exhaustion
  • Mental stress
  • Poor diet especially lacking in vitamin B-12, folic acid, or iron
  • Smoking
  • Weakening of health due to another illness (i.e., AIDS, Crohn's disease, Bechet's syndrome)

Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.


Symptoms

The symptoms associated with canker sores can assist with diagnosis:

  • Presence of white sores (often surrounded by red borders) on the inner surfaces of the mouth
  • Pain in the mouth where the sores are present
  • Difficulty with eating and speech
  • Fatigue, swollen neck glands, and fever

Conditions That May Be Mistaken for Canker Sores

  • Oral thrush

Laboratory Work

A visual examination is conducted to identify the presence of sores. In severe or persistent cases, a biopsy of the ulcers may be taken. This tests for the presence of the herpes simplex virus, and allows the doctor to rule out the presence of secondary bacterial infections.

Goals of Treatment

Medications and remedies may be used to relieve the pain associated with the sores themselves.

This condition usually corrects itself over a period of one to two weeks, but tends to recur. Relieving the pain and maintaining good oral hygiene, canker sores are an effective treatment for canker sores. Antibiotics are only used to treat secondary infections, which occur rarely. Further treatment, such as antiviral medication, may be necessary to address an underlying disorder.

Treatment Overview

The key to dealing with recurring canker sores is identifying the cause, although it is often impossible. If this can be done, the treatment can be much more effective. In the cases of ill-fitting dental appliances, like braces or dentures, consult your dentist to fix any problems. For sores related to stress and food allergies, the obvious course of action should be to avoid or reduce your exposure. Try various relaxation exercises and be sure to eat properly.

Even though the cause is often never identified, the sores will heal by themselves. Over-the-counter products and various remedies can be used to diminish the pain.

Activity and Diet Restrictions

There are no activity restrictions when dealing with canker sores, although sometimes the canker sores can be so painful that eating or speaking can be extremely uncomfortable.

Treating canker sores doesn't require a specific diet. However, many people find that food is the underlying cause of the sores. If you find yourself dealing with more sores after eating certain foods, make an effort to avoid those foods. Look even for a correlation between eating gluten (wheat products) and canker sores.

If you are prone to getting canker sores, coffee, chocolate, spices, citrus fruit, strawberries, walnuts, and tomatoes should be avoided or consumed in small amounts, since they've been linked to the eruption of canker sores.

There have also been numerous findings that show canker sores to be related to various nutrient deficiencies, including the following:

It may be beneficial to consult a professional who can test which nutrients you may be lacking, and help you correct your imbalances.

The Quality of Your Life

Severe, recurrent canker sores can be a sign of more serious infections, and should be looked at by a physician to insure proper treatment. Usually, with good dental hygiene, proper diet, and a relaxed lifestyle, one can avoid these painful sores.

Considerations for Women

Many women have outbreaks of canker sores just before menstruation. For women with recurrent episodes related to menses, oral contraceptives seem to help reduce frequency and severity.

Considerations for Children and Adolescents

Keep the child's eating and drinking utensils separate to avoid secondary infection. Also, letting the child use a straw for drinking will minimize the pain in his or her mouth. Milk, liquid gelatin, yogurt, ice cream, and custards are foods that seem to be swallowed most easily and cause the least amount of pain.

Do not give aspirin to children or teenagers as a means of relieving pain. The rare, but often fatal, Reye's syndrome has been associated with giving youngsters aspirin.

Considerations for Older People

As the body ages, the immune system gets weaker, and disease and infection are more common.

Current Therapies Available

Most therapies for treating canker sores focus on relieving the pain of the sore. In some cases, a medicated mouthwash containing tetracycline may be prescribed to assist in healing and treating a secondary infection. A soft toothbrush and baking soda can be used to clean the teeth instead of regular toothpaste, which may be irritating to inflamed tissues.

Topical anesthetics, in paste and liquid form, can help reduce the pain of a sore and make eating less painful. Protective dental pastes that contain a steroid derivative have also been known to prevent pain when applied to an arising sore. Aspirin, acetaminophen, or ibuprofen may also be used to help control pain.

Using salt water is one of the most helpful ways to treat canker sores and speed up the healing process. Rinse your mouth several times a day with a mild saltwater solution containing one-half teaspoon of salt mixed with one cup of warm water. It is also helpful to clean the sores frequently with a cotton swab dipped in glycerol peroxide (Glyoxide) or a solution of one part 3% hydrogen peroxide to four parts water. These therapies help keep the sores clean of excess debris and bacteria.

Goals of Treatment

Medications and remedies may be used to relieve the pain associated with the sores themselves.

This condition usually corrects itself over a period of one to two weeks, but tends to recur. Relieving the pain and maintaining good oral hygiene, canker sores are an effective treatment for canker sores. Antibiotics are only used to treat secondary infections, which occur rarely. Further treatment, such as antiviral medication, may be necessary to address an underlying disorder.

Treatment Overview

The key to dealing with recurring canker sores is identifying the cause, although it is often impossible. If this can be done, the treatment can be much more effective. In the cases of ill-fitting dental appliances, like braces or dentures, consult your dentist to fix any problems. For sores related to stress and food allergies, the obvious course of action should be to avoid or reduce your exposure. Try various relaxation exercises and be sure to eat properly.

Even though the cause is often never identified, the sores will heal by themselves. Over-the-counter products and various remedies can be used to diminish the pain.

Activity and Diet Restrictions

There are no activity restrictions when dealing with canker sores, although sometimes the canker sores can be so painful that eating or speaking can be extremely uncomfortable.

Treating canker sores doesn't require a specific diet. However, many people find that food is the underlying cause of the sores. If you find yourself dealing with more sores after eating certain foods, make an effort to avoid those foods. Look even for a correlation between eating gluten (wheat products) and canker sores.

If you are prone to getting canker sores, coffee, chocolate, spices, citrus fruit, strawberries, walnuts, and tomatoes should be avoided or consumed in small amounts, since they've been linked to the eruption of canker sores.

There have also been numerous findings that show canker sores to be related to various nutrient deficiencies, including the following:

It may be beneficial to consult a professional who can test which nutrients you may be lacking, and help you correct your imbalances.

The Quality of Your Life

Severe, recurrent canker sores can be a sign of more serious infections, and should be looked at by a physician to insure proper treatment. Usually, with good dental hygiene, proper diet, and a relaxed lifestyle, one can avoid these painful sores.

Considerations for Women

Many women have outbreaks of canker sores just before menstruation. For women with recurrent episodes related to menses, oral contraceptives seem to help reduce frequency and severity.

Considerations for Children and Adolescents

Keep the child's eating and drinking utensils separate to avoid secondary infection. Also, letting the child use a straw for drinking will minimize the pain in his or her mouth. Milk, liquid gelatin, yogurt, ice cream, and custards are foods that seem to be swallowed most easily and cause the least amount of pain.

Do not give aspirin to children or teenagers as a means of relieving pain. The rare, but often fatal, Reye's syndrome has been associated with giving youngsters aspirin.

Considerations for Older People

As the body ages, the immune system gets weaker, and disease and infection are more common.

Current Therapies Available

Most therapies for treating canker sores focus on relieving the pain of the sore. In some cases, a medicated mouthwash containing tetracycline may be prescribed to assist in healing and treating a secondary infection. A soft toothbrush and baking soda can be used to clean the teeth instead of regular toothpaste, which may be irritating to inflamed tissues.

Topical anesthetics, in paste and liquid form, can help reduce the pain of a sore and make eating less painful. Protective dental pastes that contain a steroid derivative have also been known to prevent pain when applied to an arising sore. Aspirin, acetaminophen, or ibuprofen may also be used to help control pain.

Using salt water is one of the most helpful ways to treat canker sores and speed up the healing process. Rinse your mouth several times a day with a mild saltwater solution containing one-half teaspoon of salt mixed with one cup of warm water. It is also helpful to clean the sores frequently with a cotton swab dipped in glycerol peroxide (Glyoxide) or a solution of one part 3% hydrogen peroxide to four parts water. These therapies help keep the sores clean of excess debris and bacteria.


Preventing the Recurrence of Canker Sores

Canker sores are difficult to prevent due to the variety of factors that cause them. You can decrease your likelihood of contracting recurring canker sores by avoiding situations, including particular foods or stress, that have caused outbreaks in the past.

Self-Care Measures

  • Keep sores clean to prevent bacterial infection.
  • Chew your food slowly and carefully. For many people, the worst part of having a canker sore is biting it while chewing.
  • Don't chew gum. You might bite the sore.
  • Avoid foods that irritate the sore, which typically include spicy and acidic items. Citrus fruits and tomatoes are especially irritating.
  • Swish warm salt water around in your mouth, then spit it out. Do this several times a day.

Call your healthcare provider if:

  • Pain becomes severe
  • You cannot consume enough liquid to stay well hydrated
  • Sores last longer than two weeks


Websites & Organizations

Dental Zone
3900 Walnut Street Box H71
Philadelphia, PA 19104
Phone: 215-417-3215
Fax: 215-893-4376
Email: dentalzone@aol.com

Guide to Medicinal Herbs Online
Canker Sores Web Page

Health Resource Directory

Health Touch Online

McKinley Health Center
Canker Sore Web Page

National Institute of Dental Research

The Office of Disease Prevention and Health Promotion
National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
Phone: 800-336-4979

Sources for This Article

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Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.

Duke, J. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.

Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.

Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.

Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.

Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.

Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.

Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.

Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.

Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.



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Saxen, MA, Ambrosius, WT, Rehemtula, al-KF, Russell, AL, Eckert, GJ. "Sustained Relief of Oral Aphthous Ulcer Pain from Topical Diclofenac in Hyaluronan: A Randomized, Double-blind Clinical Trial." Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 84(4):356-61. 1997. Oct

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