Medical Today

Definition

Canker sores are small sores or ulcers that appear inside the mouth. They are painful and often recur from once every few years to almost continually. Canker sores are known medically as apthous ulcers or apthous stomatitis.

Description

Canker sores occur on the inside of the mouth, usually on the inside of the lips, cheeks, and/or soft palate. They can also occur on the tongue and in the throat. Often, several canker sores will appear at the same time and may be grouped in clusters. They are painful and sensitive to touch. The average canker sore is about one quarter inch in size, although they can occasionally be larger. The sores may last for weeks at a time and leave a scar. The initial symptom is a tingling or mildly painful itching sensation in the area where the sore will appear.

After one to several days, a small red swelling appears, which eventually becomes a grayish ulcer with a red ring of inflammation surrounding the sore. Canker sores can be very painful, especially if they are touched repeatedly (e.g., by the tongue). They last for one to three weeks.

Approximately 20% of the United States population is affected with recurring canker sores, and more women than men get them. Women are more likely to have canker sores during their premenstrual time. Canker sores may be confused with cold sores caused by the herpes simplex virus because the appearance of both is similar. However, herpes infections occur most commonly on the outside of the lips, on the hard palate, and on the gums, whereas canker sores usually occur on the soft tissues inside the mouth. Unlike canker sores, herpes cold sores are infectious.

Causes & symptoms

The exact cause of canker sores is unknown. There seems to be at least some link to immune reactions. There may also be a genetic tendency to develop canker sores. Accidental injuries to the mouth from vigorous toothbrush scrapes, poorly fitted dentures, braces, or self-inflicted bites may give rise to canker sores. They can also be triggered by stress, dietary deficiencies, hormonal changes, and food allergies. Sodium lauryl sulfate, which is an ingredient in many types of toothpaste, may contribute to the development of canker sores by stripping the mucous coating inside the mouth.

Diagnosis

Canker sores are diagnosed by observation of the sore. A distinction between canker sores and cold sores should be made because the latter is infectious. Other disorders of the mouth may need to be ruled out as well; a skin lesion biopsy may be required for further diagnosis.

Treatment

Since canker sores heal themselves in most cases, treatment usually isn’t necessary. Topical anesthetics, such as lidocaine and similar remedies, may be used for pain relief. Corticosteroid ointments may be used to reduce inflammation and speed healing. A protective paste, like Orabase, can be used to prevent irritation of the sores by teeth, dental appliances, or fluid intake.

Severe cases may be treated with the antibiotic tetracycline. This is not recommended for children, however, because it may permanently discolor any teeth that are still forming. Chemical or physical cautery or low-powered laser treatments may also be used to decrease severe pain. Ulcers tend not to recur where a laser has been used.

Expected results

Canker sores tend to heal spontaneously. The pain usually decreases within a few days, and other symptoms resolve in one or two weeks. If symptoms last longer, if there are increasing numbers of outbreaks, or if the pain is severe, a doctor should be consulted.

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