Canker Sores: Causes and Treatments
Mouth ulcers (Aphthous stomatitis) are a very common, often painful problem. Also known as canker sores, mouth ulcers are shallow sores found on the inner cheeks, lips or gums; are white, yellow or red in color; and occur in clusters. Around 20 percent of the population may experience recurrent mouth ulcers, with the sore(s) occurring in one area of the mouth and reappearing shortly after initially healing.
Mouth ulcers are not generally caused by infection, and therefore are not contagious. Most heal without treatment in one to two weeks, but can be very painful, causing discomfort when eating, speaking or swallowing. In many cases, a cause can be identified that will prevent the occurrence of canker sores.
Types and Causes
There are three types of Recurrent Aphthous Stomatitis (RAS): minor, major and herpetiform.
- Minor aphthae account for 75–85 percent of all cases. They are small—usually 10 mm or less—and round, found inside the cheeks or lips, on or under the tongue, or on the gums, often in clusters.
- Major aphthae are generally deeper and larger, making up 10–15 percent of cases. They may exceed one centimeter in diameter, and usually occur singly.
- Herpetiform lesions are the least common, may occur in large numbers and are usually one–three millimeters in diameter.
While the exact cause is unknown, several factors appear to trigger RAS. In many cases, these factors may be identified and avoided to prevent or reduce outbreaks, though rarely, RAS is caused by a disease or condition outside the patient’s control.
Factors affecting RAS include:
- Low levels of certain nutrients, particularly iron, B12, zinc, folic acid and vitamin C.
- Hormonal changes (such as menstrual cycle).
- Food sensitivities, especially high acid content or certain preservatives.
- Mouth trauma, such as a sharp tooth or dental appliance.
- Bechets disease, an auto-immune condition.
- Bowel diseases such as Crohn’s or ulcerative colitis
- Skin diseases such as Lichen Planus or Herpes Simplex.
Treatment and Prevention
Treatment is typically reducing discomfort, though there are measures that may prevent outbreaks. Mouth trauma appears to be the most common cause of mouth ulcers. Many kids and adults suddenly start developing canker sores when they begin orthodontic treatments. Braces and other appliances can rub at thin skin, causing irritation, which can eventually lead to mouth ulcers. In some cases, your orthodontist can make adjustments to prevent the appliance from rubbing against your gums. It’s also important to use a soft-bristled toothbrush to avoid causing abrasions.
Certain dietary triggers may also cause mouth ulcers. Foods with a high acid content, such as citrus fruits have been closely linked to the development of mouth ulcers, and studies show there may be a strong correlation to certain food allergies or sensitivities. Nutritional deficiencies may also play a role so if you suffer from frequent outbreaks, a visit to the doctor may help rule out those possibilities. Supplementing the deficient nutrients will help prevent mouth ulcers.
In the event of an outbreak, there are several treatments using common over-the-counter medications or household items, which may offer pain relief:
- Salt water solution. Rinse mouth as needed with a solution of ½ teaspoon salt dissolved in eight ounces (1 cup) of water.
- Maalox/Diphenhydramine solution. Combine 1–2 tablespoons of Maalox (or an equivalent product) with ½ tablespoon of Diphenhydramine (Benadryl) liquid. Swish 1-2 teaspoons for one minute and spit it out. This may be done every four to six hours.
- Over-the-counter numbing medications such as Anbesol or Orabase may be used as directed.
In certain cases, a dentist or doctor may prescribe an antibiotic mouthwash, a topical steroid or an acid solution that can cauterize and dry up the sore. Be sure to contact your provider if sores recur frequently, last longer than two weeks or if pain is intolerable.
Shannon Fields is a freelance writer from Edmond and a Certified Pharmacy Technician at Innovative Pharmacy Solutions.