CANKER
SORES
Aphthous
Ulcers, Recurrent Aphthous Stomatitis,
Ulcerative Stomatitis
(Oct 1999)
Canker sores are painful, round or oval, red ulcers in the mouth that typically have a yellowish or grayish center. Also referred to as aphthous stomatitis, canker sores are a common problem that affects at least 20% of the population at one time or another.
Canker sores are classified into three categories. The first type (Minor) is most common and may begin in childhood. Minor canker sores develop on mucous membrane surfaces in the mouth with the sidewalls of the mouth, the inner surfaces of the lips, and under the tongue being most commonly affected. One to six sores smaller then a pencil eraser typically develop and last up to ten days. The second type (Major) may also begin in childhood. Major canker sores are larger and may affect any location in the mouth or even other places including the stomach, intestines, or rectum. These can also number from one to six but may last up to a month or longer and sometimes heal with scarring. The third type, herpetiform ulceration is rare but most severe and affects mostly women. These canker sores begins as ten to 100 tiny ulcers that grow together to look like a large sore. Herpetiform ulceration generally begins in young adulthood and most often develops on the undersurface of the tongue. This variant of canker sore can last up to a month or more.
Although some researchers have suggested that viruses may play a role in causing canker sores, there is no known scientifically proven cause. Certain disease processes include canker sores as part of their symptoms but this observation has not helped explain how and why canker sores develop. Approximately one out of three people with canker sores will have a family history of the condition. Some people tend to develop recurrent canker sores, and in these people there may be certain circumstances that trigger the eruptions. The most commonly reported triggers include trauma to the mucous membrane surfaces of the mouth as well as iron or vitamin B12 deficiencies. In some women, canker sores may be related to changes in the menstrual cycle and are occasionally triggered by the use of contraceptive pills. Once a trigger has been clearly identified, reasonable steps should be taken to minimize exposure to that trigger when possible.
Canker sores are not generally associated with underlying health problems and rarely if ever pose a significant health problem themselves. The main concern of people with canker sores is that the sores tend to be extremely painful. Although canker sores resolve without treatment, many people desire treatment both to provide pain control and to make the sores heal faster.
Several over the counter and prescription remedies are available to treat canker sores. Products are also available that minimize the chance of developing recurrent sores. Mucous membrane injury or trauma is a primary trigger of cold sores. This trauma often occurs during brushing of teeth. Rembrandt Toothpaste is a new product that has been proven to decrease the risk of forming cold sores as a result of dental care. Zilactin oral gel is a safe and effective over the counter remedy that contains a topical anesthetic, which is applied, topically to temporarily relieve the pain associated with cold sores. Used several times daily, this product can help make canker sores bearable.
For people who have repeated bouts of canker sores despite careful dental hygiene that are not adequately relieved by Zilactin or similar products, prescription remedies are available. For many people, pain can be decreased and healing enhanced by the topical application of a prescription oral gel containing a medium to high strength cortisone anti-inflammatory. Recently, another topical prescription product called Aphthasol has been introduced. This product has been proven to speed healing of canker sores but the way in which it works is unknown. Both cortisone-based products and Aphthasol tend to work best when applied to the sores four times daily, after meals and before bed. Another time tested prescription remedy consists of applying wet compresses consisting of a soft cloth soaked in a measured solution of tetracycline and water to the entire mouth surface for ten to fifteen minutes three times daily.
Canker sores are often a painful nuisance but only very rarely represent a serious medical problem. Fortunately, both over the counter and prescription remedies exist. While most canker sores can be treated with simple and safe over the counter measures, (canker sore products) a physician should be consulted if there is any question about the correct diagnosis or if the canker sores become a significant ongoing or recurrent problem.
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