Herpetiform Canker Sore

Herpetiform Canker Sore

Dental Health
Nutrition & Dietetics
Contributed byKrish Tangella MD, MBAAug 08, 2019

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

  • Aphthous Ulcer - Herpetiform Canker Sore

What is Herpetiform 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. It is mainly caused by an injury to the mouth. Canker sores are not contagious and cannot be transmitted from one individual to another
  • There are 3 types of Canker Sores each with their own set of associated symptoms:
    • Minor Canker Sores
    • Major Canker Sores
    • Herpetiform Canker Sores
  • A Herpetiform Canker Sore is typically an irregular-shaped small mouth ulcer that generally appears in clusters up to 100 in numbers. This type of Canker Sore is called herpetiform, since it is present in small clusters similar to a herpes cold sore; however, Herpetiform Canker Sore is not caused by the herpes virus
  • The risk factors may include a family history of the condition and allergic reactions to substances such as spicy foods, dental work, or even contact sports causing mouth injuries
  • Herpetiform Canker Sores are generally diagnosed on a visual examination. In case it is required, a biopsy may be undertaken to confirm the diagnosis
  • In most cases, Herpetiform Canker Sores heal in 1-2 weeks with suitable treatment. Certain oral gels and pastes can be used to speed up recovery. The prognosis with adequate treatment is generally good
  • Herpetiform Canker Sores can be prevented by avoiding mouth injury or by avoiding spicy foods. However, the condition can be recurrent

Note: Herpetiform 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 Herpetiform Canker Sore? (Age and Sex Distribution)

  • Individuals of any age can develop a Herpetiform Canker Sore. Canker Sores are more commonly seen in the 10-40 years age group
  • However, unlike the Major or Minor Canker Sores, Herpetiform Canker Sore affect more young and middle-aged adults than children
  • 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 Herpetiform Canker Sore? (Predisposing Factors)

The risk factors for Herpetiform 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 such mouth ulcers
  • 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

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 Herpetiform Canker Sore? (Etiology)

The exact cause of a Herpetiform 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 chances of Canker Sore formation and these include:

  • The common triggers include: Injury to the mouth due to dental work (such as braces), aggressive brushing, sports injury, cheek/lip/tongue bite, etc.
  • 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
  • Severe emotional stress

Herpetiform 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 Herpetiform Canker Sore?

The first indication is a tingling or burning sensation where the Herpetiform Canker Sore will eventually appear, about a day or two before it is actually visible. 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
  • These ulcers are very small in size (1-3 mm) and often multiple in numbers
  • It is seen in clusters of up to 100; the clusters usually merge into one large Canker Sore
  • The ulcers are white or yellow in color; the mouth ulcers are generally painful
  • The ulcers appear first, which is followed by blister formation
  • 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

Herpetiform Canker Sores are less common than Minor or Major Canker Sores.

How is Herpetiform Canker Sore Diagnosed?

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

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

Complications are usually not observed with Herpetiform Canker Sores. However, in some cases, the complications may include:

  • Recurrence: Some individuals can have multiple recurrences within a year
  • Oral antibiotic rinses (used in treatment) can cause oral infection known as candidiasis (thrush); though it is easily treated

How is Herpetiform Canker Sore Treated?

The following signs and symptoms of Herpetiform Canker Sores may necessitate treatment:

  • 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

Herpetiform Canker Sore treatment mainly includes pain management via any of the following methods:

  • Mouth rinses or oral gels can be applied to the 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 mouth ulcers
  • 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 sores
  • Oral medications are used for severe cases of Herpetiform Canker Sores. They are usually used for intestinal ulcer treatments, but can be used to manage Canker Sores too
  • Cautery of Herpetiform 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
  • If the condition is associated with any other underlying disease/disorder, then the treatment of the 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 Herpetiform 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 Herpetiform Canker Sore be Prevented?

Herpetiform 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 Herpetiform 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 mouth sores
  • Treat any associated underlying conditions
  • Avoid spicy foods
  • Use suitable protective gear (helmets, mouth guards) while participating in contact sports
  • Stop smoking

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

  • In general, the prognosis of Herpetiform Canker Sore is usually good. The sores usually go away within 1 or 2 weeks with treatment, and the prognosis is generally excellent
  • In many, Herpetiform Canker Sores can last longer than Minor Canker Sores and Major Canker Sores

Additional and Relevant Useful Information for Herpetiform Canker Sore:

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.

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team


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