Definition
Canker sores are small ulcers inside the mouth that are white or grayish
with red borders. They are not contagious. Canker sores should not be
confused with cold sores, which occur outside the mouth around the lips,
are caused by a virus, and are very contagious.
Description
Canker sores are small patches of raw skin on the tissues that line the
cheeks and the inside of the lips. They may also occur at the base of the
gums or below the tongue on the floor of the mouth. They may appear
as single ulcers or in clusters. Most are about three-eighths of an inch
(1 centimeter) wide, but some are larger.
Doctors classify canker sores into three groups: minor sores, which are
smaller than half an inch (1.3 centimeters) and heal by themselves in seven
to ten days; major sores, which are larger than half an inch (1.3 centimeters),
are usually deeper than minor sores, may take as long as a month
to heal, and may leave scars; and herpetiform sores, which are small, form
clusters that look like the fever blisters caused by herpes viruses, and
heal in about a week. About 80
sores, 10 percent are major sores, and 5
–85 percent of canker sores are minor–10 percent are herpetiform. Demographics
Canker sores are most common in children over ten years of age and
young adults. They are estimated to occur in 30
population. They appear to be equally common in all races and
ethnic groups but are slightly more common in women of childbearing
age than in men. Herpetiform sores are more common in older people
than in younger patients.
Canker sores appear to run in families even though they are not contagious;
about 50 percent of people who have frequent occurrences of
canker sores have relatives with the same problem. People with certain
digestive disorders, including Crohn disease, irritable bowel syndrome,
and celiac disease, are also at increased risk of recurrent canker sores.<!-- adsense -->
Causes and Symptoms
The exact cause of canker sores is not known; however, some doctors
think that the sores develop when the person
the tissues of the mouth. There are a number of possible factors that may
trigger such a reaction:
’s immune system targets 
•
is irritated by poorly fitted dentures, loose wires from orthodontic
braces, a rough tooth, or accidentally biting the inside of the
mouth. Brushing too hard or using a very stiff toothbrush have
also been associated with damage to the lining of the mouth and
canker sores.
Trauma. Canker sores sometimes develop when a person’s mouth •
vitamin B12, iron, zinc, or folic acid in their diet are more likely
to develop canker sores.
Nutritional deficiencies. People who are not getting enough •
stomach ulcers.
Infection by Helicobacter pylori, the same bacterium that causes •
people with higher-than-average anxiety levels are more likely to
develop canker sores.
Stress. Researchers have noted that high-achieving people and •
are often associated with an outbreak of canker sores.•
immune system.
AIDS and other disorders that affect the •
oils, benzoic acid, cinnamon, gluten, cow
milk, coffee, chocolate, potatoes, cheese,
figs, nuts, citrus fruits, and certain spices
have all been associated with canker sores
in some people.
Food allergies. Flavoring agents, essential’s •
toothpastes and mouthwashes, particularly
sodium lauryl sulfate (SLS), a chemical
added to toothpaste to thicken it
and create a lather during brushing.
Canker sores are preceded by one or two
days of tingling or a mild pain in the area where
the sore is developing. The reddened area then
turns into a whitish patch of broken skin surrounded
by a reddish rim. The area in the
middle of the sore that looks white or grey is
actually partially destroyed. This is the reason
why anything containing acids (fruit juices,
sodas, coffee), is hot, or is heavily spiced can
cause considerable pain if it touches the sore.
Some people find it difficult to brush their teeth,
talk, or eat until the sore heals.
Sensitivity to certain chemicals found in Diagnosis
The doctor or dentist will usually diagnose canker sores on the basis of
their appearance inside the mouth. If the sores do not heal or become
more severe, a sample of tissue may be taken to check for other possible
mouth disorders. Patients with AIDS, for example, may have an infection
in the mouth along with the canker sores. In a very few cases, a sore
that does not heal is a symptom of cancer.
Treatment
Minor canker sores will heal eventually without treatment, although
dentists frequently prescribe a mouthwash that contains a steroid medication
or a rinse that contains an antibiotic. The antibiotic rinse is notusually given to children because it can cause their teeth to discolor.
Other treatments include pastes like Orabase, Aphthasol, or Lidex.
These can be applied directly to the sore to speed healing and protect
the sore from further irritation by food, tooth brushing, or orthodontic
braces. The dentist may also prescribe mouthwashes or gels that contain
a local anesthetic. The gels can be applied directly to the sore with a
cotton swab.
Patients can also care for canker sores at home by making a solution
of 1 teaspoon of salt in a pint of warm water and using it to rinse out the
mouth as often as desired. Other home remedies that work for some
people include making a paste of baking soda and water to be applied
to the sores; allowing small chips of ice to melt slowly over the sores;
or applying a small amount of milk of magnesia to the sores several times
a day.
Patients with severe canker sores may be treated with steroid medications
injected directly into the tissues under the sores. Some dentists have
used lasers to treat severe canker sores in patients who do not respond to
other forms of treatment. Laser therapy gives good results in treating
canker sores but is considered experimental because it requires specialized
training to use effectively.
Other treatments that are beneficial for some patients include
vitamin and mineral supplements, zinc lozenges, stress management
techniques, and avoiding foods that are likely to irritate the mouth. For
many people, these
spices, salty foods, tomatoes, and citrus fruits.
“problem foods” include nuts, chips, pretzels, certain Prognosis
Most canker sores heal on their own in one to two weeks, although
major sores may take as long as a month to heal completely. Patients
with sores that do not respond to any treatment, take longer than a
month to heal, or do not heal at all should see their doctor or dentist
as soon as possible.
Prevention
There is no way to completely prevent canker sores in people who are
susceptible to them because of family history or an underlying disease
condition like AIDS. However, maintaining good oral hygiene, eating a
nutritious diet, using softer toothbrushes, and checking with the dentistto be sure that braces or dentures are fitted properly can all help to lower
the risk of canker sores.
The Future
Canker sores are a common health problem that is likely to affect about a
third of the general population for the foreseeable future. Further
advances in laser therapy may offer a new treatment option for people
with recurrent or severe canker sores.
SEE ALSO
bowel syndrome
AIDS; Allergies; Celiac disease; Cold sore; Crohn disease; Irritable For more information
BOOKS
Smith, Rebecca W.
Guide to Family Dental Care
Columbia University School of Dental and Oral Surgery’s. New York: W.W. Norton, Inc., 1997. PERIODICALS
Brody, Jane E.
1987. Available online at http://query.nytimes.com/gst/fullpage.html?res=
9B0DE5DA1138F933A25755C0A961948260&sec=&spon=&pagewanted=
all (accessed May 13, 2008).
“Personal Health: Canker Sores.” New York Times, June 10, WEB SITES
American Academy of Family Physicians (AAFP) Patient Information.
Sores
at http://www.aafp.org/afp/20000701/160ph.html (posted July 1, 2000;
accessed May 13, 2008).
American Dental Association (ADA).
http://www.ada.org/public/topics/mouth_sores.asp#faq (accessed May 13,
2008).
Mayo Clinic.
health/canker-sore/DS00354 (updated January 31, 2008; accessed May 13,
2008).WORDS TO KNOW
Aphthous ulcer:
The medical term for canker sore. Herpetiform:
Resembling blisters caused by herpes. Stomatitis:
of the mouth.The medical term for an inflammationCanker—What Are They and What Can You Do about Them?. Available onlineCommon Mouth Sores. Available online atCanker Sore. Available online at http://www.mayoclinic.com/In women, hormonal changes during menstruation and pregnancy–60 percent of the general Canker Sores