Overview

Canker sores, also known as aphthous ulcers, are small, painful ulcers that develop inside the mouth, commonly on the inner cheeks, lips, tongue, or gums. They are usually round or oval with a white or yellow center and a red border. Canker sores are non-contagious and typically heal on their own within 1 to 2 weeks. While often harmless, they can cause significant discomfort, especially during eating, drinking, or speaking.

Causes

The exact cause of canker sores is not completely understood, but several factors are known to contribute to their development:

• Mouth Injury: Minor trauma from accidental cheek biting, dental braces, sharp teeth, or aggressive tooth brushing.
• Stress: Emotional stress and anxiety can trigger outbreaks in some individuals.
• Nutritional Deficiencies: Lack of certain nutrients like vitamin B12, folic acid, iron, and zinc increases the risk.
• Food Sensitivities: Certain foods, such as citrus fruits, tomatoes, chocolate, coffee, and spicy foods, can trigger sores.
• Hormonal Changes: Fluctuations during menstruation can lead to canker sores in some women.
• Allergic Reactions: Sensitivity to specific oral care products or ingredients like sodium lauryl sulfate (SLS) in toothpaste.
• Medical Conditions: Conditions like celiac disease, Crohn’s disease, and Behçet's disease are associated with recurrent canker sores.
• Immune System Issues: A weakened or overactive immune system may mistakenly attack cells in the mouth lining.

Symptoms

Canker sores present with easily recognizable signs and symptoms:

• Small, round or oval ulcers with a white or yellow center and red border
• Burning or tingling sensation before the sore appears
• Pain or discomfort, especially when eating, drinking, or talking
• Most sores heal within 7 to 14 days without scarring
• Severe cases may feature larger sores (major canker sores) or multiple ulcers at once (herpetiform canker sores)

Diagnosis

Canker sores are usually diagnosed through a simple visual examination by a healthcare provider or dentist:

• Physical Examination: The doctor visually inspects the sores and reviews symptoms.
• Medical History: Evaluation of potential triggers such as diet, stress, or medical conditions.
• Blood Tests: May be recommended if canker sores are frequent or severe, to check for nutritional deficiencies or underlying conditions.
• Biopsy: In rare cases, a biopsy may be done to rule out other causes of oral ulcers like oral cancer or infections.

Treatment

Canker sores generally heal without treatment, but several options can relieve pain and speed up healing:

• Topical Medications: Over-the-counter gels or ointments (benzocaine, hydrogen peroxide) to numb pain and protect the ulcer.
• Mouth Rinses: Antiseptic or steroid mouthwashes may be prescribed for severe cases.
• Pain Relief: Oral pain relievers such as acetaminophen or ibuprofen can help manage discomfort.
• Nutritional Supplements: Addressing vitamin or mineral deficiencies can prevent recurrence.
• Avoiding Triggers: Identifying and avoiding trigger foods or irritating oral care products.
• Oral Hygiene: Gentle brushing and use of a soft-bristled toothbrush can prevent further irritation.

Prognosis

The prognosis for canker sores is excellent. Most episodes resolve within one to two weeks without complications. Recurrences are common but can often be managed with preventive measures like avoiding known triggers and maintaining proper nutrition. In cases of frequent or severe canker sores, treating the underlying cause usually improves outcomes. While canker sores can be painful, they do not lead to long-term health problems and are generally considered a minor condition.