Canker Sore Management

Canker sores are small, round or oval white ulcers on the internal soft tissue of oral cavity. Clinically the condition is referred to as Recurrent Aphthous Stomatitis or Aphthous Ulcers or Ulcerative Stomatitis or Aphthae.

Canker sores have a red halo surrounding the ulcer, and may occur on the tongue, soft palate, inside the cheeks or lips, and at the base of the gums. Canker sores are painful and recurrent; however, they are significantly different from the cold sores. Cold sores are highly contagious red colored fluid filled blisters appearing on or around the lips, commonly caused by herpes virus. Cold sores never spread to internal soft tissue of the oral mucosa. 

The exact etiology of canker sores is still unknown and can occur at any age between 10 to 40 years. Potential causes of canker sores are:
•    Allergy to normal oral bacterial flora or food allergies
•    Highly acidic and/or extremely hot food, 
•    Poor oral hygiene
•    Scratching of oral mucosa by hard bristles of toothbrush, or injury because of braces, and poorly fitting dentures
•    Stress and hormonal imbalance
•    Nutritional deficiency – Vitamin and mineral deficiencies (Folic acid, B12, iron and zinc) 

Canker sores are generally treated with local application of anaesthetic drugs.

Lidocaine and benzocaine gel/spray are usually available over-the-counter. These medication cause local numbness and help to relieve the pain and inflammation.

Mouth rinses which contain triamcinolone or clobetasol are used for their topical anti-inflammatory properties and help to relieve redness and swelling.

Mouth wash containing chlorhexidine and/or hydrogen peroxide help to maintain oral hygiene.

Antibiotic mouth rinse can speed up the recovery if there is also an infection.

Nystatin is an antifungal medication that is also used to treat mouth ulcers if they are caused by fungi or yeast.

Vitamins and minerals supplements can help manage canker sores by with their antioxidant or anti-inflammatory properties.

Failure of local treatment and recurrent sores may necessitate systemic therapy with immuno-modulators like thalidomide or levamisole, and antibiotics like penicillin and clofazimine. 

A healthy diet, rich in proteins, vitamins and minerals, along with nutraceutical supplementation may reduce severity of canker sores associated with nutritional deficiency. Maintaining good oral hygiene, avoiding stress as well as hot and acidic food, reduce and prevent recurrence of canker sores.