Canker Sore

Canker Sore

Article
Dental Health
Nutrition & Dietetics
+2
Contributed byMaulik P. Purohit MD MPHAug 09, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Aphthous Stomatitis
  • Aphthous Ulcer

What is Canker Sore? (Definition/Background Information)

  • A Canker Sore is a benign lesion that develops in one’s mouth, at the base of the gums, under the tongue, on the inside of the cheeks, on the roof of the mouth, or on the inside of the lips
  • Any individual can develop a Canker Sore, but they are seen mostly in children and young adults. The risk factors for the condition may include family history of Canker Sores and allergic reactions to certain substances in the mouth
  • Canker Sores are mainly caused by injury to the mouth. It can also be associated with foods or any substance that comes in contact with the mouth. Canker Sores are not contagious and do not spread from one individual to another
  • There are 3 types of Canker Sores each with their own set of associated symptoms:
    • Minor Canker Sores: It is the more common form of Canker Sore
    • Major Canker Sores: It is generally larger than a minor sore
    • Herpetiform Canker Sores: This type is more uncommon than both the minor or major sore
  • Canker Sores are generally identified or diagnosed on a visual examination. In case it is required, additional tests, such as a biopsy, may be required to confirm the diagnosis
  • Small Canker Sores usually go away or recede spontaneously. The healing period depends on the type of sore. When necessary, certain gels and pastes can be used to speed up recovery
  • Canker Sores can be prevented by avoiding injury to the mouth and by avoiding spicy food. However, an individual can develop a Canker Sore 2 to 3 times a year, or continually one after another
  • The prognosis with adequate treatment is generally good, irrespective of the type of the Canker Sore. Most ulcers heal within 2 weeks, while some may take longer

Note: Canker Sores should not be confused with cold sores. Cold sores are caused by herpes simplex virus (HSV) and can be passed on from one individual to another.

Who gets Canker Sore? (Age and Sex Distribution)

  • Individuals of any age can develop a Canker Sore. Though, it is more commonly seen in the 10-40 years age group; children, teens, and young adults are affected the most
  • Both males and females are affected, but it is more commonly seen in females
  • No specific racial or ethnic group bias is seen
  • It is estimated that 1 in 5 individuals may experience some type of Canker Sore in their lifetime

What are the Risk Factors for Canker Sore? (Predisposing Factors)

The risk factors for Canker Sores may include the following:

  • Having a family history of Canker Sores may predispose the individual to the condition
  • A hereditary link may play a role in increasing the risk of development. In such individuals, certain environmental factors, such as foods or substances, may trigger the development of Canker Sores
  • Poorly-fitting dentures; poor oral hygiene
  • Orthodontic devices: If caused by allergic reaction to nickel containing orthodontic devices, the condition may be classified as a type of oral contact dermatitis
  • Spicy foods
  • Contact sports causing injury to the mouth
  • Hormonal changes including menstruation, pregnancy, and menopause can increase risk

Note: In general, even though Minor Canker Sores are more common than other Canker Sore types; all 3 types of Canker Sores have typically the same set of risk factors.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Canker Sore? (Etiology)

The exact cause of Canker Sore formation is still unknown in a majority of the cases. They are thought to form due to an overreaction by the body immune system. A combination of factors may increase the odds of Canker Sores development.

  • Injury to the mouth due to dental work (such as braces), aggressive brushing, sports injury, cheek/lip/tongue bite, etc. These factors are considered as common triggers for Canker Sores
  • Any toothpaste or mouthwash product that contains sodium lauryl sulfate
  • Certain foods including chocolate, coffee, strawberries, eggs, nuts, cheese, and spicy or acidic foods
  • Helicobacter pylori bacterium can cause Canker Sores. This is the same bacteria that cause ulcers in the stomach
  • A diet lacking in vitamin B-12, zinc, folate (folic acid), or iron
  • Allergies to certain bacteria found in the mouth
  • Certain hormonal shifts during menstruation, pregnancy, or menopause
  • Individuals who are under high emotional stress

Canker Sores may be present in association with other conditions such as:

  • Celiac disease, an intestinal disorder, when an individual is sensitive to products that contain gluten
  • Inflammatory bowel diseases including Crohn’s disease and ulcerative colitis
  • Behcet’s disease, which is an inflammatory condition
  • A faulty immune system where cells in the mouth are attacked causing mouth ulcers
  • Immune system suppressing conditions such as HIV/AIDS

What are the Signs and Symptoms of Canker Sore?

The first indication is a tingling or burning sensation where the Canker Sore will eventually appear, about a day or two before it is actually visible. The signs and symptoms of Canker Sores depend on the type of Canker Sore and are explained below. All Canker Sore types are generally painful.

The signs and symptoms of Minor Canker Sores may include:

  • These are the most common type and are small in size
  • The average size of a Minor Canker Sore is around 0.5 cm
  • The ulcers are white or yellow in color
  • They are usually oval in shape with redness around the edges of the ulcers
  • The signs and symptoms usually last 1 to 2 weeks
  • A complete healing of the ulcer may occur with no scarring taking place

The signs and symptoms of Major Canker Sores may include:

  • It is less common than the minor sores
  • They can be large in size and deep
  • Major Canker Sores are usually less than 1.5 cm (about 0.5 inches) in size
  • The ulcers are white or yellow in color
  • The smaller ulcers are usually round-shaped with well-defined border. As the ulcers become larger in size, they may be irregular in shape with surrounding redness
  • A complete healing of the ulcer may take up to 6 weeks
  • The ulcers may leave extensive scarring in the mouth

The signs and symptoms of Herpetiform Canker Sores may include:

  • It is an uncommon type of Canker Sore, which generally develops later in one’s life (into adulthood)
  • These ulcers are very small in size and often multiple in numbers
  • It is seen in clusters of 10 to 100; the clusters usually merge into one large Canker Sore
  • The ulcers are white or yellow in color
  • The Canker Sore is surrounded by irregular edges
  • A complete healing of the ulcer may occur in 1-2 weeks, with no scarring taking place
  • Even though the name indicates, Herpetiform Canker Sores are not caused by the herpes virus

How is Canker Sore Diagnosed?

Most often no tests are needed to diagnose Canker Sores. A healthcare provider will be able to diagnose the condition via a visual exam. Sometimes, the following tests may be undertaken, if Canker Sores are severe and persistent. 

  • Blood test or culture to eliminate any possible infection/condition
  • Biopsy of the Canker Sore

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Canker Sore?

Complications are usually not observed with Canker Sores. However, they may be observed with respect to some of the treatments administered, and may include:

  • Oral antibiotic rinses can cause an oral infection known as candidiasis (thrush), though it is easily treated
  • Oral steroid therapy for severe outbreaks can cause a variety of effects seen all around the body such as upset stomach, increased blood sugar, candidiasis, increased fat, acne, high blood pressure, and unusual hair growth
  • Canker Sore recurrence: When Canker Sores recur, the condition is called recurrent aphthous stomatitis (RAS); the sore may recur as a minor or major sore. This may be commonly observed with underlying systemic conditions
  • Some individuals can have multiple recurrences within a year

How is Canker Sore Treated?

The treatment of Canker Sores depends on the specific subtype of Canker Sore. A majority of the Minor Canker Sores heals spontaneously with no treatment being necessary. However, the following signs and symptoms may warrant a visit to the healthcare provider:

  • The Canker Sore is larger than usual; over 1.5 cm in size
  • New Canker Sores appear before the old ones heal
  • Frequent outbreaks are noted
  • Canker Sores last longer than the usual period of 2 weeks
  • Uncontrollable pain that affects eating and drinking
  • High fever is associated with the Canker Sores

Irrespective of the type of the Canker Sore, the treatment mainly includes pain management via any of the following methods:

  • Mouth rinses or oral gels can be applied to Canker Sores to decrease pain and inflammation. These can be used about 4 times each day, especially before meals. Mouth rinses or oral gel products can be purchased at pharmacy stores without a prescription
  • Topical products (pastes, creams, gels, or liquids) to decrease pain and increase recovery that can be applied directly to the Canker Sores
  • Oral antibiotic rinses can be used 4 times daily for 10 days, to provide a coating on the mouth ulcers and prevent the development of new Canker Sores
  • Oral medications are used for severe Canker Sores. They are usually used for intestinal ulcer treatments, but can be used to manage Canker Sores too. Also, oral steroid medications can be used, but generally as a last resort only
  • Cautery of Canker Sores can be done where they are burned, seared, or destroyed with an instrument or using chemicals
  • Nutritional supplements may be recommended by a healthcare provider, in some cases of nutritional deficiency
  • If the Canker Sores is associated with any underlying condition, then the treatment of underlying condition should be considered

The following home remedies can be helpful in decreasing pain and helping in the healing process. The home remedies are usually helpful only with small ulcers. One should always consult a healthcare professional if home remedies are not helping and if the signs and symptoms are severe.

The home remedies for Canker Sores may include:

  • Rinsing the mouth with saltwater or baking soda (1 teaspoon of baking soda and ½ cup of warm water)
  • Applying a small amount of milk of magnesia to the sores, a few times a day
  • Applying ice to the mouth sores

How can Canker Sore be Prevented?

Canker Sores can be mostly prevented by managing sharp tooth surfaces or dental appliances that trigger the condition. The following considerations may be useful in preventing Canker Sores:

  • Be careful when eating nuts, chips, pretzels, certain spices, salty/acidic foods as they may irritate the mouth
  • Avoid nutritional deficiencies
  • Undertake proper oral hygiene on a daily basis (brush teeth after meals, floss once a day, use a soft brush, brush gently, etc.)
  • Reduce stress in order to decrease the chances of developing stress-induced Canker Sores
  • Treat any associated underlying conditions
  • Avoid spicy foods
  • Use suitable protective gear (helmets, mouth guards) while participating in contact sports

What is the Prognosis of Canker Sore? (Outcomes/Resolutions)

  • In general, the prognosis of Minor, Major, or Herpetiform Canker Sore is usually good
  • Canker Sores usually go away within 1 or 2 weeks on their own, and the prognosis is generally excellent
  • In some, it can last for up to 6 weeks, when the condition is severe. This timeframe can be shortened, if suitable treatment measures are used
  • If there are multiple large ulcers, the prognosis can be adversely affected due to the formation of extensive scars during the healing process
  • The prognosis of minor sores are better than that of major sores, because scarring on healing of the sores is not seen

Additional and Relevant Useful Information for Canker Sore:

Please visit our Dental Health for more physician-approved health information:

http://www.dovemed.com/healthy-living/dental-health/

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Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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