Canker Sores (Aphthous Ulcers)

Medical Author : John P. Cunha, DO, FACOEP

Medical Editor : Jerry R. Balentine, DO, FACEP

Canker sores facts

  • Canker sores are small, painful ulcers on the inside of the mouth, lips, or throat.
  • Symptoms of canker sores include small, painful, crater-like ulcers.
  • See a doctor if canker sores are accompanied by fever, last more than three weeks, or the affected individual has difficulty swallowing.
  • Multiple factors may cause canker sores, including injury to the mouth, acidic or spicy foods, vitamin deficiencies, hormones, stress, or autoimmune disorders.
  • Canker sores are not the same thing as fever blisters (cold sores).
  • Most canker sores require no treatment and resolve on their own.
  • To help relieve pain and speed healing, treatments and remedies for canker sores include topical medications, mouthwashes, and over-the-counter pain medications.
  • People with frequent canker sores should see their doctor to get tested for possible underlying medical conditions.

    What are canker sores?

    Canker sores (aphthous ulcers or aphthous stomatitis) are small, painful ulcers inside the mouth. They may occur on the tongue and on the inside linings of the cheeks, lips, and throat. They usually appear white, gray, or yellow in color, with a red border.

    Canker sores are the most common type of oral lesion, affecting about 20% of people. Women get canker sores more often than men. Canker sore susceptibility may be inherited, and the condition can run in families.

    Canker sores are not the same as cold sores (fever blisters), which are an infection caused by the herpes virus and are contagious. Canker sores are not contagious and are categorized into three types:

    1. Minor sores measure from 3 to 10 millimeters (mm) and are the most common type of canker sore. Lesions last 10 to 14 days and heal without scarring.
    2. Major sores are larger and deeper than minor sores, have an irregular border and a diameter of greater than 10 mm. Major canker sores may take weeks to months to heal and can leave a scar after healing.
    3. Herpetiform sores are characterized by large groups of multiple sores. These are small ulcers (2-3 mm) but there may be as many as 100 ulcers present at the same time. They tend to heal without scarring. Continue Reading
    Picture of a canker sore (aphthous ulcer)
    Picture of a canker sore (aphthous ulcer)

    What are symptoms and signs of canker sores?

    Canker sores are painful sores inside the mouth. They may occur on the tongue, the lining of the cheeks, the gums, the inside of the lips, or the soft palate on the back of the roof of your mouth. Common symptoms of canker sores include the following:

    • A burning, tingling, or prickling sensation, up to 24 hours before the sore appears
    • Crater-like ulcers that are white, gray, or yellow in color, with a red border
    • Sores are usually painful
    • Difficulty speaking, eating, or swallowing

    Less common symptoms that can also indicate a more serious underlying infection include

    Contact your doctor or dentist if your canker sores are

    • larger than usual,
    • spreading,
    • lasting more than three weeks,
    • causing severe pain even after taking over-the-counter pain medication,
    • causing difficulty drinking enough fluids to stay hydrated,
    • accompanied by fever.

      What are the causes of canker sores?

      The cause of most canker sores is not well understood, and multiple factors may cause sores to appear. Some possible causes of canker sores include the following:

      • Injury to the mouth may cause simple canker sores. Injury could be from vigorous tooth brushing, dental work, braces or dentures, or a sports accident.
      • Acidic foods, including citrus fruits, may trigger a canker sore or make it worse.
      • Food sensitivities or allergies (anything from highly acidic foods to chocolate and coffee)
      • Diets low in vitamins B12, zinc, folate (folic acid), or iron
      • Toothpaste containing sodium lauryl sulfate
      • Allergy to certain bacteria in the mouth
      • Hormones
      • Emotional stress
      • Smoking
      • Gastrointestinal tract diseases such as Celiac disease or Crohn's disease
      • Autoimmune disorders such as systemic lupus erythematosus or Behçet's disease

      Are canker sores the same thing as fever blisters?

      No, canker sores are not the same thing as fever blisters (cold sores).

      Canker sores occur inside the mouth and are not contagious. Fever blisters are infections caused by the herpes simplex virus (HSV), they mostly occur on the lips and outside of the mouth, and they are very contagious. Continue Reading

      Picture of cold sores and canker sores
      Picture of cold sores and canker sores

      What is the treatment for canker sores?

      In most cases, canker sores do not require any treatment. If a person already has a canker sore, there are steps that can be taken to help relieve the pain or irritation caused by the sore and speed healing:

      • Topical medications applied directly on the sore, mouthwashes, and oral medications can relieve pain or inflammation.
      • Avoid acidic foods such as citrus fruits or spicy foods that may aggravate the sore.
      • If there is any vitamin deficiency (a doctor can test for this), take supplementation as prescribed.
      • Brush teeth gently and use a brush with soft bristles.
      • Use toothpaste and mouthwash that does not contain sodium lauryl sulfate.
      • Another home remedy is to mix milk of magnesia with Benadryl liquid and use as a mouth rinse.
      • Other natural remedies include goldenseal mouth rinse, deglycyrrhizinated licorice (DGL) gargled in warm water, and saltwater rinses.

        What kind of topical medications (gels or ointments) are available for canker sores?

        Topical gels or ointments are used for canker sores to relieve pain, decrease inflammation, and prevent infection.

        • Topical pain medications: Gels such as benzocaine (Oragel) and lidocaine (an anesthetic) are used directly on the canker sore to relieve pain or discomfort. These types of medications can be found over the counter.
        • Topical anti-inflammatory medications: Steroid medications can be used topically to decrease inflammation from canker sores. These medications usually require a prescription and should be used exactly as directed.
        • Topical antibiotics: These medications may be prescribed by your doctor or dentist if there is a possibility of the canker sore becoming infected with bacteria. Redness, crusting, pus discharge, or fever are signs of infection.

        Can mouthwash solutions be used to treat canker sores?

        There are several mouthwash solutions that may be used to treat canker sore symptoms.

        • Diphenhydramine suspension (Benadryl Allergy liquid) is available over the counter and can be used as a mouth rinse because it has topical anesthetic effects on the tissue of the mouth and the canker sore. Put the suspension in your mouth, swish it around for 30 seconds to one minute, and spit it out. Do not swallow the rinse.
        • Anti-inflammatory steroid mouth rinses may be prescribed by your doctor or dentist to help reduce inflammation.
        • Tetracycline antibiotic rinses may be prescribed and have been shown to relieve the pain and promote healing of canker sores. Tetracycline should not be used by pregnant women, people allergic to tetracycline, or children under 16 years of age.

          What oral medications are available to help canker sores?

          Several oral medications may help relieve symptoms of canker sores.

          • Over-the-counter pain medications such as ibuprofen (Advil), acetaminophen (Tylenol), or naproxen (Aleve) can be used to help with discomfort from canker sores.
          • Zinc lozenges or vitamins B and C may also help relieve symptoms of canker sores.

          What should I do if I get canker sores frequently?

          If a person suffers from frequent canker sores, there may be an underlying medical reason or illness that causes them. See a doctor or dentist if there are any concerns that canker sores are frequent.

          Predisposition to canker sores may just be genetic. However, some diseases that affect the immune system such as lupus, Crohn's disease, celiac disease, or HIV/AIDS may cause frequent or recurrent canker sores.

          Doctor's can order tests to determine if there is an underlying medical reason for a person's frequent canker sores.

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