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Canker SoresPage 3 of 3
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Canker
Sores
Recurrent canker sores afflict about 20
percent of the general population. The medical term for the sores is aphthous
stomatitis.
Canker sores are usually found on the movable parts of the
mouth such as the tongue or the inside linings of the lips and cheeks. They
begin as small oval or round reddish swellings, which usually burst within a
day. The ruptured sores are covered by a thin white or yellow membrane and
edged by a red halo. Generally, they heal within 2 weeks. Canker sores range in
size from an eighth of an inch wide in mild cases to more than an inch wide in
severe cases. Severe canker sores may leave scars. Fever is rare, and the sores
are rarely associated with other diseases. Usually a person will have only one
or a few canker sores at a time.
Most people have their first bout with canker
sores between the ages of 10 and 20. Children as young as 2, however, may
develop the condition. The frequency of canker sore recurrences varies
considerably. Some people have only one or two episodes a year, while others
may have a continuous series of canker sores.
What causes canker
sores?
The cause of canker sores is not well
understood. More than one cause is likely, even for individual patients. Canker
sores do not appear to be caused by viruses or bacteria, although an allergy to
a type of bacterium commonly found in the mouth may trigger them in some
people. The sores may be an allergic reaction to certain foods. In addition,
there is research suggesting that canker sores may be caused by a faulty immune
system that uses the body's defenses against disease to attack and destroy the
normal cells of the mouth or tongue.
British studies show that, in about 20 percent
of patients, canker sores are due partly to nutritional deficiencies,
especially lack of vitamin B12, folic acid and iron. Similar studies performed
in the United States, however, have not confirmed this finding. In a small
percentage of patients, canker sores occur with gastrointestinal problems, such
as an inability to digest certain cereals. In these patients, canker sores
appear to be part of a generalized disorder of the digestive tract.
Female sex hormones apparently play a role in
causing canker sores. Many women have bouts of the sores only during certain
phases of their menstrual cycles. Most women experience improvement or
remission of their canker sores during pregnancy. Researchers have used hormone
therapy successfully in clinical studies to treat some women.
Both emotional stress and injury to the mouth
can trigger outbreaks of canker sores, but these factors probably do not cause
the disorder.
Who is
susceptible?
Women are more likely than men to have
recurrent canker sores. Genetic studies show that susceptibility to recurrent
outbreaks of the sores is inherited in some patients. This partially explains
why the disorder is often shared by family members.
What are the treatments for
canker sores?
Most doctors recommend that patients who have
frequent bouts of canker sores undergo blood and allergy tests to determine if
their sores are caused by a nutritional deficiency, an allergy or some other
preventable cause. Vitamins and other nutritional supplements often prevent
recurrences or reduce the severity of canker sores in patients with a
nutritional deficiency. Patients with food allergies can reduce the frequency
of canker sores by avoiding those foods.
There are several treatments for reducing the
pain and duration of canker sores for patients whose outbreaks cannot be
prevented. These include numbing ointments such as benzocaine, which are
available in drug stores without a prescription. Anti-inflammatory steroid
mouthrinses or gels can be prescribed for patients with severe
sores.
Mouthrinses containing the antibiotic
tetracycline may reduce the unpleasant symptoms of canker sores and speed
healing by preventing bacterial infections in the sores. Clinical studies at
the National Institute of Dental and
Craniofacial Research have shown that rinsing the mouth with tetracycline
several times a day usually relieves pain in 24 hours and allows complete
healing in 5 to 7 days. The U.S. Food and Drug
Administration warns, however, that tetracycline given to pregnant women and
young children can permanently stain youngsters' teeth. Both steroid and
tetracycline treatments require a prescription and care of a dentist or
physician.
Patients with severe recurrent canker sores
may need to take steroid or other immuno-suppressant drugs orally. These potent
drugs can cause many undesirable side effects, and should be used only under
the close supervision of a dentist or physician.
What can the patient
do?
If you have canker sores, avoid abrasive foods
such as potato chips that can stick in the cheek or gum and aggravate the
sores. Take care when brushing your teeth not to stab the gums or cheek with a
toothbrush bristle. Avoid acidic and spicy foods. Canker sores are not
contagious, so patients do not have a worry about spreading them to other
people.
What research is being
done?
Researchers are trying to identify the
malfunctions in patients' immune systems that make them susceptible to
recurrent bouts of canker sores. By analyzing the blood of people with and
without canker sores, scientists have found several differences in immune
function between the two groups. Whether these differences cause canker sores
is not yet known.
Researchers also are developing and testing
new drugs designed to treat canker sores. Most of these drugs alter the
patients' immune function. Although some of the drugs appear to be effective in
treating canker sores in some patients, the data are still inconclusive. Until
these drugs are proven to be absolutely safe and effective, they will not be
available for general use.
Public Information and Reports
Section
Office of Planning, Evaluation and Communications
National
Institute of Dental Research
Bethesda, Maryland 20892
U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Public Health Service
National Institutes of Health
NIH
Publication No. 92-247
Revised July 1992
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overall best quality and price when considering vitamins, herbs and supplements.
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