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Alternative namesAphthous ulcer; Ulcer - aphthous
DefinitionA canker sore is an open sore in the mouth, which appears as a painful white or yellow ulcer surrounded by a bright red area. A canker sore is benign (not harmful). See also herpes , which can also cause mouth sores.
Causes, incidence, and risk factors
Canker sores are a common form of mouth ulcer . They occur in women more often than men. They may occur at any age, but usually first appear between the ages of 10 and 40.
They usually begin with a tingling or burning sensation, followed by a red spot or bump that ulcerates. Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks. Particularly large ulcers (greater than 1 cm in diameter) often take longer to heal (2 to 4 weeks). Occasionally, a severe occurrence may be accompanied by nonspecific symptoms of illness, such as fever or malaise . Canker sores often come back again in the future.
There may be an inherited tendency to develop canker sores, as they often run in families. There may also be an immune system link. Ulcers may develop in response to a mouth injury such as dental procedures or aggressive tooth cleaning.
Canker sores may also occur at the site of a bite when the tongue or cheek is bitten. They can be triggered by emotional stress, dietary deficiencies (especially iron, folic acid , or vitamin B12 ), menstrual periods, hormonal changes, food allergies , and similar situations. They occur most commonly with viral infections. They may occur with no identifiable cause.
Signs and tests
A diagnosis is based on the distinctive appearance of the lesion. If canker sores persist or continue to return, a health care provider or dentist should be consulted to rule out other causes of mouth ulcers . (These include erythema multiforme , drug allergies , herpes simplex infection, pemphigus, pemphigoid, bullous lichen planus , and other disorders.)
Squamous cell carcinoma may first appear as a mouth ulcer that does not heal, but this is rare. A relatively new ulcer-like condition is hairy leukoplakia, a condition that occurs with HIV infection and may be mistaken for the common canker.
A skin lesion biopsy may be used to differentiate a canker sore from other causes of mouth ulcers.
Treatment is usually not necessary. In most cases, the condition is self-limited and healing is spontaneous.
Tetracycline is usually not prescribed for children until after all the permanent teeth have fully developed. If children use tetracycline suspension before their permanent teeth are fully developed, it can permanently discolor teeth that are still forming. Multiple, painful mouth ulcers may treated with an antiviral agent such as acyclovir.
The easiest home remedy is to apply hydrogen peroxide (1 part hydrogen peroxide and one part water with a cotton swab) on the canker sore. Then dab a small amount of milk of magnesia on the canker 3-4 times a day. This is not only soothing, but appears to help healing.
Expectations (prognosis)Canker sores usually heal spontaneously. The pain usually decreases in 3 or 4 days. Other symptoms disappear in 10 to 14 days.
Calling your health care providerApply home treatment and call your health care provider if symptoms of canker sores persist or worsen, or canker sores recur more often than 2 or 3 times per year.
Call your health care provider if symptoms are associated with other problems such as fever , diarrhea , headache , or skin rash .
Update Date: 1/13/2003Jonathan Fanaroff, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT