Aphthous
ulcers, also called canker sores, are extremely common, affecting
about 20-30 percent of the population. They are essentially small
ulcers or erosions that occur inside of the mouth. It's not a serious
condition, but can cause discomfort and pain. Many people have the
lesions more than once.
The exact cause of canker sores is not clear. Vitamin deficiencies
increase the likelihood of developing these lesions and many people
relate them to stress, trauma or sun exposure. Many believe a localized
immune system reaction may lead to canker sore development. The cause
may also be related to inherited factors, as the condition often runs
in families. Canker sores are not contagious and cannot be "spread"
to other people. Though they may start at any time, most people have
their first canker sore between the ages of 10 and 20. Women are more
likely than men to have recurrent canker sores.
The
most common form of canker sore is a single ulcer or erosion that
is less than ½ inch in diameter. Common locations include the inside
of the lip, the cheek, the gums and the tongue. Canker sores do not
generally occur outside the mouth and if a lesion that looks like
a canker sore is seen on the outside of the lip, it's probably a fever
blister, a similar but slightly different condition.
The common form of canker sore usually causes fairly quick onset of
pain that lasts for 3 or 4 days. Symptoms then get better as the lesion
heals over the next week or so, usually without any scarring. Severe
attacks may make a person feel as though they have the flu and cause
fever and swollen neck glands. Many people have one to three attacks
of canker sores per year. Treatment in the average case does not require
medical attention.
In some people, canker sores can be multiple or quite large, resulting
in more severe symptoms and the possibility of scar formation as the
lesions heal. Large lesions may require months to heal. Some people
may also have much more frequent "outbreaks" of canker sores.
These more severe types of canker sores usually prompt the affected
person to seek medical attention.
The diagnosis of a canker sore can usually be made by its appearance.
In unusual or severe cases, the lesions may resemble other more serious
conditions, such as cancer. The diagnosis usually becomes clear over
time, though blood and other tests may be ordered to make sure a more
serious condition is not present.
In those with severe or unusually frequent outbreaks, blood and other
tests may be done to rule out a curable cause for the ulcers, which
is rare. As mentioned, vitamin deficiencies can worsen canker sores.
In addition, certain allergic and immune system disorders can also
worsen canker sores.
Treatment of mild cases may not be needed, as the lesions generally
heal on their own within 2 weeks. If a person is uncomfortable or
experiencing pain, over-the-counter topical preparations are available
to reduce pain and irritation. Aspirin or another over-the-counter
pain reliever may also help reduce pain.
Affected persons are also advised to avoid abrasive or irritating
foods, such as potato chips, that can stick in the cheek or gum and
aggravate the canker sores. Acidic and spicy foods should also be
avoided. When brushing the teeth, care should be taken to avoid brushing
over the sore with the bristles.
In more severe cases, a healthcare provider may prescribe various
medications to relieve pain, prevent irritation, reduce inflammation
and help speed healing. These medications include topical steroids,
an anti-inflammatory medication and steroid mouthwashes. Pill forms
of steroids are reserved for the worst cases due to the many possible
side effects. Some providers may also prescribe an antibiotic mouthwash,
a protective dental paste such as Orabase® to protect the ulcer
and prevent irritation, a topical anesthetic ("numbing"
medicine) to relieve pain or other newer agents to speed healing,
such as Amlexanox.
Canker sores are common lesions that are not contagious and rarely
pose any type of health risk. For the common type of canker sore,
treatment can be done at home with over-the-counter remedies. Those
with large or unusually frequent lesions or lesions that do not heal
within 2 weeks are advised to seek medical attention to make sure
a more serious underlying condition is not present.
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