“When the lips are opened, we behold the image of the soul.” –Sir Thomas Higgons

It’s an irony that canker sores affect more women than men. Maybe they use their lips and mouth more than men. In severe cases, it could be a burden for women to worry about not able to talk than to drink or eat.

Canker sores are harmless but in case of an underlying ailment needs treatment. They are also known as aphthous or mouth ulcers.

There is another worrying condition of it called Recurrent Aphthous Stomatitis. In this case, canker sores are developing recurrently and cause more discomfort. Once the previous ones healed new ones appear. In some cases even without the old ones healing new sores will be formed.

Canker sores are disruptions of the oral mucosa. They are shallow lesions that occur on the lips, tongue, soft tissues of the mouth and throat. They are generally white, gray or yellow with a red border. Depending on the types they are from 3 mm to 15 mm in size.

One out of five people is affected by canker sores once in their life. Though it may affect anyone, it is more common in the age group of 10 to 40 years. Treatment strategies directed towards providing symptomatic relief by reducing pain. Also, they involve the duration of the ulcer-free periods and accelerate ulcer healing.

Canker sores are generally harmless and non-contagious. But they can be painful and last for a few days to several weeks. If they last for more than two weeks, it is better to consult the doctor.

It is because it causes unbearable pain not even to talk, drink or eat. Also, it is essential to differentiate it from oral cancers if they are severe. If they are due to an underlying ailment, it could be complicated for its healing.

There are three types of canker sores depending on the numbers and severity. The first minor is very average and easily heals within days. The second major have large sores and could be painful and takes weeks to recover. The third form is Herpetiform which is a cluster of 10 t0 100 pinpoint ulcers merged into one entity.

Many confuse cold sores with canker sores. Canker sores appear inside the mouth, but cold sores appear outside the mouth as blisters and become sores once these blisters pop. Cold sores are caused by herpes simplex virus whereas the exact cause of canker source is not known. One of it could be due to infection which could spread if untreated.

Canker sores can be developed due to numerous reasons. But most of them are easily curable. Hereditary and insufficient vitamin and mineral intake are the main reasons. Its effects can be relieved by simple home remedies.

Home remedies for canker sores include some easy things like drinking cold milk, eating yogurt or ice creams. Also, the pain can be alleviated by gargling with salt water or sodium bicarbonate solutions. Even applying ghee or castor oil could relieve pain.

Dentists can fix improper fitting of dentures and other issues. They provide the best and immediate relief from canker sores by laser treatment.

Treatments for canker sores differ as per the underlying cause, severity of the sores, and other causes of it. They may also eliminate the possibility of oral cancer before providing treatment. Doctors prescribe numbing medicines for children below two years

Salient features of canker sores:

Patients with aphthae are usually healthy if it is without an underlying ailment
Erythema migrans or red rashes similar to canker sores affect the tongue and typically are not serious
Patients with canker sores for more than 3 weeks should undergo biopsy or other investigations. It is to exclude malignancy or other severe conditions.
Topical corticosteroids aid the resolution of ulcers.
Systematic immunomodulation may be required when ulcers are severe
Some common forms of orofacial pain are burning mouth syndrome, atypical facial pain, and mandibular pain-dysfunction.

Symptoms Of Canker Sores:

Symptoms of canker sores depend on their types. It usually starts with a burning or tingling feeling in the mouth. It lasts for a few days and in severe cases for a few weeks. And for some, it may repeatedly occur after healing of the previous sores.

The common symptoms of canker sores include:

Typically it starts with a burning or tingling feeling in the mouth before any visible presence occurs
This feeling is more concentrated in the part of the mouth where the lesions will start appearing in a day or two
Shallow soars appear on the tongue or the inside of the lips or cheek
The ulcers will have a red border and a white, gray or yellow center
The sores may be round or an oval shape
They may appear on the top surface of the top, tip and underneath the tongue
It may also appear on the floor of the mouth, inside the lips and cheek
For some, it may appear on the gum tissue and the soft palate or the back portion of the roof of the mouth
The sores may be large or small
There may be one or more sores at the same time
In severe cases the following symptoms can be found:
Sores become swollen and painful
It makes eating, drinking and talking difficult for the affected persons
There will be fever and in severe cases the temperatures could soar
There will be physical sluggishness and fatigue
Due to the sores there could be the formation of swollen lymph nodes

Specific symptoms as per the type of canker sores:

As per the three types the symptoms vary which include:

Minor Canker sores:

The sores will be smaller in size of 2 – 3 mm
Sores will be oval shaped with a red edge
Heals within one or two weeks without leaving any scarring

Major Canker Sores:

The sores will be broader and more profound than in minor canker sores
The size of the sores could be 10 mm or more
They are usually round in shape and with defined borders
In severe cases, they may have irregular edges to the large sores
There will be extreme pain
Will last up to six weeks or in some rare cases up to 10 weeks
Leaves extensive scarring after healing

Hypertherm Canker Sores:

They are of a pinpoint in size
Often occurs in clusters of 10 to 100 sores which may later merge into one large ulcer
They are with irregular edges
Heals within 1 to 2 weeks without scarring

Causes Of Canker Sores:

The root cause of canker sores is yet is unknown, but it runs through the family. But it does not spread being non-contagious. It may be due to various reasons including:

Emotional and other stresses to the mind and body
For woman may develop during the menstrual cycle
By hurting the mouth like biting inside the cheek or lips, overzealous brushing, and during dental work. Sportsperson who are prone more to mouth injuries can also develop canker sores.
Having braces on the teeth
Could affect persons who are allergic to certain foods like chocolate, coffee, eggs, nuts, cheese, tomatoes, strawberries, pineapples, apples, figs, and many others
Eating or drinking food or juice which contains more of acids like oranges, and lemons,
Hot and spicy foods intake may also be the reason for some developing canker sores
Lack of minerals and vitamins like iron, zinc, calcium, vitamin B12, B-3 niacin, and B-9 folic acid in the daily diet
Broken teeth and their restorations with their sharpness rub on the oral tissues to cause painful canker sores
Ill-fitted or partial dentures due to rubbing on the soft tissues could cause canker sores/ They have to be immediately rectified or replaced by dentists or denturists to alleviate canker sore effects
Orthodontic attachments like brackets, bands due to friction on the oral tissues cause canker sores. It starts with the orthodontic treatment and continues throughout all the stages of its treatment.
Chewing tobacco or consuming smokeless tobacco consuming cause canker sores. It mostly develops in the part where the tobacco kept in the mouth for a prolonged time. It is due to the hundreds of toxic, harmful and irritating chemicals found in these addictive chewing tobacco products.
Using toothpaste which contains sodium lauryl sulfate is associated with the development of canker sores
Allergic reactions to certain types of bacteria found in the mouth may result in canker sores
Persons who are allergic to metals like nickel will develop when they are wearing orthodontic attachments to move the teeth made of nickel. It is commonly called dermatitis.
People who have the celiac disease could develop canker sores. It is because the gluten found in foods like wheat can develop canker sores for celiac disease patients
Helicobacter Pylon bacteria which causes peptic ulcers have been found to cause canker sores
Hormonal changes mainly during pregnancy, menopause, and menstruation in women could be one of the causes of it
Hereditary and genetic factors could be responsible
People suffering from IBD or inflammatory bowel diseases like Crohn’s disease and ulcerative colitis are prone to develop canker sores
Canker sores are familiar with a lack of immunity like the HIV AIDS affected patients. Also, a faulty immune system instead of attacking pathogens like viruses and bacteria affects the healthy cells in the mouth.
People suffering from Behcet’s disease which is a rare disorder causing blood vessel inflammation could also be the cause.`
Those who suffer from Cellulitis a common bacterial skin infection could develop canker sores

Diagnosis Of Canker Sores:

Usually, there is no need for any diagnosis for canker sores. By physical examination itself coupled with the above questions, the doctor could arrive at the cause and treatment. But in case of underlying ailment tests for that is necessary to check its severity. The patients should provide the proper inputs for the doctors to give treatment.

But in some cases, doctors want to take blood tests or biopsy if there is a severe break out of sores. But they are advised by doctors if they suspect the following:

Virus infections or severe breakouts
Vitamins or mineral deficiency
Hormonal disorder
Malfunctioning immune system

Some symptoms of oral cancer seem to appear similar to that of canker sores. They may appear like painful ulcers and swelling in the neck. Also, a cancerous lesion may appear as a canker sore. But in these cases, unlike canker sores, it will not be healed with treatments.

Oral cancers differ from canker sores with their unique symptoms which include:

Bleeding mouth or gums
Loose tooth
Having difficulty in swallowing food
Earaches

It is very crucial to consult the doctor if the above symptoms resemble canker sores. Only by proper diagnosis, the chances of oral cancer can be ruled out.

Treatment For Canker Sores:

Canker sores usually need not be treated, and if the pain persists, a lot of home remedies could help. Some lifestyle changes also can heal canker sores without treatment. But in case of severe or continuing for more two weeks, it is recommended to consult a doctor immediately.

OTC Medications for canker sores:

Pain relievers like NSAIDs or nonsteroidal anti-inflammatory drugs like Aspirin, Ibuprofen or Advil, and Naproxen or Aleve. Because of the Reye Syndrome, Aspirin is not advisable for people below 18 years of age.

Anbesol
Milk of Magnesia

Nutritional supplements:

Since the lack of vitamins and minerals is one of the leading causes of canker sores, doctors prescribe dietary supplements. According to the deficiency of a particular vitamin or mineral, supplements can be specified. Like in case of anemia, an iron supplement could solve the underlying ailment and also the canker sores.

Mouth Rinses or Washes:

Mouthwashes can fasten the healing process of canker sores and also prevent the spreading of the infections. But children below two years of age should not use mouthwashes Mouth rinses containing the following medicines could help in healing canker sores.

Hydrogen peroxide mouth rinses
Antibiotic or antimicrobial rinses like Listerine
Chlorhexidine like Peridex or Periogard
A combination of Dexamethasone to reduce inflammation or Lidocaine to minimize pain
Doxycyclines like Monodox, Adoxa and Vibramycin antibiotic mouthwashes or pills
Corticosteroid lozenges in the form of mouthwashes or spray reduce pain and are best when used as soon as the sore appears

Tropical products:

OTC prescribed products in the form of pastes, creams, gels or liquids may help in alleviating the pain. Also, it accelerates the healing process when applied to the spores as soon as they appear. Some of these products have active ingredients and some without them. Consult the doctor or dentist before choosing these OTC tropical products.

Corticosteroid ointments like hydrocortisone, hemisuccinate or beclomethasone
Benzocaine like Anbesol, Kank-A Orabase, Zilactin-B
Fluocinonide like Lidex and Vanos
Hydrogen peroxide like Oragel, Antiseptic Mouth Sore Rinse, Peroxyl

Oral Medications:

When tropical treatments are not effective, then oral medications are the next best choice. Some of them include medicines that are not explicitly intended for canker sores but help in healing them. They include:

Sucralfate or Carafate a coating agent which normally treats for intestinal ulcer treatment
Colchicine which is used to treat gout
Oral steroid medications are a last resort because of their dangerous side effects
For occasional uses like in the case of canker sores during menstrual cycle oral contraceptives with Progestogen can be used

Cautery of sores:

Cautery is a process of using an instrument or chemical substance to burn sear, or destroy the troubling tissue. They include:

Debacterol a topical solution could reduce the healing time within a week. It is done by chemically cauterizing canker sores and also used in gum problems
Silver nitrate an another chemical cautery of canker sores help relieve pain but is not speed enough like Debacterol

Homemade treatments for canker sores:

Applying ice on the sores by making the ice chips to dissolve slowly over the sores promote healing with a soothing effect
Rinsing the mouth with a mixture of warm water and baking soda could help reducing pain and heal sores. One tablespoon of baking soda in half a cup of warm water is the right mixture.
Applying honey is an effective and sweetening way of treating canker sores especially for children
Tiny amounts of milk of magnesia are spread on the sores for fast relief
Rinsing the mouth with lukewarm saline water and holding it for a short time could help. 2 to 3 times of doing it could heal the sores faster and give good relief.
Apply ghee or butter to the ulcers
Chewing tulsi leaves help to heal with their natural anti-inflammatory properties
Applying castor oil helps in alleviating the pain and gives comfort
Damp chamomile tea bags can be placed on the ulcer for relief from pain
Brush the teeth gently and carefully so that the bristles of the brush does not touch the sore from increasing the ulcer
Applying alum powder mixed in water dry out the canker sores by shrinking the tissues
Using readily available coconut oil with its antimicrobial abilities cures canker sores caused by bacteria and also prevents its spreading. Its anti-inflammatory properties reduce redness and pain.
Rinsing the affected mouth 2 to 3 times with Echinacea tea will be highly beneficial
DGL or Deglycyrrhizinated licorice an herbal licorice extract with its anti-inflammatory abilities can be used as a mouth wash for healing canker sores
Sage tea mouthwash with its antibacterial, anti-inflammatory, antiseptic and astringent properties help to relieve pain and healing sores
Zinc lozenges boost immunity and heal immune-related crank sores
Watermelon frosts available in various forms could help to treat canker sores

Prevention Of Canker Sores:

Fundamental changes in food habits and lifestyles could be beneficial for a holistic healthy life. And more importantly, do not suffer from canker sores it is the best way to prevent it. It becomes more significant with the exact cause of canker sores are mostly not known. The prevention can be according to food and lifestyle changes.

Food habits:

We are what we eat is an old saying which squarely applies to canker sores. By knowing what the right food to eat is and what to avoid will help to heal canker sores tremendously.

Foods to eat:

Bananas and other foods rich in vitamins and minerals
Milk-based foods

Foods to avoid:

Spicy
Hot
Hard and sharp foods
Foods with a lot of acidities

Lifestyle changes could help in a big way:

Avoid chewing gum
Eat the food slowly and chewing them well and without talking
Avoid alcohol and smoking totally
Control stress and anxiety by meditation and breathing techniques
Practice good oral healthcare by using soft brushes, toothpaste without sodium laurel sulfate and many others

Canker sores though harmless and not contagious. But it could cause a lot of pain and discomfort in severe conditions. Also, if it is due to an underlying ailment, it is better to consult a doctor and take proper treatment. Avoiding smoking, chewing tobacco and alcohol could prevent canker sores in a big way.

Canker sores could be quickly and healed nowadays with dental laser treatment. Still, it is necessary to have a healthy life without crank sores. Proper healthy food habits and good lifestyles are the best ways.

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Canker Sores: Causes, Picture, Symptoms and Treatment