Canker sores are small shallow and painful ulcers or lesions that develop on the soft tissues in the inside lining of your mouth or at the base of your gums. The sores usually start as white to yellowish ulcers that are surrounded by redness.
These sores can be very painful and often make eating and talking difficult and uncomfortable for you. The cause of canker sores is unknown, however, it can be caused by stress or minor injury to the inside of your mouth.
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The main cause of canker sores is unclear, but there are certain triggering factors that can make the sores appear.
The triggers include:
- Certain types of food including citrus or acidic fruits and vegetables (such as lemons, oranges, pineapples, apples, figs, tomatoes, strawberries). These foods can trigger your canker sore or make it worse.
- Food sensitivities, particularly to chocolate, coffee, strawberries, eggs, nuts, cheese, and spicy or acidic foods
- A minor injury to your mouth from dental work.
- Brushing your mouth harshly, especially if the toothbrush is not soft
- Accidentally biting your cheek
- Your diet may be lacking in vitamin B-12, folic acid, iron, or zinc
- Sports accidents, especially if you do contact sports
- Your body’s allergic response to certain bacteria that are in your mouth
- Hormonal shifts during your menstruation
- Stress, especially emotional stress
- Your dental appliance, such as braces
- Ill-fitting dentures or a sharp tooth surface
- Sometimes, your use of nonsteroidal anti-inflammatory drugs, like ibuprofen (Motrin or Advil) can give you canker sores.
Types of canker sores
There are three types of canker sores: Simple, Complex, and Herpetiform.
Simple or minor
These are the most common types of canker sores.
- You can get simple canker sores at any age, but they typically occur in people between ages 10 and 20.
- They may appear three or four times a year, lasting up to a week on each occurrence.
- These sores are usually small
- They are oval-shaped with a red edge
- Usually, they heal in one or two weeks without causing you any scarring.
Complex or major
These are less common and
- Occur if you’ve previously had simple canker sores in the past.
- Usually round with defined borders. However, when the sores are very large they may have irregular borders.
- Are larger and deeper than simple canker sores
- Can be extremely painful
- It may take up to 6 weeks to heal. After healing, the sores may leave extensive scarring in your mouth.
- It can occur if you have nutritional problems, such as a deficiency in iron, folic acid, vitamin B-12, or zinc.
- You have diseases of the immune system. If you have a faulty immune system, it may cause your body to attack healthy cells in your mouth instead of pathogens, such as viruses and bacteria.
Diseases of the immune system include:
- HIV/AIDS suppresses your immune system and increases your risk of getting canker sores.
- Inflammatory bowel disease (including Crohn’s disease, celiac disease, and ulcerative colitis).
- Celiac disease is a serious intestinal disorder that results if you have a sensitivity to gluten, a protein found in most grains.
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Herpetiform canker sores
These are uncommon and usually develop later in life. They:
- Are usually pinpoint in size
- Often occur in clusters of between 10 – 100 sores, which may merge into one large cluster.
- Anyone can develop canker sores, but you’re more likely to get it if you’re a teen or a young adult.
- You’re more likely to have it if you’re a female.
- If you have recurrent canker sores, you may have a family history of the disorder.
- You may have it due to heredity or resulting from factors such as certain foods or allergens.
The following are signs that you have canker sores:
- Round or oval painful sores inside your mouth. They’ll have a white or yellow center and a red border. The sores occur under your tongue, soft palate, or inside your cheeks or lips, or at the base of your gums.
- Round, white or gray sores inside your mouth with a red edge or border.
- A burning or tingling sensation prior to the appearance of sores inside your mouth
- You may have a fever, swollen lymph nodes with a severe attack from canker sores.
Are canker sores the same as cold sores?
When you have canker sores, you should not mistake them for cold sores because they’re not the same.
- Cold sores are also known as fever blisters or herpes simplex type 1. It is an infection caused by a virus and is extremely contagious. A canker sore is not an infection and is not contagious.
- Cold sores usually occur as clusters of painful, fluid-filled blisters.
- If you have cold sores, they typically appear outside your mouth, not inside it like canker sores. You’ll usually find them under your nose, around your lips, or under your chin.
Canker sores on the other hand occur inside your mouth and are not caused by an infection. They’re therefore not contagious.
If you have canker sores, the sore will usually heal in about a week or two. There are some over-the-counter products that you may use to relieve the pain.
When to see a doctor
You should see your doctor if:
- you’ve developed unusually large sores
- your sores are spreading
- you have difficulty drinking fluids
- your sores have lasted for three weeks or longer
- you have intolerable pain that doesn’t respond to over-the-counter (OTC) medicines
- a fever developed with the appearance of the canker sores
If your sores are large, persistent, and painful, your doctor may prescribe a mouthwash containing dexamethasone to reduce your inflammation, irritation, and pain. He may also prescribe a corticosteroid ointment or an antibacterial mouth rinse.
Your doctor doesn’t need to run any tests to make a diagnosis. A visual examination will usually be only what is needed. When he looks at the sores inside your mouth, he/she will be able to make a determination.
Additional tests may be ordered to check for other underlying health issues that you may have. This will be done especially if you have canker sores that are ongoing and are severe.
Prevention of canker sores
There is no cure for canker sores because they often recur. You can only take measures to prevent frequent recurrence of the condition.
These are the measures you need to take:
- Avoid oral hygiene products that contain sodium lauryl sulfate.
- Use a soft-bristled toothbrush after meals. You should also floss daily. By doing this, you’ll keep your mouth free of foods that might trigger a sore.
- Avoid irritating your gums from chewing gum
- You should avoid foods that are likely to irritate your mouth. These include hot or spicy foods. Other foods include chips, nuts, pretzels, salty foods, and acidic fruits, such as grapefruit, pineapple, and oranges.
- Eat healthy foods so you don’t have nutritional deficiencies. You should eat plenty of fruits, vegetables, and whole grains.
- If you wear braces, protect the inside of your mouth by making sure that you don’t have any sharp edges on the braces. The sharp edges will likely cause blisters in your mouth.
Your dentist should be able to cover sharp edges on your braces with orthodontic waxes so that they won’t irritate the inside of your mouth and cause canker sores.
- Know the importance of good oral hygiene to delay future recurrences. As mentioned earlier, you should regularly brush your mouth after meals and floss once a day. This practice will keep your mouth clean and free of foods which might trigger canker sore recurrence.
- Choose a soft toothbrush for brushing your mouth. This will prevent the irritation of the delicate tissues inside your mouth.
- Avoid mouth rinses and toothpaste that contain sodium lauryl sulfate.
- Because stress can cause canker sores, you should take necessary measures to avoid stress. Learn stress-relieving techniques such as guided imagery and meditation, and practice them as part of your lifestyle.
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