Canker Sores

Canker sores are also known as aphthous ulcers or aphthous stomatitis. They are characterized by small, shallow lesions found on the inside of the mouth. Eating or drinking can be difficult and very painful with canker sores, depending upon the size and location of the lesions.

Contrary to the beliefs of many people, canker sores are not an infection of the herpes virus. They are not the same thing as fever blisters or cold sores, which are usually found on the outside of the mouth. Unlike cold sores, canker sores are not contagious, and canker sores are also generally caused by bacteria, whereas cold sores are caused by a virus.
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Additionally, if a cold sore is located on the inside of the mouth it will usually be found on the roof of the mouth, which is not a location that canker sores will be found.

Causes of Canker Sores

The exact cause of canker sores is not known, but doctors believe they are triggered by a number of different factors. Allergies are one possible cause. Some health professionals believe that the sores can be brought on due to an allergic reaction to certain foods, or due to an allergy of a type of bacteria that is typically found inside the mouths of humans.

A variety of other foods have been identified by health professionals as possible triggers of canker sores, including chocolate, shellfish, soy, walnuts, oats, mustard, and dairy products.

Immune system and nutritional deficiencies are also possible explanations for outbreaks. British doctors have concluded that a lack of folic acid, iron, and vitamin B12 are found in about 20 perfect of patients with canker sores.

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Associations have also been found between vitamin C deficiencies and the presence of canker sores. It is also possible that a problem with the patient’s immune system leads the body to attack normal cells in the mouth.


Hormones can also play a role in the development of canker sores. Many women feel that their outbreaks occur during their menstrual period, and others notice that they go into a remission stage while they are pregnant. Currently there is not enough research into this area to be able to make any definitive conclusions as to whether hormones play a major role in canker sore outbreaks.

Injuries to the mouth can also be causes of canker sores. Biting the side of your cheek while chewing food or having sharp, metal braces rub against the inside of the patients mouth may develop a sore. They also may be caused by a person brushing their teeth too hard with a toothbrush.

Trauma may also come from food, such as a jagged edge of a potato chip rubbing against the inside of a person’s mouth. In one study it was determined that about four out of ten participants with canker sores believed that their lesions were caused by some sort of trauma or abrasion that occurred before the sores developed.

Although the presence of canker sores does not necessarily indicate an underlying medical condition, there are some diseases that present them as symptoms. In patients with Crohn disease, canker sores indicate a relapse or flare-up. Behcet’s disease is characterized by canker sores as well as eye inflammation and genital sores. Additionally, they have also been linked to the AIDS virus.


Certain medications have also been suggested to have possible connections with canker sore outbreaks. Beta blockers, anti-inflammatory medications, and chemotherapeutic agents have all shown some sign of being related to canker sores. Individuals with persistent or recurring sores should consult their physician if they are taking one of these medications.

Canker Sore Risk Factors

Anyone can develop a canker sore, as it is suggested that 80% of the population between the ages of 10 and 20 have experienced them. There are, however, some groups that are more susceptible to them than others. Canker sores are more common in women, especially in cases of clustered lesions.

Having a family member that has had canker sores can also make a person more likely to get them. A study has shown that of all the people that have recurrent canker sores, about a third of those individuals have a family history of them. It is not know whether this trend is due to genetics or the fact that individuals of the same family are more than likely exposed to the same foods and environmental factors.

Canker Sore Symptoms

To discuss the symptoms of canker sores, it is first important to differentiate the three types of sores, which are minor, major, and herpetiform canker sores. Minor canker sores are generally oval shaped and less than 1/2 inch in diameter. Generally they heal within a couple of weeks and do not result in any scarring.

Major canker sores are less common and more severe than minor canker sores. They have irregular edges and are larger than 1/2 inch diameter. Extensive scarring is usually observed with this type of sore, and they can take up to six weeks to heal.

Herpetiform canker scores typically develop later in life and occur in clusters of up to 100 sores. They have irregular sides, but they are typically smaller than 1/8 inch diameter. Like the minor sores they will heal within a couple of weeks with relatively no scarring.

Canker Sore Color

Most canker sores are white or yellow in color with a red border. Typically they are round or oval in shape, and they are found on the inside of the patient’s mouth. Generally they can be located on the gums, on or under the tongue, or inside the patient’s cheeks.

Some slight burning may be experienced at the site of the canker sore a couple or days before it appears. In some cases, patients may complain of other symptoms along with the actual sores. These include swollen lymph nodes and fever.

Treatment of Canker Sores

Minor canker sores typically do not need treatment, as they tend to heal on their own within a week or two, but treatment action may be taken in order to relieve some of their symptoms. Major or persistent sores often need medical care, as they tend to be very painful. There are a variety of treatment options available, including mouth rinses, topical pastes, oral medications, Debaceterol, and nutritional supplements.

Mouth Rinses

Mouth rinses are typically prescribed if a patient has multiple unpleasant sores. Rinses containing steroid dexamethasone can help to reduce inflammation and pain in the affected area. Patients are instructed to rinse with the product for a predetermined amount of time and then spit it out completely. Homemade rinses of hydrogen peroxide and water can also provide temporary relief and can prevent the sores from infection.

Rinses containing tetracycline help to reduce the painful symptoms of sores and also have been found to speed up the heal process, as the rinse prevents bacterial infections within the sores. When this type of rinse is used several times a day, it can relieve pain for 24 hours and can result in complete healing within 4-7 days.

The drawback of tetracycline is that it can make a patient more susceptible to the fungal infection oral thrush. This can cause painful lesions within the mouth, and it can permanently stain the teeth of children.

Mouthwashes containing chlorohexidine gluconate, like Peridex, area also especially effective in relieving the pain of canker sore patients. A study determined that when used three times a day, this mouth washed reduced the number of days that they lesions lasted in approximately 20 percent of users.

Topical Pastes

Topical pastes or gels are usually obtained with a prescription over the counter. Orabase is one possible paste that could be prescribed, and it contains benzocain, which can help to ease pain and speed up the healing process if it is applied as soon as the sores appear. Other possible recommendations may be Aphthasol, which contains amlexanox, and Lidex or Vanos, which contain fluocinonide.
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There are other over-the counter products that people battling canker sore pain may find useful, as they contain a numbing agent that can help to relieve the painful symptoms of the lesions. Anbesol and Orajel are both recommended for canker sores, and both of these medicines can easily be obtained from a local pharmacy or grocery store.

Oral Medications

Oral medications may also be prescribed if the canker sores are severe and if they have developed into secondary infections. Zovirax, which is an antiviral drug, may be required if there are multiple and very painful lesions.

Some medications that are typically not intended specifically for canker sores are sometimes helpful in reducing their symptoms, including Tagamet, which is generally a heartburn drug, and colchicine, which is usually used to treat gout.

Corticoid steroids such as dexamethasone and prednisone may also be prescribed for treatment, although their usage is fairly rare. Steroid treatments are usually considered a last resort due to their serious side effects.


Debacterol is another topical solution, and it was created specifically to treat canker sores as well as gum problems. It works by chemically cauterizing the lesions, which reduces the time it takes for the sore to heal.

Nutritional Supplements

If a patient consumes a low amount of important nutrients, a physician may prescribe some supplements that will help the immune system to heal the affected area. Some possible prescriptions would be zinc, folic acid, vitamin B6, or vitamin B12.

Home Remedies

For people afflicted with canker sores that want to take a natural approach to symptom relief, there are many ingredients from their own cupboard that can be used. Baking soda and water can be mixed together to form a paste, and after it is applied to the sore it can provide some pain relief. One teaspoon of honey mixed with 1/4 teaspoon of turmeric can be dabbed on the sore as well.

The patient can also moisten a tea bag and apply it directly to the sore, causing it to be dried about by the tannic acid. Dabbing milk of magnesia onto the sore area has also been suggested as a method to relieve the pain caused by canker sore lesions.

When looking for relief in the freezer, ice is the most logical solution. This won’t make the sore go away, but it will certainly make it feel better and will numb the affected area.

It has been suggested that when taking this approach, the most relief will come from allowing the ice chips to melt over the affected area. From the spice rack, a person can create a combination of water and sage and rinse their mouth with it several times a day. Cayenne pepper also contains capsaicin, which temporarily desensitize nerves that carry pain.

When to See a Doctor

A patient should consult with a medical professional when canker sores become unusually large or if sores are recurring and new ones develop before old ones go away. If sores are persistent and do not go away, or if the pain is so severe it can’t be controlled with home care, a patient should also see their physician. Other red flags are high fever or extreme difficulty in drinking or eating, and these symptoms would definitely warrant a trip to the doctor’s office.

When preparing for a medical appointment regarding canker sores, there is some information the patient will want to gather before entering the doctor’s office. The patient will want to go over all of their symptoms, and they should write them down if necessary in order to not forget to mention something during the appointment.

The patient should bring in a list of their previous medical history as well as a list of all the medications they are taking. Personal information, including if any major changes have recently occurred in the patient’s life, should also be considered. Bringing all of this information into the physician’s office will help to save time and will ensure that the patient is properly diagnosed so the most effective treatment can be started.

The Actual Appointment

During the appointment, the patient’s doctor will also ask them a number of questions regarding their canker sores. In addition to the information discussed previously about what information to bring into the appointment, the doctor may ask about the patient’s daily diet, when they first noticed the lesions, if the patient has had any recent dental work done, and if the patient has ever had, or been treated for, similar sores in the past.

Generally with canker sores, a physician does not need to run any other tests to make a diagnosis. The patient’s doctor should be able to do this solely by looking at the lesions. If the physician feels that the sores are the result of another underlying medical condition, then he or she may perform other tests to determine if something else is the cause.

Canker Sore Prevention

People with a history of canker sores should avoid toothpaste with sodium lauryl sulfate in order to prevent new sores. This ingredient is irritating to mouth tissue, and avoiding it can be helpful for some patients. When the person brushes their teeth and gums with this type of toothpaste, or with any type of paste for that matter, they should be sure to brush gently so they do not irritate the areas where canker sores can develop. Toothpastes without foaming agents, like TheraBreath, may also be considered.

In order to prevent future canker sore flare ups, individuals should also watch what they eat and monitor their diet. Salty or spicy foods that can irritate a person’s mouth should be avoided, such as grapefruit, oranges, pineapple, or any other acidic fruit, as well as salty nuts, potato chips, or pretzels. The individual should also continue to eat healthy foods to maintain appropriate levels of nutrients within their body. Acidophilus, which is found in yogurt, contains beneficial bacteria that may fend off canker sores before they even begin.

Foods high in vitamin C should also be consumed, as long as they are not overly acidic and irritating to the oral cavity, as this vitamin helps to protect a person’s body against viruses.

Stress Causing Canker Sores

Canker sores have also been linked to stress, so eliminating as much stress from your life as possible can help to ward off future canker sore flare ups. Many people that report a canker sore outbreak also report that they are going through a period of emotional or psychological stress.

Studies have shown that patients with increased anxiety traits that are traced back to hereditary deficits also have higher rates of canker sore outbreaks. When a person is experiencing excessive stress, their body’s immune system is compromised, and their ability to fight off foreign bacteria or germs is inhibited.

Because stress is a possible trigger of canker sores, a way to prevent these outbreaks is to make sure that the individual gets plenty of exercise. Exercise promotes health and well being in the individual’s body as well as clears the mind. All of these components are important in fighting of canker sores and other types of illnesses or diseases the individual might face.

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