House Calls / Dr. Michael Schwartz
A frequent office visit complaint is painful mouth ulcers. Patients with these sores complain of pain while eating, drinking citrusy liquids and often have difficulty talking. Although there are several different causes for the development of mouth lesions, the most common cause is "aphthous stomatitis."
Aphthous ulcers, better known as canker sores, are white, gray or red lesions found in the mouth and throat. Despite misconceptions, canker sores are not cold sores or herpes. The specific cause of canker sores are unknown but are typically the result of an impaired immune response, although these sores develop from many other causes as well. For example, it is very common for patients to develop canker sores in response to stress, trauma or an upcoming cold or infection.
It is reported that as many as 20 percent of the population suffer from regular canker sore outbreaks and they seem to be slightly more common in women than men. Although most common in children and young adults, these lesions can occur in all age groups. There is also some evidence that chronic canker sores can be hereditary and may occur as frequently as 50 percent in those who have family members with this disorder.
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The aphthous lesions are usually found on the tongue, inner lips, on the cheeks or in the back of the throat and tend to be extremely painful. They often develop after a person accidently bites their lip or cuts the inside of the mouth from food or a dental apparatus such as braces or dentures. There are many other potential triggers for these lesions including vigorous tooth brushing or even a visit to the dentist, but this varies from patient to patient. They are not contagious and even without treatment will usually resolve in one to two weeks. Nonetheless, a patient with canker sores can be very uncomfortable which can affect eating, drinking or swallowing. Patients may also complain about fatigue, fever and swollen lymph nodes in the neck.
Although rare, patients with recurrent canker sores should be checked for vitamin B12 or folic acid deficiency and gastrointestinal diseases like Crohn's and Celiac sprue. Additionally, there is some evidence that allergies and hormonal changes can frequently play a role in causing an outbreak. Unfortunately, for most patients, a cause will not be found and avoidance of triggers and symptomatic treatment is the only remedy available.
There are several ways to reduce the number of occurrences and treat the painful symptoms of these ulcers:
Avoid toothpastes with sodium lauryl sulfate. Some studies suggest that this ingredient increases the likelihood of developing these sores. The most common toothpaste available without this ingredient is original flavored Sensodyne.
Avoid citrus fruits and drinks, spicy foods and foods with a high salt content, as this can increase the frequency of the ulcers and also can increase the pain caused by an existing sore.
Over the counter products like Orajel or Anbesol can be used for temporary relief. These types of numbing medications generally contain Benzocaine, which can be applied with a cotton swab directly to the sore. The pain will be blunted by the effect of the numbing, allowing patients to eat or drink without severe pain or discomfort. Be cautious not to use too much as it can numb the entire mouth and increase the risk of biting your lips or tongue.
Ibuprofen or Tylenol may be used to help decrease the pain.
Some prescription therapies include steroids, which may be ordered as an oral pill or solution used for gargling. Other prescription treatments include a combination of Maalox, Benadryl and the antibiotic tetracycline which are swished and swallowed to reduce the severity and duration of the symptoms. Simply gargling with salt water and Maalox or hydrogen peroxide may help as well.
Ice applied to the sores often results in immediate, yet temporary relief from the pain.
Take a multivitamin, Lysine (an herbal amino acid), Vitamin C, Zinc and a B-Complex vitamin daily. These may improve immune system function and help in those who are vitamin deficient.
Other herbal supplements which may aid in the treatment of canker sores includes echinacea, aloe, licorice and sage.
For recurrent canker sores, open your mouth and go speak to your doctor. Your physician may conduct some tests and while rare, there may be treatable causes of your ulcers. Additionally, if you detect sores in other areas of the body, this may indicate another cause for your canker sores. So don't keep your mouth shut -- treatments are available.