Overview

A canker sore on the tongue is a small, shallow ulcer that appears on the soft tissues inside the mouth, including the sides, tip, or underside of the tongue. Also known as aphthous ulcers, canker sores are not contagious and typically resolve on their own within 1 to 2 weeks. These sores can be painful, especially while eating, drinking, or speaking. While generally harmless, frequent or unusually large canker sores may indicate an underlying health condition that needs medical attention.

Causes

The exact cause of canker sores is not always clear, but several factors may contribute to their development:

• Minor injury: Accidental biting of the tongue, irritation from braces, or aggressive brushing can trigger sores.
• Stress: Emotional stress is a known factor in many recurrent cases of canker sores.
• Food sensitivities: Spicy, acidic, or rough-textured foods may cause irritation that leads to sores.
• Nutritional deficiencies: Low levels of iron, vitamin B12, folic acid, or zinc can increase the risk.
• Hormonal changes: Hormonal shifts during menstruation may trigger canker sores in some individuals.
• Immune response: An overactive immune system may mistakenly attack the cells of the mouth lining.
• Underlying conditions: Diseases like celiac disease, Crohn’s disease, and Behçet’s disease may present with recurrent canker sores.
• Allergic reactions: Sensitivities to toothpaste (especially sodium lauryl sulfate), mouthwash, or dental materials can trigger sores.

Symptoms

A canker sore on the tongue typically presents with the following symptoms:

• Round or oval ulcer: With a white or yellow center and a red border, located on the tongue.
• Pain or burning sensation: Especially while eating spicy or acidic foods, brushing teeth, or speaking.
• Tingling or sensitivity: Often felt a day or two before the sore visibly forms.
• Single or multiple sores: May appear in clusters or as a single lesion.
• Difficulty eating or speaking: Especially when the sore is on the tip or side of the tongue.
• No fever or systemic symptoms: Unlike cold sores, canker sores are not caused by viruses and do not cause flu-like symptoms.

Diagnosis

Diagnosis of a canker sore is usually clinical, based on appearance and symptoms:

• Physical examination: A healthcare provider can identify a canker sore through a simple visual inspection.
• Medical history: Recurrent episodes, dietary habits, and history of stress or autoimmune conditions may be discussed.
• Blood tests: May be recommended if sores are frequent or severe to check for vitamin deficiencies or systemic conditions.
• Biopsy (rare): If the sore does not heal within two weeks or appears suspicious, a biopsy may be done to rule out other causes like oral cancer.

Treatment

Most canker sores heal on their own without treatment. However, several options can help relieve pain and speed up healing:

• Topical treatments: Over-the-counter gels and ointments containing benzocaine, fluocinonide, or hydrogen peroxide can reduce pain and inflammation.
• Mouth rinses: Antiseptic or saltwater rinses can help keep the area clean and reduce discomfort.
• Oral medications: For severe cases, doctors may prescribe corticosteroids or immune-modulating drugs.
• Nutritional supplements: Supplementation may be recommended if a vitamin deficiency is identified.
• Avoid triggers: Spicy, acidic, or sharp foods and harsh toothpaste should be avoided during healing.
• Good oral hygiene: Using a soft-bristled toothbrush and non-irritating mouthwash helps prevent further irritation.

Prognosis

The prognosis for canker sores on the tongue is excellent. Most sores heal completely within 7 to 14 days without leaving scars. Pain typically subsides after the first few days. Recurrent canker sores can usually be managed with preventive care and lifestyle adjustments. In rare cases, persistent or unusually large sores may signal an underlying health issue that requires further evaluation.

With proper management and identification of triggers, individuals can reduce the frequency and severity of outbreaks and maintain overall oral health.