Canker sores, also known as recurrent aphthous stomatitis (RAS), are a common and painful oral condition characterized by small, shallow ulcers that develop on the soft tissues inside the mouth. These sores typically appear as white or yellow lesions surrounded by a bright red area. Unlike oral sores caused by viral, fungal, or bacterial infections, canker sores often seem to arise without a clear cause. While most canker sores heal on their own within a few weeks, their recurrence and the associated discomfort can significantly impact an individual's quality of life. Understanding the potential triggers and causes of canker sores is crucial for effective management and prevention.
What are Canker Sores?
A canker sore is a painful, open sore in the mouth. Canker sores are white or yellow and surrounded by a bright red area. Canker sores most often appear on the inner surface of the cheeks and lips, tongue, upper surface of the mouth, and the base of the gums. Symptoms include:
- One or more painful, red spots or bumps that develops into an open ulcer
- White or yellow center
- Small size (most often under one third inch or 1 centimeter across)
- Gray color as healing starts
Less common symptoms include:
- Fever
- General discomfort or uneasiness (malaise)
- Swollen lymph nodes
Pain often goes away in 7 to 10 days. It can take 1 to 3 weeks for a canker sore to completely heal.
Common Causes and Triggers of Canker Sores
Although the exact cause of canker sores remains an area of ongoing research, several factors have been identified as potential triggers or contributing factors. These include:
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- Mouth Injury: Trauma to the mouth, such as from dental work, rough teeth cleaning, or accidental biting of the tongue or cheek, can sometimes lead to the development of canker sores. Irritation from sharp, poky, or abrasive foods can also irritate the soft tissues. Many people who have traditional metal braces complain about canker sores.
- Emotional Stress: Periods of heightened emotional stress have been linked to an increased occurrence of canker sores.
- Hormonal Changes: Hormonal fluctuations, particularly in women, may play a role in triggering canker sores.
- Food Allergies and Sensitivities: Allergic reactions or sensitivities to certain foods can contribute to the development of canker sores in susceptible individuals.
- Problems with the Body's Immune System Canker sores may also be linked to problems with the body's immune system.
- Dietary Deficiencies: Lack of certain vitamins and minerals in the diet (especially iron, folic acid, or vitamin B-12)
The Role of Nutritional Deficiencies
Nutritional deficiencies, particularly those involving vitamin B12, folate (folic acid), iron, and zinc, have been strongly implicated in the development and recurrence of canker sores. These nutrients play essential roles in maintaining the health and integrity of the oral mucosa (the lining of the mouth), and their deficiency can compromise the body's ability to repair tissue damage and prevent ulcer formation.
Vitamin B12 Deficiency
Vitamin B12 is crucial for red blood cell production, nerve function, and DNA synthesis. A deficiency in vitamin B12 can lead to pernicious anemia, characterized by fatigue, neurological issues, and oral manifestations such as mouth ulcers. Vitamin B12 deficiency impairs DNA production in the mucous membrane, leading to cell death and ulcer formation.
Dietary Sources of Vitamin B12: Seafood, red meat, poultry, eggs, and dairy products are excellent sources of vitamin B12.
Folate (Folic Acid) Deficiency
Folate, another B vitamin, is essential for DNA synthesis and repair. Similar to vitamin B12, folate deficiency can impair cell regeneration in the mouth, leading to ulcer formation. Folate deficiency can occur due to poor dietary intake, certain gastrointestinal conditions, and high alcohol consumption. Certain medications, especially those taken by pregnant women, can also interfere with folate metabolism and increase the risk of deficiency.
Dietary Sources of Folate: A diet rich in fiber, including leafy green vegetables, fruits, and fortified grains, is crucial for ensuring adequate folate intake.
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Iron Deficiency
Iron is a vital mineral for oxygen transport and red blood cell production. Iron deficiency, also known as anemia, can cause a range of symptoms, including fatigue, weakness, and mouth sores.
Zinc Deficiency
Zinc plays a critical role in immune function, wound healing, and cell growth. Zinc deficiency has been linked to recurrent canker sores in preliminary studies. Supplementation with zinc has been shown to reduce canker sore recurrences, particularly in individuals who are zinc deficient.
Dietary Considerations for Preventing and Managing Canker Sores
In addition to addressing potential nutritional deficiencies, certain dietary modifications can help prevent and manage canker sores:
Avoiding Acidic and Irritating Foods
Acidic foods, such as citrus fruits (oranges, lemons, pineapples), tomatoes, and strawberries, can irritate the soft tissues in the mouth and trigger or worsen canker sores. Similarly, spicy foods containing hot peppers and other spices can also irritate the oral mucosa. It is advisable to limit or avoid these foods, especially during outbreaks of canker sores.
- Citrus Fruits: Although high in vitamin C, citrus fruits contain acids that can irritate canker sores.
- Strawberries: Like citrus fruits, strawberries are acidic and may exacerbate canker sores.
- Tomatoes: Tomatoes and tomato-based products, such as tomato sauce and tomato soup, are highly acidic.
- Spicy Foods: Foods containing hot peppers and spices can irritate the soft tissues in the mouth. When ordering spicy dishes, opt for milder versions with fewer chili peppers.
- Soft Drinks: Soft drinks are high in acid and corn syrup, both of which can contribute to oral irritation.
Identifying and Eliminating Food Allergens
For individuals with food allergies or sensitivities, identifying and eliminating the offending foods from their diet can help reduce the frequency and severity of canker sores. Common food allergens include:
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- Chocolate: For some people, chocolate can trigger allergic reactions that manifest as canker sores.
- Gluten: Gluten, a protein found in wheat and other grains, is a common allergen or sensitivity for many individuals. Sensitivity to gluten has been associated with recurrent canker sores in some people.
Choosing Gentle Oral Hygiene Products
Sodium lauryl sulfate (SLS), a common ingredient in many toothpastes, has been identified as a potential cause of canker sores. SLS is thought to increase the risk of canker sores by removing a protective coating (mucin) in the mouth. Switching to SLS-free toothpaste may help reduce the occurrence of canker sores.
Other Remedies
- Over-the-counter Medicines: Over-the-counter medicines ease pain in the area.
- Salt Water Rinse: Rinse your mouth with salt water or mild, over-the-counter mouthwashes. (DO NOT use mouthwashes that contain alcohol which can irritate the area more.)
- Hydrogen Peroxide and Milk of Magnesia: Apply a mixture of half hydrogen peroxide and half water directly to the sore using a cotton swab. Follow by dabbing a small amount of Milk of Magnesia on the canker sore afterward. Repeat these steps 3 to 4 times a day.
- Milk of Magnesia and Benadryl: Rinse your mouth with a mixture of half Milk of Magnesia and half Benadryl liquid allergy medicine. Swish mixture in the mouth for about 1 minute and then spit out.
- Numbing Mouth Rinses or Drops: Over the counter numbing mouth rinses or drops can provide short term pain relief.
Herbal Remedies
- Aloe Vera: A gel containing the Aloe vera polysaccharide acemannan was found in one double-blind trial to speed the healing of canker sores better than the conventional treatment Orabase Plain. The gel was applied four times daily.
- Deglycyrrhizinated Licorice (DGL): A mixture of DGL and warm water applied to the inside of the mouth may shorten the healing time for canker sores, according to a double-blind trial. This DGL mixture is made by combining 200 mg of powdered DGL and 200 ml of warm water. It can then be swished in the mouth for two to three minutes, then spit out. This procedure may be repeated each morning and evening for one week.
- Astringent herbs: Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. Examples of astringent herbs include agrimony, cranesbill, tormentil, oak, periwinkle, and witch hazel.
- Chamomile: Chamomile has healing properties and swishing a tincture made of strong tea may have a soothing effect on the lining of the mouth.
- Echinacea: The antiviral, immune-enhancing, and wound-healing properties of echinacea may make this herb a reasonable choice for canker sores.
- Goldenseal: Goldenseal, another traditional remedy with wound-healing properties, has a long history of use for mouth and gum irritations.
When to Seek Professional Medical Advice
While most canker sores resolve on their own within a few weeks, it is essential to seek professional medical advice in the following situations:
- Persistent Sores: If a canker sore or mouth ulcer does not go away after 2 weeks of home care or gets worse.
- Frequent Recurrences: If you get canker sores more than 2 or 3 times a year.
- Accompanying Symptoms: If you have symptoms with the canker sore such as fever, diarrhea, headache, or skin rash.
- Large Sores: If the sores are larger than a centimeter (bigger than a pea).
- Interference with Daily Activities: If the canker sores interfere with eating, drinking, or other daily routines.
These signs may indicate an underlying condition that requires medical attention.
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