If you have not already experienced a canker sore, you have at least heard of them from a multitude of television commercials touting a non-prescription treatment. While usually not serious for the 20 percent of Americans who suffer from them, they are a real ‘pain in the mouth’.
What are canker sores and what is the difference from cold sores?
Canker sores are small ulcers that develop from a concentrated bacterial infection, and can appear under the tongue, inside the cheeks or lips and at the base of the gums. While anyone at any age can get a canker sore, typically people aged between 10 and 20-years-old experience canker sores, but they can appear in older persons as well.
Cold sores are distinctly different because they develop from a viral infection and are contagious. Cold sores also appear on the lip or the lip line. However, canker sores are like most bacterial infections, and are therefore not contagious. So someone suffering from a canker sore need not worry about infecting others.
How do canker sores form?
Canker sores are always round, range in size from 2mm to over a centimeter, and can appear as a solitary spot, or a cluster of up to 100 pinhead-sized infections. The sore itself can be yellowish or grey, and is surrounded by a circle of inflamed tissue that can appear reddish or white, referred to as a “halo.”
If the shape or color appears to fall outside the these basic parameters, seek advice from a medical or dental professional immediately to find out whether the lesion is a garden-variety canker sore or a more serious condition requiring immediate medical attention.
3 Types of canker sores
Canker sores have been around for millennia, first appearing in the historical record in the 4th century BCE. In general canker sores are medically referred to as recurrent aphthous stomatitis (RAS). There are three types of canker sores.
1. Minor canker sores
Also known as Minor RAS, this is the most common form accounting for 80 percent of all reported cases, according to the Journal of Oral and Maxillofacial Pathology, posted by the National Institutes of Health (NIH). These sores usually appear one at a time and range in size from 8mm to 10mm, about the size of a pea. They can impede speaking or eating. The upside is they usually heal on their own in under two weeks, and thankfully do not leave a scar.
2. Major canker sores
Major RAS, also known as Sutton’s Disease, affects about 15 percent of all canker sore sufferers. “Major” means that while these ulcers start small, they can grow to be larger than a centimeter in diameter, about the size of a penny. They usually develop near the lips or under the tongue. While they heal on their own, it can take up to six weeks and leave a scar.
3. Herpetiform canker sores
The Journal of Oral and Maxillofacial Pathology describes Herpetiform Canker Sores as “recurrent crops of multiple ulcers.” While they are very small, 2mm to 3mm, about the size of a pinhead, up to 100 can develop at a time. They can also merge together into a much larger lesion. While these can seem pretty horrific, they heal on their own in less than two weeks and do not cause permanent scarring.
Why do canker sores develop?
While the answer to why canker sores form continues to elude researchers, there are several risk factors which to contribute to the chances of suffering from these ulcers.
About 40% of sufferers have other family members who have also had canker sores in the past. People with family members who have experienced canker sores are more like to get them as well.
Getting a shot of local anesthetic before a dental procedure, accidentally biting your cheek, even accidents involving objects in the mouth like using a toothbrush vigorously on the gums, are thought to contribute to the development of these sores. What happens here is bacteria enters the gums through the tiniest of lacerations, causing an infection.
Gluten sensitivities, Celiac Disease, Crohn’s disease and ulcerative colitis are all believed to have a connection with canker sores. If you suffer from one of these illnesses, it is important to talk to you dentist about several oral health risks that can stem from gluten or food-related intolerance.
The below medications have all been shown to cause oral ulcers, which may actually be canker sores. If you are taking any these medications, do not stop, but do contact your healthcare provider and have a discussion.
- Angiotensin converting enzyme inhibitor captopril – Prescribed to treat high blood pressure and heart failure, and also to help prevent problems after a heart attack and to prevent kidney problems associated with Diabetes;
- Gold salts – Used to treat pain associated with Arthritis and other inflammatory diseases;
- Nicorandil – Prescribed to treat Angina and prevent the narrowing of blood vessels near the heart;
- Phenindione – An anticoagulant prescribed to treat unwanted blood clots and to reduce the risk of having an unwanted clot.
- Phenobarbital – Prescribed for Epilepsy, this medication stabilizes the electrical activity of the brain;
- Non-steroidal anti-inflammatory drugs (NSAIDS) – Include ibuprofen, diclofenac and naproxen, are all used to treat pain.
- Piroxicam – Also a NSAID is used in gel form to target and treat specific areas experiencing pain, such as sore muscles or joints.
It is strongly believed that stress acts as a trigger for canker sores. Additionally, it is believed that those people who react to stress by unconsciously biting their lips or cheeks can inflict the kind of trauma that can develop into a canker sore.
Everyone knows a balanced diet is key to long-term health. Deficiencies in iron, vitamin B12, and folic acid can contribute to the development of canker sores.
If you have a sore that you believe is unusual, or is stubborn and not healing within two weeks,. If the lesion is something more serious than a canker sore, the earlier it gets identified, the faster we can work with you to determine the cause and help treat and manage the symptoms.
Make the time to address any changes in your oral health. Jefferson Dental offers convenient dental appointments in the evenings and even Saturdays, as well as walk-in emergency appointments to meet dental emergency needs!