Painful Canker Sores in the mouth

Jul 15, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We counted eighteen of them. I still think we've got a couple MIA. White and black and red. Light blue, dark blue and gray. Most had short sleeves and were made of light weight, quick drying synthetic fibers. A few were cotton. A few had long sleeves. A couple were sweatshirts. I remember, years ago, that someone made a quilt out of the first 10 or so of them. After finding them, like any sane person, I took them on and off one at a time. During this fashion show, Emily tried have me to stand in one place and take my picture. All of this reminds me I'm going to be doing something in July that I always do in September.

Something else that can mess with your routine 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.

The annual MS Bike Tour from Dauphin to Clear Lake has gone virtual. People from all over Manitoba and Canada are not coming to Dauphin the week after September Long to cycle up a hill. Instead, on July 25th, people are going to ride around their neighborhoods or even on their stationary bikes at home. They will track their rides on a cycling app and of course raise money to help end MS. I did the virtual fashion show of almost all the shirts from my MS Bike Tours as part of a welcome video for the virtual riders this year. So, if you see me riding to Clear Lake on the 25th, give me a little space on the highway, and don't forget to go online and donate.

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 - www.youtube.com/watch?v=6O2Gr_eQoqU

Trevor's MS Bike Tour donation page - https://secure3.convio.net/mssoc/site/TR/BikeTour/ManitobaDivision?px=1001988&pg=personal&fr_id=6986

 


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