Canker Sores

Jul 6, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Look at that recorder player! He's so Hot!" No one has ever uttered those words. Back in Shakespeare's day they were staring at the guy with the lute. In 1965, Dylan blew them away at Newport when he plugged his guitar to an amp and played "Like a Rolling Stone". In 1992 Clapton blew them away again when he threw away his amp and played "Layla" unplugged. Singers get the spotlight, but Ax-men drive the show. This is all just a prelude to saying how impressed I was with Eric's report card. No, I didn't care that Eric is really good at math. The fact that his reading is improving in leaps and bounds didn't matter either. I mean really, how useful are math and reading when you grow up? The music section of Eric's report card hit me like the Trogg's "Wild Thing". It said Eric was learning guitar and he could play several 1 and 2 cord songs! One more chord and he can take over from Angus Young of AC/DC!

Unless you are Hendrix and playing with your teeth, guitar playing is more likely to cause paing in the fingers than in the mouth. A common cause of pain in the mouth are canker sores. Canker sores are little ulcers or erosions in the mouth. Their medical name is aphthous stomatitis or aphthous ulcers. A person usually gets their first canker sore between the ages of 10 and 20. Somewhere between 5-25% of the population gets them. Usually canker sores happen less often as we age. Women, people under 40, people with a family history of canker sores and people with upper-middle socioeconomic status tend to get canker sores more often.

We don't know what causes canker sores. There are probably lots of factors involved. We think the most common predisposing factors are trauma to the mouth (like biting your cheek, or the sharp corners of dental appliances rubbing) and stress. Certain foods may play a role including chocolate, coffee, peanuts, almonds, strawberries, cheese, and tomatoes. A poor diet may cause nutrient deficiency which makes canker sores more common. Some pain killing drugs like NSAID's may also aggravate the canker sore situation.

Canker sores can be more than just annoying. Patients with more severe canker sores may have a lot of pain which can cause difficulty eating, speaking and swallowing. There are 3 types of canker sores: minor, major and herpetiform. Far and away the most common canker sores are the minor aphthae which account for 70-90% of the cases. Minor aphthae or minor canker sores are painful, small, round or oval ulcers which have clear raised edges with a red halo around them. They are smaller than 1 cm and usually have a whitish grey pseudomembrane over them. Minor canker sores occur singly or in groups up to 5 on the inside of the lips, cheek, floor of the mouth, underside of the tongue and the soft palate. Minor canker sores heal by themselves in 7-10 days, which is good, but that is more slowly than other oral wounds heal. Some people might feel some discomfort a few days before the actual canker sore occurs. Major aphthae or major canker sores are not very uncommon. They are larger than 1 cm in size and can be in groups of more than 5. Herpetiform aphthous ulcers are the least common canker sore. They are multiple clusters of small pin-point ulcers than can number in the 100's.

To prevent canker sores, first try to minimize trauma to the inside of your mouth. Chew slowly and carefully to try to avoid accidental self biting. Avoid sharp-edged food like hard candies, hard toast, crackers and potato chips. If it feels like your teeth or dental appliances have sharp spots that are hurting the inside of your mouth, see your dentist.

We have several non-prescription options to treat canker sores. The dentists all seem to love salt water rinses several times per day. Dissolve a teaspoon of salt in 250 mL of warm water, rinse, spit and repeat. Do a salt water rinse several times a day. This helps to keep the canker sore clean which promotes healing. Local anesthetics like benzocaine and lidocaine, like in the product Orajel, will numb the pain of a canker sore for 20-45 minutes. For gels, ointments and pastes to work the best, dry the canker sore with a Kleenex before applying. Then apply with a Q-tip and avoid eating, drinking and speaking for 30 minutes. These analgesic gels can be used up to 4 times a day.

In addition to local anesthetics, you could use acetaminophen or tylenol pills. Don't use ibuprofen, naproxen or ASA. It is possible these NSAID's will make canker sores worse. Protecting pastes like orabase can also do a nice job of covering up the canker sore to make it more comfortable.

If your canker sores don't go away in less than 2 weeks or if they are very painful, you should see your dentist. They may prescribe an oral paste with the steroid triamcinolone in it to decrease the pain and inflammation. They could prescribe a numbing mouth wash called tantum or benzydamine to reduce mouth pain. They could also ask the pharmacist to compound a tetracycline mouth wash. Tetracycline is an antibiotic. As a mouth wash it can reduce canker sore pain and size of the sore. However, like other antibiotics, it has potential side effects like oral thrush, skin rash, sore throat and stained teeth.

I learned the recorder in elementary school music class. I'm sure that is the reason I am not a Guitar God. It had nothing to do with my complete lack of talent, interest or practice time. Things could be different for Eric. I can't play "Jump" like Eddie Van Halen. I can't play the opening riff of "New Orleans is Sinking" like Rob Baker. I'm 44 have a job, a house, a family, and not a groupie in site. If Eric knocks off with the math and reading stuff and learns at least one more chord, he could have a real life. He could sleep in a van, change a tire an hour outside of Thunder Bay in January, decide if he liked drugs or alcohol better, get married and divorced 4 times, go through rehab and launch an anniversary tour all before he gets to my age. A father can dream......

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

Canker Sore video - https://www.youtube.com/watch?v=6O2Gr_eQoqU

Songs that only need 3 chords - https://www.ultimate-guitar.com/news/features/basics_10_famous_songs_using_only_3_chords.html

 


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