Aphthous Ulcers (Canker Sores)

If you have never had a mouth ulcer, thank your lucky stars!  They are terribly painful and interfere with eating, speaking, and brushing your teeth.  The most prevalent type of mouth ulcer is called an aphthous ulcer, and it is commonly referred to as a canker sore.  Aphthous ulcers are unusual in that, even now in 2017, we still do not know exactly what causes them.  There are many studies showing correlation between certain diets, vitamin deficiencies, hormone changes, and stress levels with the occurrence of aphthous ulcers.  But correlation is not the same as causation.

What are aphthous ulcers?

There are three main types of aphthous ulcers: 1) minor, 2) major, and 3) herpetiform.  They all the share similar appearance of a round or oval-shaped ulcer with an inflamed red border around a yellowish-white film that covers the deeper ulceration.

• Minor aphthous ulcers are the most common and least painful. They typically are less than 1 cm in diameter and last for 7-14 days.
• Major aphthous ulcers are much larger, up to 3 cm, and can last over a month. Due to their increased size and duration, they are much more painful.
• Herpetiform aphthous ulcers take their name from herpes lesions (also called cold sores) caused by a Herpes Simplex Virus, which occur in clusters. Herpetiform aphthous ulcers also occur in clusters and can easily be misdiagnosed as viral sores.  Herpes viral sores and aphthous ulcers differ in cause and location.  There is no virus associated with aphthous ulcers, and they only occur on freely movable mucosa.  This includes the inner lining of the lips, cheeks, tongue, floor of mouth and the soft palate.  Herpes lesions, or cold sores, occur on the outside of the lips or any attached gum tissue like the hard palate or gums covering the teeth.  When herpetiform aphthous ulcers form in a cluster, the ulcers often coalesce or blend together to form one very large, very painful ulcer.

What causes aphthous ulcers?

There is currently no scientific data identifying one specific cause of these ulcers.  The research studies have shown a correlation in the occurrence of aphthous ulcers with certain predisposing factors, listed here.

• Genetics – Some studies suggest a genetic component because children are much more likely (90%) to experience aphthous ulcers if both of their parents have had them.
• Certain GI problems – There is a high correlation between patients who experience aphthous ulcers and those with gastrointestinal issues like ulcerative colitis, Crohn’s disease and Celiac Disease.
• Vitamin deficiencies – Some studies show a correlation between patients with aphthous ulcers and low levels of iron, vitamin B12, and folic acid.
• Hormone levels – Many women experience aphthous ulcers at regular intervals correlating to their menstrual cycle.
• Stress – Because stress cannot be quantitatively measured, this one is difficult to prove scientifically. But it’s no surprise to people who suffer with these ulcers that stress can make them more likely to appear.
• Trauma – This is likely the most common cause of aphthous ulcers. Trauma can range from anything as simple as accidentally biting the inside of your lip or hitting your gums with the toothbrush to routine dental treatment or a complicated oral surgery procedure.

How are aphthous ulcers treated?

There are many ways to treat the painful symptoms of aphthous ulcers, but there is no cure to prevent them from recurring.  There are many options available, and it is best to discuss them with Dr. Jill and Dr. Cara to figure out which one is best for your specific ulcers.  Some of the possible treatment options are listed here.

• A topical gel or paste – Usually a prescription product, this is applied to the ulcer with a Q-tip or clean fingertip multiple times a day. It typically contains a steroid, which reduces the severity and duration of the ulcer, but does not change the frequency of occurrence.
• A prescription mouthwash – Also used to alleviate symptoms only, this can contain an antibiotic, antifungal, steroid anti-inflammatory, antihistamine (like Benadryl), and antacid (which creates a thick coating over the oral lining). When used 4-6 times per day, it can reduce the symptoms of the painful ulcers.
• Laser treatments – A laser can be used to treat the ulcer, which reduces inflammation and speeds up the healing process by making changes to the surface of the ulcer.
• Dietary changes – Patients who are afflicted with frequent or multiple aphthous ulcers and have celiac disease or a gluten intolerance show a marked reduction in ulcer occurrence when gluten is eliminated from their diet. A very recent study has also shown an improvement in occurrence of ulcers when a dairy-free diet is observed.  This is based on a new study showing a higher level of antibodies to cow’s milk proteins in patients who have aphthous ulcers.
• Vitamin therapy – In patients who do show deficiencies in iron, vitamin B12, and folic acid and experienced frequent aphthous ulcers, the ulcer occurrence rate decreased after vitamin therapy to treat those deficiencies.

What can I do about aphthous ulcers?

The most important step you can take is contacting your dentist as soon as you notice the lesion.  All of the above treatment modalities are most effective when started early in the life of the ulcer.

Ulcers are aggravated by acidic foods, spicy foods, and hot temperatures, so avoid them in order to reduce your painful symptoms.  Use caution when eating and talking so that you do not reinjure the area and cause the ulcer to last longer.  Cold can temporarily alleviate symptoms, so we do recommend drinking ice water and holding a piece of ice against the ulcer until you see the dentist for other treatment options.

Do you think you have an aphthous ulcer?

Call us now to see Dr. Jill and Dr. Cara so you can get started on the best treatment to reduce the pain and length of your ulcer.  972-347-1145