Are you prone to canker sores? Top tips for prevention and treatment

Ouch! Not again! Canker sores are such a painful bother — bad ones can interfere with your ability to eat, and even compromise your health. Wouldn’t it be great if you never had to deal with one again?

Canker sores are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. Also known as “aphthous ulcers”, according to MayoClinic.org, they are classified according to size, and can be minor, major, or herpetiform. The most common are minor, which are oval-shaped with a red edge, and typically disappear within one to two weeks. Major ones are deeper, and can be very painful and can leave deep scars. The herpes virus does not cause Herpetiform canker sores: they’re tiny sores that cluster into one large ulcer, and usually develop in seniors.

According to WebMD.com, although canker sores and cold sores are often confused with each other, they’re quite different. Cold sores are also known as fever blisters or herpes simplex type 1 — they’re viral, and very contagious. Fluid-filled cold sores typically appear outside the mouth, near the nose, lips, or under the chin.

Why do some people get more canker sores and some never do? According to MayoClinic.org, researchers have ascertained that a combination of factors can contribute, some even in the same person. Certain diseases or conditions such as celiac disease (gluten allergy), inflammatory bowel diseases including Crohn’s and uncreative colitis increase risk. HIV/AIDS, which suppresses the immune system, increases risk for canker sores.

Possible triggers include:

• Minor injury to the tissues inside the mouth, from dental work including braces, bad-fitting dentures, hard brushing, even an accidental cheek bite.
• Sodium Laurel Sulfate: a common ingredient in toothpastes and mouth rinses, is a surfactant derived from palm oils. It’s responsible for the “foaming effect” when brushing, and a Norwegian study showed a 60-70% reduction in patients who used a SLS-free toothpaste during a 3-month period.
• Food sensitivities: Chocolate, coffee, strawberries, eggs, nuts, cheese, and spicy or acidic foods: citrus fruits may be especially irritating.
• Nutritional deficiencies: diets low in B-vitamins B-12, folic acid (vitamin B-9), niacin (B-3), zinc, or iron.
• Stress: People who lead very stressful lives tend to have more canker sores, and have a weaker immune system. Although the research hasn’t yet definitively described how exactly stress and immunity are related, it’s noted that the benefits of reducing stress are many, including lower incidence of canker sores. According to LiveScience.com, canker sores are more common in women, especially during the menstrual cycle. WebMD notes that women’s hormonal fluctuations during puberty, during the menstrual cycle, when taking birth control pills, during pregnancy, and at menopause all make women more susceptible.
• Heredity? Or Environment? According to Medscape.com, studies show a 50% correlation between first-degree relatives and incidence of canker sores (parents/children/siblings). But, correlation is not causation, and the relationship could be due to exposure to certain factors like habits, diets, and even psychological environments.
• Other infections: Viral infections and bacteria, such as the bacteria that causes stomach ulcers, Helicobacter pylori, can manifest as canker sores.

Minor canker sores will clear within a week or two, and although there’s no “cure” for canker sores, there are some lifestyle and home remedies that can help relieve the pain and promote healing.

• Rinse: Herbal tea: Sage and thyme (salvia y tomillo) are thought to be natural antiseptics. Steep a few spoonfuls in a cup of hot water, allow the mixture to cool to room temperature, then rinse your mouth with it for about a minute and spit it out. Rinse with warm water and salt or baking soda (1 teaspoon in ½ cup water): swish gently for one minute and spit.
• Milk of Magnesia: put a dab on the sore a few times daily.
• Aloe vera: As reported on Colgate Oral Health Center, the Academy of General Dentistry says aloe vera can be helpful for both canker sores and cold sores. They cite research that shows aloe vera speeds healing and reduces pain associated with canker sores and doesn’t sting or taste bad when applied. Aloe vera juice can be taken as a drink or gel can be applied topically, according to the researchers.
• Hydrogen peroxide is a disinfectant, but use sparingly: prolonged use is irritating and not recommended.
• Ice: A pain-reliever: Apply ice chips directly to the sore and slowly dissolve.

The Massachusetts Dental Society also recommends consulting with your dentist about which of the following may be helpful for you.

• Corticosteroids: Prescription gels or creams reduce inflammation caused by canker sores.
• Antibacterial mouthwashes: Only a few mouthwashes are clinically proven to reduce bacteria including Listerine® (contain alcohol and other possibly irritating ingredients). Medicated mouthwashes that contain chlorhexidine gluconate may help, but prolonged use could stain teeth: use only with the advice of your dentist or physician.
• Pain-relieving (analgesic) gels: containing the active ingredient benzocaine or diphenhydramine HCL. Some form a protective film over the canker sore. Over the counter, and some may require a prescription especially those containing 2% lidocaine.
• Aphthasol:Approved by the FDA and shown to reduce canker sore pain and shorten healing time.
• Acemannan hydrogel patch: Reports show that this treatment reduces the healing time, as well as the pain, of canker sores. The patch, which contains a form of aloe vera, has received FDA approval and is being sold as the Carrington Patch. Dentist.net reports on a number of other patches available over-the-counter and online.
• ORA5: A topical antibacterial compound that uses copper sulfate and iodine to cover the irritated area, greatly reducing the pain.

Prevention if Possible:

• Avoid irritating foods, such as those that might scratch the inside of your mouth (chips, pretzels), and especially acidic fruits, such as oranges, grapefruits, and pineapple.
• Food sensitivities and allergies: keep a journal and note reactions to any foods, especially nuts, dairy, wheat, soy, eggs, shellfish, or fish.
• Stay healthy: Avoid possibility of deficiency by eating a wide array of fruits and vegetables, whole grains, and legumes.
• Be nice to your mouth: avoid hard toothbrushes, and don’t brush too hard. Avoid toothpaste and rinses with sodium laurel sulfate.
• Minimize stress: since research is pretty clear about the relationship between decreased immunity and increased stress, practice stress reduction with yoga, meditation, and guided imagery. Read more about reducing stress here.

See Your Dentist: Mouth sores may be a symptom of a disease or disorder. Your dentist should examine any mouth sore that lasts a week or longer.

According to WebMD, call your dentist about canker sores if you have:

• Unusually large sores
• Sores that are spreading
• Sores that last three weeks or longer
• Intolerable pain despite avoiding trigger foods and taking over-the-counter pain medication
• Difficulty drinking enough fluids
• A high fever with the appearance of the canker sores

Sources

LiveStrong.com. Canker Sores and Vitamin Deficiencies. http://www.livestrong.com/article/459886-canker-sores-and-vitamin-deficiencies/

Massachusetts Dental Society: Canker Sores. http://www.massdental.org/cankersores.aspx

Medscape.com. Consult Your Pharmacist — Advising Patients About Oral Ulcers. http://www.medscape.com/viewarticle/407626_4

Psychology Today. 5 Quick Tips to Reduce Stress and Stop Anxiety. https://www.psychologytoday.com/blog/finding-cloud9/201308/5-quick-tips-reduce-stress-and-stop-anxiety

WebMD.com.  Hormones and Oral Health. http://www.webmd.com/oral-health/hormones-oral-health

World Journal of Gastroenterology. Helicobacter pylori and oral pathology: Relationship with the gastric infection. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123373/

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Susan Burke March is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management, and a Cuenca expat. Contact her at SusantheDietitian@gmail.com