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Ulcer, Aphthous / Canker Sore

Definition:
Small and out-of-sight, but painful, persistent and annoying. That's what canker sores, also called aphthous ulcers (aphthae), are for people who experience them. These shallow ulcers in your mouth can make eating and talking uncomfortable. They may occur on your tongue, on your soft palate, inside your cheeks or lips, and at the base of your gums.

Canker sores differ from cold sores in that they occur on the internal soft tissues of your mouth and aren't contagious. Conversely, cold sores almost always start out on the lips and don't often spread to the soft tissues of your mouth. In addition, cold sores are caused by a form of the herpes virus, making them extremely contagious.

Canker sores are common, but the cause in many cases is unknown. Canker sores can occur at any age, but often they first appear when you are between 10 and 40 years of age.

Most of the time, treatment isn't necessary for canker sores. Pain usually decreases after several days, and canker sores typically heal within one to three weeks. Occasionally canker sores can develop that are larger than 1 centimeter in diameter or last longer than two weeks.

Causes:
The cause of most canker sores remains a mystery.

Researchers generally believe that stress or tissue injury may cause the eruption of canker sores. A minor injury — caused by biting the inside of your mouth or by eating rough foods, such as nuts — may trigger a canker sore. Other causes may include:
  • Faulty immune system function
  • Nutritional problems, such as a deficiency of vitamin B-12, zinc, folic acid or iron
  • A disease of the gastrointestinal tract
  • Food allergies
  • Menstrual periods
Though anyone can get cankers sores, they tend to run in families and may be an inherited condition.

When to seek medical advice:
If you experience any of the following conditions, see your doctor:
  • Unusually large sores
  • Persistent sores, lasting three weeks or more
  • Pain that you can't control with self-care measures
  • Difficulty drinking enough fluids
  • High fever with canker sores
In such cases, the sore may be a sign of some other medical condition. See your dentist if you have sharp tooth surfaces or dental appliances that seem to trigger the sores.

Symptoms:
Signs and symptoms of canker sores may include:

  • Painful sore or sores inside your mouth — on your tongue, under your tongue (soft palate), inside your cheeks or lips, and at the base of your gums
  • Tingling or burning sensation prior to appearance of the sores
  • Round, white sores with a red edge or halo
You also may experience the following signs or symptoms, though they may not be related to the canker sores:
  • Fever
  • Listlessness
  • Swollen lymph nodes

Treatment:
Often treatment isn't necessary and your canker sore will heal on its own. Your doctor may suggest prescription medication if your sores are large, painful or persistent. To relieve the pain and irritation of canker sores, your doctor may recommend a prescription mouthwash, a corticosteroid salve or an anesthetic solution.

Prevention:
Canker sores can recur, but you may be able to reduce their frequency by addressing factors that seem to trigger canker sores:
  • Watch what you eat. Avoid foods that seem to irritate your mouth. These may include acidic foods, nuts and certain spices.
  • Don't chew and talk at the same time. You could cause minor trauma to the delicate lining of your mouth, triggering a canker sore.
  • Follow good oral hygiene habits. Regular brushing after meals and flossing once a day can keep your mouth clean and free of foods that might trigger a sore. Using a soft brush may help you avoid irritation of mouth tissues.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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