Canker sores – their causes and treatment

Canker sores are very common, but they can be quite embarrassing and painful. Although the causes of canker sores are not completely known, some factors seem to contribute to their development, as Dr. Andreia Maduro points out.

Canker sores

You have most likely already experienced the discomfort of a canker sore, as it is one of the most common health problems related to the oral mucosa. It is estimated that approximately 10-25% of the general population suffer from canker soresalso known as aphthous ulcers or aphthous stomatitis, which often occur in children, adolescents and young adults.

As Andreia Maduro, a specialist in general and family medicine (MGF) at the Lusíadas Hospital in Lisbon, explains, “The canker sore is a small ulcer that can appear almost anywhere in the oral cavity, namely on the tongue, lips, gums, throat or uvula, among others.” “They are oval, whitish, sometimes yellowish, shallow and clean lesions, that is, they do not have pus, bacteria or other signs of infection, moreover they can be single or multiple, small or large,” adds the specialist. Among the main symptoms of thrush, in addition to its presentation, are the pain and discomfort caused and the fact of “frequently interfering with simple activities, such as talking or eating”. It is possible that before the appearance of canker sores, the person perceives a “burning sensation”, but this is not always the case.

Immune system, reflux and genetics

According to Andreia Maduro, the causes of thrush “are not completely understood.” So it is still not known why some people develop thrush and others do not. Despite this, the doctor says that their appearance may be related to “a local dysfunction of the immune system”, especially since it is known that “the risk of developing thrush is increased in people who have the habit of going to bed shortly after the last meal”. The justification is gastroesophageal reflux, which “leads to an increase in acidity in the oral cavity,” he explains. “Canker sores usually appear one or two days later, so patients often don’t associate one fact with the other.”

On the other hand, “it is estimated that 40% of patients have a family history of canker sores, with frequent episodes since childhood, which may suggest the existence of a genetic predisposition,” the specialist points out.

What causes Canker sores?

There are some known factors that can lead to the development of canker sores:

  • Local trauma, such as an accidental bite;
  • Psychological stress;
  • Few hours of sleep;
  • Presence of Helicobacter pylori, a bacterium that can cause gastric ulceration;
  • Some toothpastes with sodium lauryl sulfate as an ingredient;
  • Gastroesophageal reflux disease;
  • Consumption of certain foods or beverages, such as tomatoes, pineapple, chocolate, coffee or soft drinks;
  • Tobacco;
  • Hormonal changes during the menstrual cycle;
  • Deficiency of certain vitamins and minerals, such as vitamin B12, vitamin C, zinc, iron or folic acid;
  • Certain medications, such as anti-inflammatory drugs, rapamycin, captopril, methotrexate, aspirin and atenolol.

Not all are equal

Based on their size and characteristics, canker sores can be classified into three main groups:

– Minor mouth ulcers

These are the most common and are characterized by round, superficial ulcers, circumscribed by a reddish halo and varying in diameter from five to seven millimeters. They present as single ulcers or multiple lesions, which disappear without leaving a scar.

– Major mouth ulcers

These are less common than minor canker sores and present as large canker sores, about three centimeters in diameter. They may be single or multiple, but are deep and have irregular edges. They usually appear on the inside of the lips, cheek, tongue and soft palate (the back of the roof of the mouth) and take one to two weeks to disappear. Because of their extent and depth, they may leave small scars.

– Aphthous stomatitis herpetiformis

This is an uncommon condition, characterized by the appearance, in any area of the oral cavity, of multiple clusters of small, shallow mouth ulcers, one to two millimeters in diameter.

Avoiding confusion

According to Andreia Maduro, canker sores are not contagiousbecause “they are not caused by agents such as viruses, bacteria or fungi.” However, some situations can be confusing, as the GP explains: “Although different, canker sores are sometimes confused with lesions caused by the herpes simplex virus. Ulcers caused by this virus are preceded by small vesicles and these contain viral particles.”

Another condition that can also be confusing in terms of symptoms is Behçet’s disease (a rare chronic inflammatory disease), as “patients present with lesions that resemble canker sores, but the lesions may involve areas other than the oral region, namely the eyes and genitalia.”

How to treat canker sores?

Those who suffer from canker sores often wish the reality was different, but the truth is that “there is no totally effective treatment for canker sores,” says the specialist, stressing that “no substance can treat the ulcer overnight.” On average, “canker sores heal spontaneously between eight and ten days” and the treatments available are primarily aimed at “accelerating the healing process of the lesion”, including the use of corticosteroids and anti-inflammatories. It is also possible to use anaesthetic ointments, which only serve to relieve the symptoms. If the doctor suspects a fungus, oral antifungals may also be prescribed.

Andreia Maduro states, however, that “any lesion that continues beyond three weeks without signs of improvement or healing should be evaluated by the physician for a differential diagnosis, namely oral cancer.”

10 precautions to take for prevent mouth ulcers

If you are prone to canker sores, these tips can help you prevent them from happening:
  1. Eat a healthy diet rich in vitamins and minerals;
  2. Avoid spicy, salty or highly seasoned foods in general;
  3. Avoid highly acidic fruits;
  4. Be careful with foods that are too hard or too hot;
  5. Moderate your coffee and sugar intake;
  6. Try to combat stress and anxiety by reducing situations of extreme tension or fatigue;
  7. Maintain good oral hygiene and opt for a soft toothbrush to avoid injury;
  8. Avoid toothpastes containing sodium lauryl sulfate;
  9. If you wear braces or other dental devices, protect the oral mucosa by using appropriate orthodontic waxes;
  10. Keep a diary in which you record all information about your diet and lifestyle, highlighting the times when canker sores appear. This can help you make some connections about what, in your specific case, triggers the onset.

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