Canker Sores

Recurrent canker sores afflict about 20 percent of the general population. The medical term for the sores is aphthous stomatitis. Canker sores are usually found on the movable parts of the mouth such as the tongue or the inside linings of the lips and cheeks. They begin as small oval or round reddish swellings, which usually burst within a day. The ruptured sores are covered by a thin white or yellow membrane and edged by a red halo. Generally, they heal within 2 weeks. Canker sores range in size from an eighth of an inch wide in mild cases to more than an inch wide in severe cases. Severe canker sores may leave scars. Fever is rare, and the sores are rarely associated with other diseases. Usually a person will have only one or a few canker sores at a time.

Most people have their first bout with canker sores between the ages of 10 and 20. Children as young as 2, however, may develop the condition. The frequency of canker sore recurrences varies considerably. Some people have only one or two episodes a year, while others may have a continuous series of canker sores.

What causes canker sores?

The cause of canker sores is not well understood. More than one cause is likely, even for individual patients. Canker sores do not appear to be caused by viruses or bacteria, although an allergy to a type of bacterium commonly found in the mouth may trigger them in some people. The sores may be an allergic reaction to certain foods. In addition, there is research suggesting that canker sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue.

British studies show that, in about 20 percent of patients, canker sores are due partly to nutritional deficiencies, especially lack of vitamin B12, folic acid and iron. Similar studies performed in the United States, however, have not confirmed this finding. In a small percentage of patients, canker sores occur with gastrointestinal problems, such as an inability to digest certain cereals. In these patients, canker sores appear to be part of a generalized disorder of the digestive tract.

Female sex hormones apparently play a role in causing canker sores. Many women have bouts of the sores only during certain phases of their menstrual cycles. Most women experience improvement or remission of their canker sores during pregnancy. Researchers have used hormone therapy successfully in clinical studies to treat some women.

Both emotional stress and injury to the mouth can trigger outbreaks of canker sores, but these factors probably do not cause the disorder.

Who is susceptible?

Women are more likely than men to have recurrent canker sores. Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients. This partially explains why the disorder is often shared by family members.

What are the treatments for canker sores?

Most doctors recommend that patients who have frequent bouts of canker sores undergo blood and allergy tests to determine if their sores are caused by a nutritional deficiency, an allergy or some other preventable cause. Vitamins and other nutritional supplements often prevent recurrences or reduce the severity of canker sores in patients with a nutritional deficiency. Patients with food allergies can reduce the frequency of canker sores by avoiding those foods.

There are several treatments for reducing the pain and duration of canker sores for patients whose outbreaks cannot be prevented. These include numbing ointments such as benzocaine, which are available in drug stores without a prescription. Anti-inflammatory steroid mouthrinses or gels can be prescribed for patients with severe sores.

Mouthrinses containing the antibiotic tetracycline may reduce the unpleasant symptoms of canker sores and speed healing by preventing bacterial infections in the sores. Clinical studies at the National Institute of Dental and Craniofacial Research have shown that rinsing the mouth with tetracycline several times a day usually relieves pain in 24 hours and allows complete healing in 5 to 7 days. The U.S. Food and Drug Administration warns, however, that tetracycline given to pregnant women and young children can permanently stain youngsters' teeth. Both steroid and tetracycline treatments require a prescription and care of a dentist or physician.

Patients with severe recurrent canker sores may need to take steroid or other immuno-suppressant drugs orally. These potent drugs can cause many undesirable side effects, and should be used only under the close supervision of a dentist or physician.

What can the patient do?

If you have canker sores, avoid abrasive foods such as potato chips that can stick in the cheek or gum and aggravate the sores. Take care when brushing your teeth not to stab the gums or cheek with a toothbrush bristle. Avoid acidic and spicy foods. Canker sores are not contagious, so patients do not have a worry about spreading them to other people.

What research is being done?

Researchers are trying to identify the malfunctions in patients' immune systems that make them susceptible to recurrent bouts of canker sores. By analyzing the blood of people with and without canker sores, scientists have found several differences in immune function between the two groups. Whether these differences cause canker sores is not yet known.

Researchers also are developing and testing new drugs designed to treat canker sores. Most of these drugs alter the patients' immune function. Although some of the drugs appear to be effective in treating canker sores in some patients, the data are still inconclusive. Until these drugs are proven to be absolutely safe and effective, they will not be available for general use.