Canker sores (aphthous ulcers)

Understanding Aphthous Ulcers: Causes, Symptoms, and Treatment

Aphthous ulcers, commonly called canker sores, are painful, small sores that form inside the mouth, often on soft tissues such as the inner cheeks, gums, tongue, and lips. These ulcers are not contagious and are different from cold sores, which are caused by the herpes simplex virus.

Key features of an aphthous ulcer include:

Painful Ulcers:

 Aphthous ulcers are often painful in nature. Pain can vary from mild discomfort to severe pain, especially when eating, speaking, or engaging in oral hygiene routines.

Round or oval in shape:

 These ulcers are usually round or oval in shape with a red border and a white or yellow center.

Size:

 Aphthous ulcers can vary in size, from a few millimeters to more than a centimeter in diameter.

Recurrent episodes:

 Many people experience recurring outbreaks of aphthous ulcers. These episodes can vary in frequency and severity, with some individuals experiencing them more often than others.

Triggers:

 The exact cause of aphthous ulcers is not fully understood, but it is thought to be caused by stress, certain foods (such as citrus fruits or spicy foods), minor injuries to the mouth, hormonal changes, and a combination of factors. are born Some medical conditions.

Types:

 There are three main types of aphthous ulcers: minor, major and herpetiform. Minor ulcers are the most common and tend to be small in size. Large ulcers are larger and more painful. Herpetiform ulcers are characterized by clusters of small ulcers that resemble herpes lesions.

Self-limiting:

 Aphthous ulcers usually heal on their own without symptoms within a week or two. Over-the-counter topical treatments or prescription medications can be used to reduce pain and speed up the healing process.

It's important to note that while aphthous ulcers are usually harmless and not a sign of a serious underlying condition, persistent or unusually large ulcers, or other symptoms, should be ruled out and should be evaluated immediately by a health care professional.

Causes of Aphthous Ulcers

The exact causes of aphthous ulcers/canker sores, are not fully understood, but are believed to be multifactorial. Many factors can contribute to the development of these ulcers, and they can vary from person to person. Here are some possible causes and triggers:

Trauma or injury:

 Minor injuries to the soft tissues inside the mouth, such as accidental bites, dental work, or aggressive toothbrushing, can trigger aphthous ulcer formation.

Stress:

 Emotional stress and anxiety are often associated with the development of canker sores. Stress can weaken the immune system, making it more susceptible to various health problems, including mouth ulcers.

Dietary factors:

 Certain foods and beverages can trigger or aggravate aphthous ulcers in susceptible individuals. Common dietary triggers include acidic foods (such as citrus fruits and tomatoes), spicy foods, and food allergies or sensitivities.

Hormonal changes:

 Fluctuations in hormones, such as those that occur during menstruation, pregnancy, or menopause, can make some people more prone to canker sores.

Genetics:

 Aphthous ulcers may have a genetic tendency, as they often run in families.

Immune system disorders:

 A compromised or overactive immune system can increase the chances of developing oral ulcers.

Underlying medical conditions:

 Certain medical conditions, such as autoimmune diseases (eg, celiac disease, Bechet's disease, and Crohn's disease), may be associated with recurrent aphthous ulcers.

Medications:

 Some medications, especially those that can irritate or weaken mucous membranes, can contribute to the development of canker sores as a side effect.

Smoking or tobacco use:

 Tobacco use, including smoking and chewing tobacco, can irritate the soft tissues of the mouth and increase the risk of mouth ulcers.

Viral infection:

 Although not a direct cause, viral infections can weaken the immune system and potentially trigger the development of canker sores in susceptible individuals.

The specific triggers and causes of aphthous ulcers can vary from person to person. Managing and preventing these ulcers often involves identifying and avoiding personal triggers, managing stress, and maintaining good oral hygiene. If you experience frequent, severe or persistent canker sores, it is advisable to consult a healthcare professional for a thorough evaluation and to rule out any underlying medical conditions.

Symptoms of Aphthous Ulcers

Aphthous ulcers/canker sores, are characterized by several symptoms, including:

Pain:

 Aphthous ulcers are usually painful. The level of pain can vary from mild to severe, especially when the ulcer comes into contact with food, liquids or the tongue.

Round or Oval Ulcers:

 These ulcers are usually round or oval in shape. They are often characterized by a red border and a white or yellow center.

Variation in size:

 Aphthous ulcers can vary in size. They can be a few millimeters or larger, larger ulcers are larger and more painful than small ones.

Location:

 Aphthous ulcers occur on the soft tissues inside the mouth such as the inner cheeks, gums, tongue and lips. They can be at any of these levels.

Recurrent episodes:

 Many individuals experience recurrent outbreaks of aphthous ulcers. These episodes can vary in frequency, with some people having them more often than others.

Discomfort with oral activities:

 Pain associated with aphthous ulcers can cause discomfort in eating, drinking, speaking, or engaging in oral hygiene routines.

Duration:

 Aphthous ulcers usually heal on their own without leaving any scars within a week or two. The duration may vary depending on the size and type of ulcer.

Other symptoms:

 In some cases, people with aphthous ulcers may experience other symptoms such as fever, swollen lymph nodes, or a general feeling of malaise, although these additional symptoms are less common.

While aphthous ulcers are usually harmless and do not indicate a serious underlying condition, persistent or unusually large ulcers, or other associated symptoms, rule out any potential problems. 

Treatment of Aphthous Ulcers

Treatment for aphthous ulcers (canker sores) aims to relieve pain, promote healing, and reduce the frequency of flare-ups. Here are some common treatments:

Topical medications:

• Over-the-counter (OTC) creams and gels: You can find OTC topical products that contain benzocaine, hydrogen peroxide, or numbing agents to help reduce pain.
• Prescription medications: In cases of severe or recurring aphthous ulcers, a healthcare provider may prescribe stronger topical medications, such as corticosteroids, that can reduce inflammation and promote healing. .

Mouth Rinses:

• Mouthwash: Rinsing your mouth with a saltwater solution or an over-the-counter mouthwash that contains soothing ingredients like baking soda can help reduce irritation and promote healing.
• Prescription mouthwash: In some cases, a doctor may prescribe a special mouthwash with an anti-inflammatory or antimicrobial agent to reduce pain and prevent infection.

Pain Relief:

• Over-the-counter pain relievers: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage the pain associated with aphthous ulcers.

Diet Adjustment:

• Avoid trigger foods: Identify and avoid foods that may trigger or worsen your aphthous ulcers, such as acidic or spicy foods.
• Vitamin and mineral supplements: Some research suggests that vitamin and mineral deficiencies, particularly B vitamins, iron and zinc, may contribute to the development of canker sores. Take supplements under the guidance of a healthcare provider is beneficial.

Oral hygiene:

• Gentle brushing: Use a soft brush and practice gentle oral hygiene to avoid further irritation. Avoid brushing directly on the ulcer.
• Mouth guard: If you have sharp or rough dental appliances, such as braces, ask your orthodontist for a solution to prevent irritation.

Stress Management:

• Reduce stress: Stress is considered a trigger for aphthous ulcers in some individuals. Engaging in stress reduction techniques such as meditation, yoga, or deep breathing exercises can help reduce the frequency of outbreaks.

Prescription drugs:

• Oral corticosteroids: In severe cases or when other treatments are ineffective, a doctor may prescribe oral corticosteroids to reduce inflammation and control the immune response.

Aphthous ulcers are usually self-limiting, meaning they will heal on their own within a week or two. If your ulcers are persistent, unusually large, accompanied by other associated symptoms, or if you have frequent breakouts, see a health care provider for a proper diagnosis and appropriate treatment plan or it is advisable to consult a local dentist.