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Canker Sores Apthous Ulcers

Canker Sores Apthous Ulcers

A Guide to Canker Sores or Apthous Ulcers

Canker sores are a commonly occurring type of mouth ulcer that is usually seen on the tongue, the inner part of the lips and cheeks, and soft palate. These are different from cold sores that can be found on the outer lip. Canker sores, in contrast, can occur only inside the mouth, although they are not contagious. They generally disappear on their own in a couple of weeks, and if you have long lasting or painful sores, it is recommended that you see your dentist.

These sores are also known as aphthous stomatitis or aphthous ulcers. They occur more often in women then men, and are more prevalent in teenagers. Canker sores have been linked to genetics.

Symptoms of Canker Sores

The earliest symptom is a burning sensation in your mouth, or a slight tingling. This usually occurs before the other symptoms begin. Small round or oval swellings appear that are red in color and painful. The center of the swelling is usually yellow or white, and it may occur either as a single spot or bump, or as a cluster. Depending on the type of canker sore, you can either have minor but not serious sores, or large, irregularly shaped lesions that can last for years, and leave scars, or clusters of tiny sores that eventually come together to form a single ulcer. Other symptoms include fever, uneasiness and swollen lymph nodes.

Types of Canker Sores

There are three categories of canker sores based on their size.

Minor Sores
Here, the sores are between 1mm to 10mm in diameter, lasting from a week to about 10 days. Close to 80% of all canker sores cases belong to this group.

Major Sores
Here the diameter of the sore is more than 10mm, and healing time can be anywhere from 10 to 30 days. In some cases these sores can last even for months and years, and they usually leave behind large scars.

Herpetiform Ulcers
These are formed by a group of several tiny sores that are each less than 3mm in size. These form 10% of all canker sores cases, and they normally heal within a week to 10 days maximum.

Causes of Canker sores

The exact causes are unclear, but doctors agree that canker sores are caused due to a combination of several causal factors. These include:

Nutritional Deficiencies
Lack of important nutrients like folic acids, iron and vitamin B 12 has been found linked to canker sores.

Immune Deficiencies
Problems with your immune system can cause your healthy mouth cells to be attacked instead of bacteria and virus, thus causing canker sores.

Oral Injury
Small injuries to your mouth may be caused due to forceful brushing, dental treatment, sports injuries and accidental biting of the cheek.

Certain people may have allergic reactions to bacteria in the mouth, causing sores.

The presence of bacteria like helicobacter pylori can cause canker sores.

Crohn's disease, ulcerative colitis, and other inflammatory conditions of the bowel, Celiac disease, an intestinal conditions caused by allergic reaction to gluten, and Behcet's disease, a condition that inflames the entire body, and the mouth, HIV/AIDS which effects your body's immune system can all cause canker sores.

Certain highly acidic foods like pineapples have been found to increase the probability of canker sores. A diet that's rich in eggs, nuts, coffee, cheese, chocolate and strawberries can put a person at risk for sores.

Toothpaste that contains sodium lauryl sulfate can also cause canker sores.

Beta blockers like atenolol and anti inflammatory medications like ibuprofen, have been found linked to canker sores.

Emotional causes
Stress anxiety or depression can also this condition.

People who smoke or chew tobacco are more likely to suffer from these sores.

Hormonal Causes
Hormonal changes that occur during menstruation or pregnancy can cause sores.

Risk Factors for Canker Sores

Certain people are more prone to canker sores.

  • Women are more prone to these sores than men.
  • People between the ages of 10 to 40 are likely to have their first experience with canker sores, and the likelihood of sores decreases with age.
  • Heredity and genes also play a role with at least half the population who suffer from canker sores also having a closely related member of the family with the same condition.

How to Diagnose Canker Sores No special tests are needed, and your dentist can easily identify these sores visually. In case of severe or extremely painful sores, your dentist may refer you to a physician for a health check up.

Treatment of Canker Sores

Minor canker sores normally go away on their own without treatment. In the case of major sores however, intervention is necessary. Some of the commonly used forms of treatment are:

Mouth Rinse Treatments
your dentist may recommend a dexamethasone-containing mouth rinse to decrease the inflammation. He may also recommend the anti biotic tetracycline.

Topical applications
Prescription pastes that contain a corticosteroid called triamcinolone acetonide, amlexanox, and fluocinonide can help reduce the inflammation, and speed up the healing process when applied directly to sores. A solution of debacterol when applied topically to the lesion, can chemically cauterize the sores.

Your dentist may prescribe a numbing anesthetic like lidocaine to reduce the pain. This has to be applied just before you eat, alleviating the pain that you feel while eating.

Vitamin Supplements
If your canker sores are caused due to nutritional deficiencies, a course of folic acid, vitamin B12 or iron supplements may help. These supplements may have to be taken for several months to be effective.

Oral Medications
Sometimes, medications recommended for other conditions can work for canker sores. An example of this is the drug cimetidine which is used for the treatment of gout. This medication can also be used to treat canker sores. Carafate, a medication that is prescribed for the treatment of peptic ulcers has also been found beneficial for canker sores treatment. Oral steroid medications are prescribed when the person doesn't respond to other forms of treatment. However, the risk of side effects is so high that these medications are used only as a last resort.

Hormonal Treatment
In women who find that canker sores flare up during certain periods of their menstrual cycle, an oral contraceptive prescribed for a 6-monh period can help.

Home Treatment
There are certain things you can use at home to reduce the symptoms of canker sores.
  • Milk of Magnesia when applied in small quantities on the sore can help.
  • Over the counter products including Orajel, can be used. Apply a paste of baking soda on the sores.
  • An oral rinse consisting of salt water, diluted hydrogen peroxide or baking soda may also help.
  • Ice when applied to the sores, can relieve the inflammation.
  • Use a soft bristled tooth brush to avoid injuries to your mouth.

Prevention of Canker Sores

You can decrease the frequency of canker sores by monitoring your diet and following proper oral hygiene practices.

  • Avoid chips, spicy or salty foods, nuts, pineapple, oranges and other acidic fruits that can irritate the sensitive lining of the mouth. Eat plenty of whole grains, fresh fruits and vegetables and yogurt containing good bacteria.
  • Brush regularly and floss at least once a day. Use a soft bristled tooth brush.
  • Protect your mouth from injuries if you wear braces by using orthodontic waxes.
  • Makes minor changes to your habits - for instance avoid talking while eating, because this can damage the lining of the mouth.

In conclusion, canker sores are not usually a serious condition, with outbreaks lasting only for a few days. Minor sores improve on their own while the more severe lesions can last longer. The possibility of canker sores decreases as you get older.
Canker sore in lining of cheek.