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

• Aphthous Ulcer - Major Canker Sore

What is Major 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 signs and symptoms:
  • Minor Canker Sores
  • Major Canker Sores
  • Herpetiform Canker Sores
• A Major Canker Sore is typically an irregular-shaped ulcer (about 0.5 inches in size) that occurs in the mouth. It can be seen mostly in children and young adults
• The risk factors for the condition may include a family history of Canker Sores and allergic reactions to substances such as spicy foods or dental work. Individuals with poor immune system have a greater risk for Major Canker Sores
• Major Canker Sores are generally identified or diagnosed on a visual examination. In case it is required, a biopsy may be performed to confirm the diagnosis
• Major Canker Sores may go away or recede spontaneously in some cases. The healing period is normally about 6 weeks. Pain management using gels and pastes may be necessary, which can also help speed up recovery. In some rare cases, steroidal therapy may be administered. The prognosis with adequate treatment is generally good
• Major Canker Sores may be prevented by avoiding mouth injury or by avoiding spicy foods. However, the condition can be recurrent

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 Major Canker Sore? (Age and Sex Distribution)

• Individuals of any age can develop a Major 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 (about 20%) may experience some type of Canker Sores in their lifetime

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

The risk factors for Major Canker Sores may include the following:

• Having a family history of Canker Sores may predispose one to the condition
• A hereditary factor may play a role in increasing the risk for development of the same. In such individuals, certain environmental factors, such as foods or substances, may trigger the development of these mouth ulcers
• It is more common in immune suppressed individuals or those with decreased immune system
• 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 the 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 Major Canker Sore? (Etiology)

The exact cause of a Major Canker Sore formation is still unknown in a majority of the cases. They are thought to form due to an overreaction of the body immune system to a triggering factor. A combination of factors may increase the chances of Canker Sore formation and these include:

• Common triggers: Injury to the mouth due to dental work (such as braces), aggressive brushing, sports injury, cheek/lip/tongue bite, etc.
• Use of 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 a common 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
• Hormonal shifts during menstruation, pregnancy, or menopause
• Severe emotional stress

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

• Celiac disease, an intestinal disorder, in which 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 infection and AIDS

What are the Signs and Symptoms of Major Canker Sore?

The first indication is a tingling or burning sensation where the Major Canker Sore will eventually appear, about a day or two before it is actually visible. The signs and symptoms of Major Canker Sores may include:

• They can be large in size and deep. The ulcers are typically white or yellow in color
• Major Canker Sores are usually less than 1.5 cm (about 0.5 inches) in size
• 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
• These sores can be very painful
• A complete healing of the ulcer may take up to 6 weeks
• The ulcers may leave extensive scarring in the mouth
• Major Canker Sores are less common than their minor counterparts

How is Major Canker Sore Diagnosed?

Most often no tests are needed to diagnose Major 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 rule-out any possible infection/condition
• Biopsy studies of the Major 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 Major Canker Sore?

Complications are usually not observed with Major Canker Sores. However, in some cases, the following complications may be noted:

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

How is Major Canker Sore Treated?

In some cases, Major Canker Sores may heal spontaneously, and no treatment may be necessary. However, the following signs and symptoms may necessitate treatment:

• The Major 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
• Uncontrollable pain that affects eating and drinking
• High fever is associated with the Canker Sores

Major 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 Major 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 only as a last resort
• Even though uncommon, systemic steroidal therapies can be used to treat Major Canker Sores
• Cautery of Major Canker Sores may be performed, where they are burned, seared, or destroyed with an instrument or using chemicals like silver nitrate
• Formulated mouthwashes can be prescribed, containing mild steroids, an antibacterial antibiotic, an antibiotic directed against yeast, and a mild anesthetic. This is often termed “Magic Mouthwash”, or it carries the name of the prescribing provider
• Nutritional supplements may be recommended by a healthcare provider, in some cases
• If the condition is associated with any underlying disease/disorder, then treatment of the underlying condition should be considered

The following home remedies can help decrease pain and with the healing process. However, these are usually beneficial for 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 Major Canker Sores 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 Major Canker Sore be Prevented?

Major 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 Major Canker Sores:

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

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

• In general, the prognosis of Major Canker Sore is usually good. The sores usually go away in about 6 weeks with treatment
• The prognosis of major sores are worse than that of minor sores, because there can be scarring on healing of the sores

Additional and Relevant Useful Information for Major Canker Sore:

In general, even though Minor Canker Sores are more common than other forms of Canker Sore; all three types of Canker Sores have generally the same set of risk factors.