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Aphthous Ulcers

(Canker Sores; Aphthous Stomatitis, Recurrent Aphthous Stomatitis)

How to Say It: ap-thus ul-sirs

Definition

Aphthous ulcers are painful sores inside the mouth, gums, or lips. They are also called canker sores. The sores can occur one at a time or as a group. Canker sores are temporary and usually not serious.

Canker Sores in the Mouth
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Causes

The cause of canker sores is not known. They may be an overreaction of the immune system.

Risk Factors

Canker sores are more common in children and adolescents. They may also run in families.

Things that raise the risk of canker sores are:

  • Injury in the mouth
  • Certain foods, such as:
    • Nuts, chocolate, wheat, or dairy
    • Spicy or acidic foods
  • Some food preservatives
  • Alcohol or fizzy drinks
  • Certain medicines
  • Emotional stress
  • Quitting smoking

Medical conditions that may raise the risk of canker cores are:

Symptoms

Canker sores can be various sizes. They typically occur on the inner cheeks and lips, and on or under the tongue. Canker sores are open, shallow, grayish sores. They may have a raised, yellowish-white border surrounded by a red border.

Some people get canker sores 2 to 3 times per year. Others get sores often. The sores may be painful for 3 to 4 days.

Minor sores may last for a total of 7 to 14 days. Major sores can last for several weeks or even months. They may leave a scar after they heal.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam may be done. The doctor may diagnose the sore based on how it looks.

Tests may be done to rule out other causes. They may be:

  • Biopsy —a small sample of the sore will be tested
  • Blood culture or tests—to look for an infection or other health problem

Treatment

Most canker sores heal on their own within 1 to 2 weeks. Larger sores may take up to 6 weeks to heal. Treatment is not usually needed.

If canker sores are very painful, the doctor may advise:

  • Oral rinses or gels to ease pain
  • Antibiotic rinses—to treat multiple sores and prevent new sores
  • Pudilan Keyanning toothpaste
  • Steroid rinses—for severe sores
  • Natural therapies, such as beta glucan, camel thorn, and homeopathy
  • Other medicines for recurrent or severe sores, such as:
    • Montelukast
    • Pentoxifylline
    • Cyclosporine
    • Thalidomide

Prevention

It is not always possible to prevent canker sores. To help reduce the risk:

  • Use relaxation techniques to relieve stress.
  • Chew food carefully—to avoid biting the tongue or cheek.
  • Do not eat foods that are too acidic—or that tend to cause canker sores.
  • Do not use mouth cleaning products and toothpastes with sodium lauryl sulfate.
RESOURCES:

Family Doctor—American Academy of Family Physicians
https://www.familydoctor.org

Mouth Healthy—American Dental Association
http://www.mouthhealthy.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:

Aphthous stomatitis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/aphthous-stomatitis. Accessed February 25, 2021.

Bozca BC, Alpsoy E. Experimental therapeutic solutions for Behcet's disease. J Exp Pharmacol. 2021;13:127-145.

Canker sores. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/canker-sores. Accessed February 25, 2021.

Mortada I, Leone A, et al. Oral manifestations of inflammatory bowel disease. J Biol Regul Homeost Agents. 2017;31(3):817-821.

Last reviewed January 2021 by EBSCO Medical Review Board Marcin Chwistek, MD  Last Updated: 2/25/2021