You feel a small, sore area on the inside of your lip or tongue. It wasn’t there yesterday. It just showed up. You have a canker sore, or in our terms, an aphthous ulcer. They are usually less than a 1/2 inch in diameter, oval, and have red border and a whitish or yellowish center. We’ll sometimes feel a tingling sensation in the area for a couple of days before they actually show up.
Don’t confuse a canker sore with cold sore. Cold sores are from viruses and are usually on the dry portion of the lip or on hard surfaces in the mouth such as the palate. Cold sores are from the Herpes virus, are contagious, and respond to anti-viral medications. Canker sores are on the loose wet tissue of the inner lips, below the gum line, and under the tongue. They are not viral nor contagious.
What causes canker sores? Most often, they just appear for no reason. However, they can be caused by rough edges on your teeth, sensitivities to foods, particularly chocolate (Sorry!), coffee, strawberries, eggs, nuts, cheese, as well as highly acidic foods. They can be related to food allergies as well as a diet lacking in vitamin B12, zinc, folate, and iron. Canker sores can also be caused by Helicobacter pylori, the same bacteria that cause stomach ulcers, and can be related to gluten sensitivities and inflammatory bowel diseases. And occasionally, I’ll see a patient whose canker sores clear up just be their changing toothpastes away from one that has the additive, Sodium Lauryl Sulfate. They are genetically related about a third of the time.
One key that we use in helping you is a diet and medication history. When did they start? What were you eating? Have there been recent changes in your diet? Have you started a new medication?
While canker sores are a nuisance, they’re usually not dangerous. If they are large or if you often get clusters of them, it will be worthwhile to get some blood tests and maybe a biopsy, but that’s the rare exception.
What are the treatments? The best treatment is no treatment. They’ll usually go away by themselves. If they are a nuisance, then your dentist or physician can prescribe antibacterial mouth rinses, topical pastes, and sometimes drugs that are used for heartburn or gout, and even cortisone preparations. There is a topical solution called Debacterol that your dentist or physician can paint on the sore to cauterize it. Nutritional supplements can also be prescribed. And I even had one patient with the most severe canker sores for years completely clear up after one chiropractic adjustment.
The key is that if canker sores are just now showing up, look at the changes that you’ve made in your medications. Usually, you can be the best detective in determining why they started. Your doctor can then help you find an alternative.
Lee N. Sheldon, DMD