Canker Sores

May 2, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

My spice rack frustrates me. You can't cook finger licking good food without an organized spice rack. The powdered kelp should be found under "k", even if it will never be used again. The fennel should be under "f". The cumin should be under "c". In the pharmacy we have row after row and shelf after shelf of medications filed alphabetically by the generic name of the drug. If you want kayexalate, you go to the "k" shelf. If you want furosemide, you go to the "f" shelf. If you want the carbamazepine you go to the "c" shelf. The system works. But our home spice rack has several fundamental flaws. Flaw number one: we have a spice rack built into the inside of a cupboard door and we have more spices than fit into that rack. Everyone puts their favorite spice into that rack in no particular order, and then gets mad when someone else demotes a spice off the rack and into the black hole of the spice shelf. Flaw number two: the black hole spice shelf. You can only see the front of the spice shelf, but again we have too many spices to all be on the front row. So when you need garlic powder, you have to empty the entire spice shelf onto the counter to find it.

One thing possibly more frustrating than the game of "Where is the garlic powder?" is mouth pain. 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 make canker sores happen more often.

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.

Pinterest sucks when it comes to spice rack ideas. I do not think buying and labelling a bazillion magnetic containers and sticking them to my fridge is less effort or more efficient. I don't want to give up an entire drawer for my spices either. You've heard of the KISS principle? Keep It Simple Stupid? Maybe I should invent a spice rack principle. The KFC principle. I'm just going to have to find Colonel Sanders' secret 11 herbs and spices and only cook with those.

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.

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

 


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