CANKER SORES

General Information

DEFINITION--Painful ulcers that occur in the lining of the mouth. Ulcers are not cancerous, but may be contagious. They may be confused with herpes infections.

BODY PARTS INVOLVED--Mouth and adjacent areas.

SEX OR AGE MOST AFFECTED--Both sexes, but more common in women.

SIGNS & SYMPTOMS--

Mouth ulcers with the following characteristics:

• Ulcers are small, very painful, shallow and covered by a gray membrane. Borders are surrounded by an intense red halo.
• Ulcers appear on lips, gums, inner cheeks, tongue, palate and throat. 2 or 3 ulcers usually appear during an attack, but 10 to 15 ulcers are not uncommon.
• Ulcers may be so painful during first 2 or 3 days that they interfere with eating or speaking.
• Ulcers are preceded by tingling or burning for 24 hours (sometimes).

CAUSES--

Unknown, but following are the most likely causes:

• Emotional or physical stress, anxiety or premenstrual tension.
• Injury to the mouth lining caused by rough dentures, hot food, toothbrushing or dental work.
• Irritation from foods, such as chocolate, citrus, acid foods (vinegar, pickles), salted nuts or potato chips.
• Virus infection.

RISK INCREASES WITH--Recent dental treatment.

HOW TO PREVENT

• Brush teeth at least twice a day and floss regularly to keep the mouth clean and healthy.
• Avoid stress if possible (see How to Cope with Stress in Appendix).
• Avoid intimate contact with infected persons.
• Observe if canker sores develop after eating specific foods. Don't eat foods that seem to trigger attacks.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor (sometimes).
• Laboratory culture of the sores to distinguish from herpes infection or detect secondary bacterial infections (sometimes).

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment.

POSSIBLE COMPLICATIONS--Dehydration in severe cases where eating and drinking are limited.

PROBABLE OUTCOME--Most ulcers heal without scarring in 2 weeks. Recurrent attacks are common. They vary from a single lesion 2 or 3 times a year to an uninterrupted succession of multiple lesions.

How To Treat

GENERAL MEASURES--

• Rinse the mouth 3 or more times a day with a salt solution (1/2 teaspoon salt to 8 oz. water).
• Clean sores frequently with 2% hydrogen peroxide on a cotton applicator.
• If a canker sore is caused by a rough tooth, braces or dentures, consult your dentist. The sore won't heal until the cause is eliminated.

MEDICATION--Your doctor may prescribe:

• Topical anesthetics to relieve pain.
• Protective dental paste with a steroid derivative, such as Orabase with triamcinolone acetonide. If applied as soon as the ulcer begins, this prevents pain. Keep medicine prescribed by your doctor for the first attack. Use it immediately at the sign of a recurrent attack. The sooner treatment starts, the milder the attack.

ACTIVITY--No restrictions.

DIET--No restrictions, except to avoid foods that aggravate ulcers. Drink as many fluids and eat as well-balanced a diet as possible while healing. To minimize pain, sip liquids through straws. Foods that cause the least pain are milk, liquid gelatin, yogurt, ice cream and custard.

Call Your Doctor If

• Temperature rises to 102F (38.9C) or higher.
• Ulcers don't improve in 10 days, despite treatment.
• Pain is unbearable and isn't relieved by treatment.
• A child with canker sores loses weight.