HEALTH TALK: Canker sores

Small, out-of-sight, painful, persistent and annoying.  These terms are descriptive of what are called canker sores or aphthous ulcers.  These shallow ulcers in your mouth can make eating and even talking uncomfortable. They may occur on your tongue, soft palate (back roof of your mouth), inside your cheeks or lips, and at the base of your gums.

Canker sores differ from cold sores (remember them?) in that they occur in the soft tissues of your mouth and are not contagious.  On the other hand, cold sores rarely develop in those areas of the mouth, and are extremely contagious, being caused by the herpes virus.

Aphthous ulcers are common, but their cause is unknown.  They can occur at any age, but often first appear between the ages of 10 and 40, like migraine headaches, incidentally.

Often, no treatment is necessary. Pain often decreases after several days, and the sores usually heal in one to three weeks.  Occasionally, severe ones can grow to larger than 1 centimeter in diameter or last longer than two weeks, or both.

WHAT ARE THE SIGNS AND SYMPTOMS?

These include:
•    Painful sore or sores inside your mouth at the sites already mentioned.
•    Tingling or burning sensation before the sores appear.
•    Round, whitish appearance to sores, with a red edge or halo.

Though not necessarily related to the canker sores, one may also experience fever, listlessness and swollen glands, properly called lymph nodes.

WHAT CAUSES THESE SORES?

The cause of most remains a mystery.

It is generally believed that stress or tissue injury may cause canker sores to erupt.  A trigger may be something as minor as biting the inside of your mouth.  Other causes may include:

•    Faulty immune system function.
•    Nutritional deficiencies of vitamin B-12 (beware, those of you who don’t eat meat), zinc, folic acid or iron, the latter found in green, leafy vegetables, red meat, liver, kidney, red beans, soy bean flour, and many other foods.
•    A disease of the gastrointestinal tract.
•    Food allergies.
•    Menstrual periods.

Anyone can get canker sores, but they tend to run in families and may be a hereditary condition.

SEE THE DOC

If you have:
•    Unusually large sores.
•    Pain that you can’t control with self-care measures.
•    High fever with canker sores.
•    Persistent sores, lasting three or more weeks.
•    Difficulty drinking enough fluids.

See your dentist if you have sharp tooth surfaces or dental appliances that seem to appear to trigger the sores.

TREATMENT

Most of the time, no treatment is necessary and canker sores will heal on their own.  Prescription medication may be suggested if your sores are large, painful, or persistent.  Pain relief may require a prescription mouthwash, a corticosteroid (anti-inflammatory) salve or an anesthetic (numbing) solution.

CAN ONE PREVENT THESE SORES IN THE MOUTH, OF ALL PLACES?

Canker sores can recur, so you may be able to reduce their frequency by dealing with factors that seem to trigger them.  Some suggestions:

Watch what you eat.  For how many things have you heard this?  Avoid foods that seem to irritate your mouth.  These may include acidic foods, nuts, and certain spices.

Don’t chew and talk at the same time.  Doing this could cause minor trauma to the delicate lining of your mouth, triggering a canker sore.

Follow good oral hygiene habits.  Regular brushing after meals and flossing once daily can keep your mouth clean and free of foods that might trigger a sore.  Using a soft brush may help you avoid irritation of mouth tissues.  You didn’t have to get these bits of advice from me; you dentist could tell you just as well or better.

CARING FOR YOURSELF

The following may provide temporary relief of canker sores:
•    Avoid abrasive, or acidic or spicy foods which may increase pain,
•    Apply ice to the sores or allow ice chips to slowly dissolve over the sores to ease pain.
•    Use a soft brush carefully to avoid irritating the sore.
•    Rinse your mouth with salt water or over-the-counter preparations.  Try diluted hydrogen peroxide or syrup of Benadryl.  Be sure to spit out the Benadryl so that the medication doesn’t make you sleepy, as you know it can.
•    Dab a small amount of milk of magnesia (MOM) on your canker sore a few times a day.  (Mom is so good to have around, yes?) This can ease pain and assist in healing.
•    Use an over-the-counter pain reliever, such as aspirin, Tylenol, Advil, Motrin, Paracetamol.  Don’t give Aspirin, to children.  It could trigger a rare but potentially fatal disorder known as Reye’s syndrome.

See you next week.

Dr. Victor Emanuel has been an educator of medical professionals in training, and the public, for over 20 years in Dominica. The contents of his articles are based on facts and research conducted, and not of his opinion.