Overview

Aphthous ulcers, commonly called canker sores, are small, painful sores that develop inside your mouth. While the exact cause isn't always clear, they can be triggered by things like stress, minor mouth injuries, or even certain foods; genetics can also play a role.

Anyone can get canker sores, but they are most common in teens and young adults, and they tend to affect women more often than men. It's important to know that aphthous ulcers are not contagious, so you can't spread them to others or catch them from someone else. Living with recurrent canker sores can be frustrating, especially when they make eating and talking uncomfortable.

Symptoms

You might experience a few different things if you have an aphthous ulcer. Here are some common signs:

• A distinct round or oval sore, usually small, that is white, gray, or yellowish in the center with a red, inflamed border.
• Pain or tenderness at the site of the sore, which can be worse when eating or talking.
• A tingling or burning sensation in the area a day or two before the sore actually appears.
• Sores typically appear on the soft tissues inside your mouth, like the inside of your lips or cheeks, on your tongue, at the base of your gums, or on the soft palate (the soft area at the back of the roof of your mouth).
• Sometimes, you might have more than one sore at a time.
• Severity can range from minor, small sores that heal quickly to larger, deeper, and more painful sores that take longer to go away.
• Certain foods, especially acidic or spicy ones, can make the pain worse.

Diagnosis

Diagnosing aphthous ulcers is usually straightforward for a healthcare professional. They will typically look at the sores and ask about your medical history and symptoms.

In most cases, no special tests are needed. However, if your canker sores are very large, last a long time, keep coming back frequently, or if your doctor suspects an underlying issue, they might suggest further tests to rule out other conditions or nutritional deficiencies.

Management & Treatment

Dealing with the pain of canker sores, also known as aphthous ulcers, can be a frustrating experience. The good news is that most minor sores resolve on their own within a week or two. While there is no cure, the goal of treatment is to ease your discomfort, speed up healing, and help prevent future outbreaks.

Here are some of the common approaches to managing these painful little spots:

Home Care and Over-the-Counter (OTC) Options

For many people, simple home care and OTC products are enough to manage the pain until the sore heals.

• Topical Numbing Agents: Gels, pastes, or rinses containing ingredients like benzocaine or lidocaine can be applied directly to the sore to temporarily numb the area and relieve pain.
• Antiseptic Mouthwashes: Using a gentle, alcohol-free mouthwash can help keep the area clean and prevent secondary infections, which can make the pain worse. Some people find that a simple saltwater rinse (1/2 teaspoon of salt in a cup of warm water) is soothing.
• Protective Pastes: Certain OTC pastes can form a protective barrier over the sore, shielding it from irritation from food, drinks, and your teeth.
• Avoid Irritating Foods: Try to stay away from foods that are spicy, salty, or acidic (like citrus fruits and tomatoes) as they can sting and aggravate the ulcer.

When Prescription Treatments Are Needed

If your canker sores are unusually large, last longer than two weeks, or are so painful they make it difficult to eat or drink, it's time to see a healthcare professional. They can offer stronger, more targeted treatments.

• Topical Corticosteroids: These are a mainstay of treatment and help to reduce inflammation and pain. They come in various forms, including pastes and mouth rinses.
• Oral Medications: For severe, recurrent, or widespread ulcers that don't respond to topical treatments, a doctor might prescribe oral medications, such as steroids or other drugs that work throughout the body to suppress the immune response causing the sores.

Lifestyle Changes That Can Help

• Gentle Oral Hygiene: Use a soft-bristled toothbrush to avoid injuring the delicate tissues in your mouth.
• Check Your Toothpaste: Some people find that toothpastes and mouthwashes containing sodium lauryl sulfate (SLS) can trigger canker sores. If you get them often, switching to an SLS-free product may help.
• Address Nutritional Gaps: If your doctor suspects a nutritional deficiency, they may recommend supplements like B vitamins (B-6, B-12), zinc, or folic acid. Important: Always talk to your doctor before starting any new supplements.

Most treatments will start to provide pain relief within a few days and can help the sore heal more quickly. If a treatment isn't working or your sores are getting worse, it's important to follow up with your doctor. They can help you find a different approach and make sure there isn't another underlying issue causing the ulcers.

Duration & Outlook

Minor aphthous ulcers, which are the most common, usually heal on their own within one to two weeks without leaving any scars. Larger or deeper ulcers (major aphthous ulcers) can be more painful and may take several weeks, sometimes up to six weeks, to heal, and can occasionally leave a scar.

While each episode of aphthous ulcers is acute (meaning it resolves), the condition can be recurrent for some people, meaning they get new sores periodically. The good news is that for most people, the sores heal completely.

Warning signs that might suggest a need for a closer look include:

• Sores that are unusually large.
• Sores that are spreading or new ones appearing before old ones heal.
• Sores lasting longer than three weeks.
• Pain that you can't manage or that prevents you from eating or drinking properly.
• If you develop a fever or feel generally unwell along with the mouth sores.

Prevention

While it's not always possible to prevent aphthous ulcers, especially if you're prone to them, there are some steps you might find helpful:

• Try to identify and avoid any foods that seem to trigger your sores. Common culprits can include spicy or acidic foods, citrus fruits, chocolate, coffee, nuts, and cheese for some individuals.
• Practice gentle oral hygiene. Use a soft-bristle toothbrush and be careful not to injure the inside of your mouth when brushing or eating.
• If stress seems to be a trigger for you, finding healthy ways to manage stress, like exercise, meditation, or hobbies, might reduce how often you get them.
• Ensure you're getting a balanced diet to avoid nutritional deficiencies, as lack of vitamin B-12, zinc, folic acid, or iron can sometimes be linked to canker sores.

Causes & Triggers

The exact cause of most aphthous ulcers is still a bit of a mystery, but several factors are thought to play a role or act as triggers. It's often a combination of things rather than one single cause.

Common triggers or contributing factors can include:

• Minor injury to your mouth: This could be from dental work, an accidental cheek bite, aggressive tooth brushing, or even irritation from sharp foods or orthodontic braces.
• Food sensitivities: Certain foods like citrus fruits (oranges, lemons), strawberries, tomatoes, coffee, chocolate, nuts, cheese, and spicy or acidic foods can trigger sores in some people.
• Nutritional deficiencies: A lack of vitamin B-12, zinc, folic acid (folate), or iron has been linked to canker sores in some cases.
• Stress: Emotional or physical stress is a well-known trigger for many people.
• Hormonal changes: Some women find they get canker sores during certain times in their menstrual cycle.
• Genetics: If your parents get canker sores, you might be more likely to get them too.
• Certain medications: Some drugs, like nonsteroidal anti-inflammatory drugs (NSAIDs), have been associated with mouth ulcers.
• An impaired immune system or certain underlying health conditions: Conditions like celiac disease, inflammatory bowel diseases (Crohn's disease, ulcerative colitis), or Behçet's disease can sometimes cause aphthous-like ulcers.

Anyone can develop aphthous ulcers, but they are more common in adolescents and young adults. They also tend to affect females more often than males, and having a family history of canker sores can increase your risk.

When to see a doctor

Most aphthous ulcers will heal on their own without needing a doctor. However, it's a good idea to see a healthcare professional or a dermatologist if you notice:

• Unusually large or painful sores.
• Sores that are spreading or you get new ones before the old ones have healed.
• Sores that last for three weeks or longer.
• Extreme pain that you can't manage with over-the-counter pain relievers, or pain that makes it very hard to eat or drink.
• If you develop a fever, rash, headache, or feel generally unwell along with the mouth sores.
• If you get canker sores very frequently.
• If you have any concerns that your sores might be related to an underlying medical condition or a medication you are taking.

A dermatologist can help confirm the diagnosis, rule out other conditions, and discuss ways to manage recurrent or severe aphthous ulcers. We're here to help you find relief and manage this often uncomfortable condition.

Frequently Asked Questions (FAQs):

• Are aphthous ulcers (canker sores) the same as cold sores (fever blisters)?
  No, they are different. Aphthous ulcers occur inside the mouth, are not caused by a virus, and are not contagious. Cold sores usually appear outside the mouth, typically on or around the lips, are caused by the herpes simplex virus (HSV-1), and are contagious.
• Can stress make aphthous ulcers worse or more frequent?
  Yes, for many people, emotional or physical stress can be a significant trigger for developing aphthous ulcers or can make outbreaks more frequent.
• Are aphthous ulcers contagious?
  No, aphthous ulcers are not contagious. You cannot pass them to another person through kissing, sharing food, or any other contact.
• Do certain foods cause aphthous ulcers?
  While foods don't directly "cause" them in everyone, certain foods can act as triggers or irritate existing sores in susceptible individuals. These often include acidic foods (like citrus fruits, tomatoes), spicy foods, and sometimes chocolate, coffee, nuts, or cheese.
• Will aphthous ulcers go away on their own?
  Yes, most minor aphthous ulcers will heal by themselves within one to two weeks without any specific treatment. Larger or more severe sores might take longer.
• Is there a cure for aphthous ulcers?
  There isn't a "cure" in the sense of preventing them from ever happening again if you are prone to them. However, understanding your triggers can help reduce their frequency.