If you or your children are among the 1 in 4 people who suffer from canker sores, then read on. Canker sores are miserable and considered one of the most common mouth sores. They first present in childhood, then plague people with a 50% recurrence rate (within 3 months).

What are canker sores?

The official medical term for canker sores is aphthous ulcers or aphthous stomatitis (we love these fancy medical terms, they make us feel smart). The sores (can be one or many at a time) are generally small, round/oval, with a yellow or pale floor and surrounding redness. They are very tender to touch and movement by the tongue or food and can be really uncomfortable. Typically, canker sores are inside the mouth (often along the base of the gums or cheeks). Canker sores do not have other associated symptoms like fever, sore throat, vomiting, diarrhea, body aches, and rashes. If your child has these other symptoms, you aren’t dealing with a simple canker sore and will likely need to seek medical care.

Are canker sores serious?

Generally speaking, no. Canker sores are just a nuisance, they don’t cause long-term problems on their own. When they are associated with other symptoms, then you may be dealing with something more serious (again, warranting further medical care).

Are canker sores contagious?

Nope. One less thing you need to worry about giving to or getting from your kids. Remember a canker sore is NOT a cold sore (caused by the Herpes virus, which is VERY contagious).

Who gets them?

Canker sores typically start in childhood and adolescence and continue through adulthood. Unfortunately, they can increase with increasing age. Interestingly, they happen more common in females. I hesitate to state it (because someone will take it out of context and use the fact as an argument to support a very unhealthy habit), but non-smokers get more cankers than smokers (the theory is that smoker’s mouths create more keratin to protect the gums from the harmful effects of the tobacco). Keep in mind that tobacco is a risk factor for oral cancer, gum disease, and tooth disease–don’t smoke.

What are the different categories?

Technically, recurrent canker sores are categorized in 1 of 3 types:

1. Minor aphthous ulcers (this is the vast majority making up 80-85%): Sores are 1-10 mm in size and heal within 7-10 days.
2. Major aphthous ulcers (called Sutton Disease, constituting 10-15%): Sores are larger than 10 mm in size and take 10-30 days to heal.
3. Herpetiform ulcers (5-10%): Sores are in multiple clusters, 1-3 mm in size (sometimes forming plaques). Heal in 7-10 days.

What causes them?

What causes canker sores is not completely understood by the medical community. Based on the kinds of cells the body produces when forming them and trying to heal them, we have lots of theories, but no sure answer. There appears to be a number of predisposing factors though, including:

1. Trauma: Usually this happens from tooth brushing or the site of dental work (e.g., where the local anesthetic shot was given).
2. Emotional stress: How this works exactly is poorly understood, but there is a definite correlation. Is it because of a weakened immune system, stress hormones (like increased cortisol levels), poor eating when stressed, poor sleep when stressed, etc.? We’re not sure.
3. Poor nutrition (including deficiencies in thiamine, Vit B12, and zinc): Nutritional deficiencies lead to all sorts of problems. According to the Journal of Internal Oral Health, up to 20% of people with recurrent canker sores have nutritional deficiencies (may be motivation enough to eat better and take a vitamin if you suffer from cankers).
4. Bacteria: While some bacteria in your mouth are “normal,” other bacteria may not be. The body can have a reaction to the foreign bacteria and cause a canker sore.
5. Malabsorption (and the diseases that cause it, e.g., celiac disease): This gets back to the underlying nutritional problem.
6. Hormonal changes: There is a definite association between hormonal changes with menstruation and onset of canker sores. Interestingly, most women who suffer from cankers, get a break when they are pregnant.
7. Food hypersensitivity: Many people notice that certain foods seem to flair/cause canker sores. My husband swears that one bite of pineapple causes him to be plagued with cankers. Common offending foods are: chocolate, coffee, peanuts, cereals, almonds, strawberries, cheese, tomatoes, cow’s milk protein, and wheat flour.
8. Genetics: There is seems to be a correlation between family members who have canker sores. There are known immunologic markers that are decreased in people who are susceptible to canker sores. Whether that is all inherited or not is not entirely clear, but interesting nonetheless.
9. Underlying diseases: There are a few underlying diseases that have aphthous ulcers as part of the whole disease picture (Behcet’s disease, Crohn’s disease, HIV/AIDS, Celiac disease, etc.). If this is the cause, there will undoubtedly be other associated symptoms. (Don’t assume your canker sore and otherwise perfect health equates to some major underlying disease…that is to say, don’t start freaking out).

How do I prevent canker sores?

Once you understand the causes, you can prevent a lot of canker sores. Here are a few tips:

1. Don’t traumatize your mouth/gums: Use a soft tooth brush, don’t bite your nails, and don’t use a toothpick.
2. Improve your nutrition: Eat better. Make healthier food choices. If all else fails, take a vitamin (it may be a good back up plan).
3. Limit stress: I recognize this is the pot calling the kettle black–it’s easier said than done. Engage in healthy, stress-relieving activities.
4. Avoid food triggers: If certain foods (e.g., acidic foods) cause cause cankers, steer clear.
5. Good oral hygiene: Good hygiene decreases the number and severity of the outbreaks (yet another reason to get on your kids about brushing twice a day).
6. Wash toothbrushes: Somewhere in my medical education (I wish I could remember where so I could quote the source), I learned the tip to wash your toothbrush in the dishwasher weekly. I started doing it. Every week, I gather up everyone’s toothbrush in our the house and run them in the dishwasher on the hottest setting. The Wonnacotts have seen a dramatic decrease in the number of canker sores in our house as a result. Toothbrushes are gross. They get thrown in a drawer with junk or left moist on the side of the sink (exposed to who knows what gross bathroom germs).
7. Get separate toothpastes: This tip goes hand-in-hand with the “wash your tooth brushes” tip. It costs a smidgen more money upfront (because you’re buying more tubes of toothpaste), but lasts longer in the end. Get every family member their own tube of toothpaste. The “normal flora” bacteria in my mouth may not be the same bacteria in my kid’s mouth. It’s a simple tip that may help decrease bacterial spread.

How do I treat them once I have canker sores?

Unfortunately, because there isn’t a perfect understanding of what causes them, there isn’t an established treatment for them. Thankfully, cankers eventually go away on their own. Most treatments are aimed at decreasing symptoms. It is worth noting, that no therapy has been proven to be completely safe/risk free and effective in preventing recurrences. I list the options to be thorough.

1. Topical medications: These include different pastes, gels, and creams. They function to topically numb the area or create a protective barrier from further irritation while the canker heals.
2. Mouthwashes: Sometimes antibiotic mouthwashes are used to help. They can help by blocking collagenase activity (which sounds great, but they come with side effects like staining teeth).
3. Systemic medications: Prescription options are really only ever used in people with severe, constantly recurring ulcerations (and may be aimed at treating other underlying causes or modifying the immune response). Other over-the-counter pain medications (e.g., Tylenol, Motrin) may be necessary if the pain is inhibiting eating or drinking.

When should I seek medical care?

You should see your doctor (or possibly your dentist, depending on the situation) if any of the following occur.

1. If the sores are huge.
2. If the sores are spreading.
3. If the sores don’t heal within the expected time frame.
4. If the pain is so bad that your child can’t drink.
5. There are other associated symptoms (body aches, high fever, etc).