Canker Sores (Aphthous Ulcers) - Health Tips

Aphthous stomatis is the medical term for canker sores. It is a common condition that produces ulcers or erosions in the mouth and on the lips. It happens over and over again, but the cause is still unknown. It is thought to be secondary to a decreased immune system, possible from stress, infection, vitamin deficiency, or hormonal changes.

Canker sores look like round shallow erosions or ulcers with a white surface, surrounded by an intense red halo and measuring 5mm. The ulcers are usually painful and last one to two weeks. They are commonly found on the lips, inner cheeks (buccal mucosa), tongue, and soft palate. Some lesions can be larger, last up to 6 six weeks and heal with a scar. These are called major aphthae.

Herpetiform aphthae are uncommon and described as multiple (up to 100 lesions), painful and differentiated from herpes.

Treatment

Treatment depends on how often the sores reoccur.

1. Identify trigger if possible, and avoid trigger in the future.
2. If recurrent, it can be helpful to rule out herpes infection, evaluate vitamin B1, B2, B6, B12, folate, zinc, and iron levels, and perform a complete blood count.
3. Treatment aimed at symptomatic relief:

• Topical anesthetics (lidocaine, dyclonine, benzocaine).
• Anesthetic mouthwash (aluminum hydroxide-magnesium hydroxide, diphenhydramine, and lidocaine).
• Nonsteroidal anti-inflammatory drugs.
• Sucralfate suspension.
• A 0.2% chlorhexidine gluconate mouthwash.

1. Topical steroids (medium potency fluocinonide gel) applied with cotton-tipped applicators (avoid eating for 30 minutes).
2. Intralesionl triamcinolone acetonide, starting at 5 mg/ml up to 40 mg/ml, every few weeks.
3. Corticosteroid mouthwash (dexamethasone elixir 0.5mg/5ml 3 times a day).
4. If the canker sores are severe and unresponsive to other treatments, systemic steroids, colchicines, thalidomide, and dapsone can be tried.

Some treatments are off labeled and their use and need should be given under the guidance of a physician.