January 27, 2006

The Best Wealth is Your Health

Canker Sores – What a Pain!

By Dr. Douglas W. Vierra, D.D.S.
Special to the Times

Millions of people suffer from recurring sores in and around the mouth. 

One type of sore – aphthous ulcers (“canker sores”) is responsible for many of these lesions. Understanding the cause and symptoms of this common oral ulcer will help prevent, treat, or minimize how frequent and long the outbreaks occur.

Canker sores are thought to form when, for unexplained reasons, a person’s immune system reacts to a foreign stimulus. The immune response results in the formation of mouth ulcers.

Dentists distinguish these ulcers from other types primarily by visual inspection. The appearance, location, and recurrent nature of these ulcers direct the diagnosis. 

Canker sores only form on the “loose” tissues of the mouth (those areas where the skin is not tightly bound to bone). Commonly this includes the inside of the lips and cheek, the floor of the mouth, the underside of the tongue, and the soft palate and tonsillar regions.  

Canker sores are typically round or oval, and very small (1/4 inch in diameter). The ulcers are extremely painful to touch and last approximately 7-10 days.

Several factors that seem to be triggers for outbreaks of canker sores have been identified. Any one or a combination of the following items may play a role in the formation of canker sores for any individual:

Toothpastes and mouthwashes that contain sodium lauryl sulfate. This foaming agent used in most toothpaste may be associated with an increased recurrent rate of canker sores. Several studies have shown that brushing with an SLS-free toothpaste reduces the number of canker sores that develop.

Mechanical Trauma. A self-inflicted bite, irritation from a sharp tooth edge, or sharp piece of food has been shown to result in ulcer outbreak.

Emotional/Psychic Stress. Many people who suffer from canker sores report that the appearance of sores coincides with periods of stress.

Nutritional deficiencies. Researchers have shown correlation between vitamin deficiencies and appearance of sores.

Allergies and sensitivities. Certain food substances such as citrus, dairy products, nuts and chocolates have been associated with outbreak of sores.

Medical conditions. There are a few medical conditions that have been associated with mouth ulcers such as Crohn’s disease, Behcet’s disease, and HIV.  

While there is no cure for canker sores, there are various treatments and remedies that can be useful in limiting their duration and lessening the pain and discomfort they cause.  Typically a combination of common sense and medication can both minimize outbreaks and relieve symptoms.

If you suffer from recurrent canker sores, evaluate the possible triggers. Switch to a toothpaste and mouth rinse that does not contain sodium lauryl sulfate. 

Be aware and eliminate any trauma to sites in the mouth. Make note if outbreaks coincide with high periods of stress and tell your dentist. Analyze your diet for foods that may be triggering an outbreak.

Certain medications show promise in controlling these painful ulcers. Anbesol or Orogel will locally numb the sore and relieve pain. Prescription medication such as Kenalog in Orobase can speed healing and relieve symptoms. 

The first prescription medication specifically for canker sores – Aphthasol – recently received FDA approval and shows promise to reduce the pain and healing time of these ulcers.

Douglas W. Vierra, D.D.S., is the owner of Plaza Dental Group, 1654 E. Capitol Expressway, San Jose, California, 95121. Call (408) 270-4333 with questions or to schedule an appointment.