What are canker sores?
Canker sores, also called mouth ulcers or aphthous stomatitis, are small, painful ulcers that develop in the mouth or at the base of the gums. They vary in size and can be white, yellow, or gray with a red, inflamed edge. Canker sores are common in people of all ages, but they are not contagious.
Description of aphthous ulcers (type, types)
Canker sores are generally classified into three types based on their size and the severity of symptoms:
- Minor aphthous ulcers: This is the most common type and is characterized by small ulcers (less than 1 cm in diameter) that heal within a few weeks without scarring.
- Major ulcers: These are larger and deeper than minor aphthous ulcers, can be more than 1 cm in diameter, and are irregularly shaped. They can take weeks or even months to heal and sometimes leave scars.
- Herpetiform ulcers: This type consists of clusters of dozens of small ulcers that can merge into larger ulcers. They are less common and can be extremely painful.
Difference between canker sores and other oral problems
Although canker sores can sometimes be confused with other mouth problems, such as cold sores, there are some distinct differences:
- Location: Canker sores develop only on the inside of the mouth, while cold sores develop outside the mouth, often around the lips, under the nose, or on the chin.
- Contagiousness: Canker sores are not contagious, while cold sores are caused by the herpes simplex virus and are highly contagious.
- Appearance: A cold sore often starts as blisters that burst and crust over, while a canker sore looks like an open sore with a white or yellow center and a red border.
These features can distinguish canker sores from other oral problems, which is essential for proper treatment.
Mouth ulcer
Canker sores can occur in various places in the mouth, each with its own level of discomfort and impact on daily activities such as eating, drinking, and speaking. Here's an overview of the most common places where canker sores can develop and how to recognize them.
Inside cheek
Canker sores on the inside of the cheek are common. They can feel like a sudden irritation followed by a painful ulcer. These ulcers are often round or oval in shape with a white or yellow center and a red, inflamed border.
Lip
Although less common than on the cheek, ulcers can also occur on the inside of the lip. These can be particularly painful due to lip movement during speech and eating. As in other areas, they have a characteristic white or yellow center with a red border.
Tongue
Canker sores on the tongue can make eating, drinking, and even talking difficult. They appear as small, painful ulcers, usually on the sides or underside of the tongue. The pain can worsen with tongue movement or contact with food, especially spicy or acidic food.
Gums
Gum ulcers can easily be confused with other gum problems. They are painful and can make brushing your teeth or wearing dentures uncomfortable. These ulcers have the same characteristic appearance as those in other parts of the mouth.
Palate
Ulcers on the palate (the roof of the mouth) are relatively rare, but can be extremely painful due to the hard structure of the palate. They can affect swallowing and the sensation of food in the mouth.
Corner of the mouth
Although less common, ulcers can sometimes appear at the corners of the mouth. This location can make opening the mouth, eating, and talking painful. The ulcers may look like cracks or fissures, but they have the typical appearance of a canker sore.
How do you recognize canker sores in different parts of the mouth?
Recognizing canker sores, regardless of where they are located in the mouth, can usually be done by looking for the following features:
- A small, shallow ulcer with a distinct border.
- A core that appears white, yellow, or gray with a red, inflamed outer rim.
- Pain or discomfort, especially when touched or exposed to certain foods or drinks.
- Unlike some other mouth problems, canker sores do not form blisters and are not contagious.
Symptoms of canker sores
Canker sores are characterized by a range of characteristic symptoms that can vary depending on the severity and type. Despite the variety of symptoms, there are some common characteristics that can help identify canker sores.
Visual features of aphthous ulcers
Canker sores are small, shallow ulcers that appear inside the mouth. They are usually round or oval with a white, gray, or yellow center. The edges are red and inflamed. Depending on the type of ulcer, they can range in size from a few millimeters to several centimeters.
Pain and discomfort
One of the most noticeable symptoms of aphthous ulcer is pain or discomfort, especially when the ulcers are touched or exposed to certain foods and drinks. Sour, salty, or spicy foods can aggravate the pain. The pain is usually most severe in the first few days after the ulcer appears and gradually subsides as the ulcer heals.
Additional symptoms (fever, fatigue, etc.)
Although less common, some people with a canker sore may also experience additional symptoms, such as:
- Mild fever
- Fatigue
- Swollen lymph nodes
These symptoms usually indicate a strong immune system reaction to the presence of canker sores, especially in severe or multiple outbreaks.
When to see a doctor?
Although most canker sores heal on their own without medical treatment, there are situations when it is advisable to seek medical attention:
- If the sores do not begin to heal after two weeks or are not completely healed after four weeks
- For extremely large or painful ulcers
- If the sores break out frequently and cause severe discomfort
- If the ulcers are accompanied by a high fever or other unusual symptoms
In such cases, a doctor can help determine the cause and recommend appropriate treatments to relieve symptoms and prevent future outbreaks.
Cause of canker sores
Although the exact cause of canker sores isn't fully understood, several factors have been identified that can contribute to their development. It's important to emphasize that ulcers are multifactorial, meaning they can be caused by a combination of factors.
Hereditary factors
Research suggests there may be a genetic predisposition to canker sores. People with family members who frequently suffer from canker sores have a higher risk of developing one themselves. This points to a possible hereditary factor.
Nutritional factors
A deficiency in certain vitamins and minerals, such as iron , folic acid , zinc , and especially vitamin B12 , can increase the risk of developing canker sores. In addition, certain foods, such as citrus fruits, spicy dishes, and some nuts, can cause ulcers in susceptible individuals.
Stress and fatigue
There's a strong link between stress , fatigue, and the development of canker sores. Stress can compromise the immune system, potentially making the body less able to defend itself against the factors that cause canker sores.
Hormonal changes
Hormonal fluctuations, especially in women, can influence the development of canker sores. Some women experience more canker sores around their menstrual period .
Reaction to certain medications or chemicals
Certain medications, including NSAIDs (nonsteroidal anti-inflammatory drugs), beta-blockers, and chemotherapy drugs, can cause canker sores as a side effect. An allergic reaction to certain chemicals in oral care products can also cause a canker sore.
Microbial factors (bacteria, viruses)
Although canker sores are not caused by an infection, bacterial, viral, or fungal infections in the mouth can increase the risk of developing them. However, it is unclear whether these microorganisms contribute directly to the development of canker sores or are secondary.
Other factors
Other possible causes include mechanical irritation (such as biting the inside of the cheek or sharp edges of teeth or dentures), allergic reactions to certain foods, and certain diseases and conditions that affect the immune system, such as celiac disease, inflammatory bowel disease, and HIV/AIDS.
While the exact cause of canker sores is often difficult to pinpoint, identifying potential triggers can help control and prevent future outbreaks. Keeping a diary of when canker sores appear and any contributing factors can be helpful for both patients and healthcare providers.
Treating canker sores
Although canker sores often heal on their own, various approaches and treatments are available to speed the healing process and relieve symptoms, particularly pain. The choice of treatment depends on the severity of the ulcers and the symptoms.
Self-care and home treatments
For most people, simple self-care measures and home treatments are enough to keep the discomfort of canker sores under control:
- Avoid Irritating Foods: Stay away from foods and drinks that can aggravate the pain, such as acidic, spicy, or hard foods.
- Good oral hygiene: Keep your mouth clean by brushing regularly with a soft toothbrush and mild toothpaste, and by flossing. Avoid toothpaste containing sodium lauryl sulfate, as it can cause irritation.
- Mouthwash: Use a saline or baking soda solution to rinse several times a day. This can help keep your mouth clean and reduce discomfort.
- Painkillers: Over-the-counter painkillers like ibuprofen or acetaminophen can help manage the pain. Always follow the instructions on the packaging.
- Lysine supplement: Numerous scientific studies show that taking lysine supplements can reduce the duration and frequency of canker sores.
When should I see a doctor?
In certain situations professional medical help is necessary:
- Persistent or severe ulcers: If ulcers do not heal after two weeks, are exceptionally large or very painful, it is advisable to consult a doctor or dentist.
- Frequent Outbreaks: People who suffer from frequent canker sores may benefit from professional advice to address the underlying causes and prevent future outbreaks.
Professional treatment
For severe cases or frequent outbreaks of canker sores, the following professional treatments may be considered:
- Medication: Several medications are available to treat canker sores, including corticosteroid creams or gels, which can be applied directly to the sore to reduce inflammation and pain. In some cases, oral medications or mouthwashes containing corticosteroids may be prescribed.
- Therapies: For patients with very severe or chronic ulcers, other therapies, such as laser treatment, may be considered to reduce pain and promote healing.
The appropriate treatment depends on individual factors, such as the severity of the ulcers, the frequency of outbreaks, and the patient's overall health. A healthcare professional can help determine the most appropriate approach.
Prevention of canker sores
While it's not always possible to completely prevent canker sores, especially in people with a hereditary predisposition, there are several methods that can help reduce the frequency and severity of outbreaks. Here are some helpful tips for preventing canker sores:
Nutritional advice
- Avoid trigger foods: Identify and avoid foods that seem to trigger your canker sores. These are often acidic or spicy foods, but certain nuts or chocolate can also be triggers.
- Eat a balanced diet: Eat a diet rich in fruits, vegetables, whole grains, and lean proteins to prevent vitamin and mineral deficiencies. Paying special attention to vitamin B12 , iron , folic acid , and zinc can help.
Tips for oral hygiene
- Soft toothbrush: Use a soft toothbrush to avoid irritation of the oral tissues and replace it regularly.
- Avoid toothpaste with sodium lauryl sulfate: Some people find that toothpaste without sodium lauryl sulfate (SLS) is less irritating and can help reduce mouth sores.
- Regular oral hygiene: Maintain good oral hygiene by brushing and flossing regularly and thoroughly. This helps reduce the risk of mouth ulcers by minimizing irritation from food debris and bacteria.
Coping with stress
- Reduce Stress : Since stress can be a major trigger, finding effective ways to manage stress, such as through relaxation techniques, exercise, or hobbies, can help reduce the frequency of canker sores.
- Get enough rest: Get enough sleep and try to maintain a balanced lifestyle to keep your immune system strong.
Checking for health problems
- Managing existing health conditions: Conditions such as celiac disease, inflammatory bowel disease, vitamin and mineral deficiencies, and hormonal fluctuations can contribute to the development of canker sores. Proper management of these conditions can help.
Regular checks
- Dental check-ups: Regular dental check-ups can help detect and address early problems that can cause mouth ulcers, such as sharp teeth or poorly fitting dentures.
While these preventive measures aren't guaranteed to prevent mouth ulcers, they can reduce the frequency and severity of outbreaks. If the problem persists, it's advisable to seek professional medical advice to identify and address the underlying causes.
