Canker Sores

Feb 4, 2021

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"I have a dream today. I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character. I have a dream today." Dr. Martin Luther King's speech on Aug 28, 1963 feels like it could have been given yesterday and it would speak to so many of today's problems. Dr. King's speech is also full of hope and hope is an essential ingredient for any monumental societal change. I am definitely not in Dr. King's league, but I had a dream too. I dreamt the handle on my Lazy Boy recliner was 4 feet long. That 4-foot handle made it difficult for me to raise my foot rest. I assume I was dreaming about my Lazy Boy handle, because the real one broke off. I now have to raise my foot rest with a broken handle nub. My daughter Emily felt sorry for me. She ordered me a replacement handle off the internet. True to the words "Lazy Boy", I haven't gotten around to attaching the new handle yet.

Something else that can be hard to handle 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. Canker sores happen less often as we age. Women, people under 40, people with a family history of canker sores, people who have recently quit smoking 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 a nutrient deficiency which can make canker sores more common. Pain killing drugs like NSAID's may also make canker sores happen more often.

One interesting theory of canker sores has to do with Vitamin B12. There is at least one case study of giving a patient with recurring canker sores a Vitamin B12 supplement. This patient's blood levels were checked and the supplement brought their B12 level back to normal. The patient then had no recurrences of canker sores for at least 6 months. Another study gave people with recurrent canker sores either Vitamin B12 1000 mcg under the tongue or a placebo. 74% of the B12 patients had no canker sores for 6 months while only 32% of the placebo group were canker sore free at 6 months. In another twist, when they checked the participants B12 levels with a blood test, it didn't seem to matter if the participants B12 blood level was normal after treatment or not. I guess that means Vitamin B12 and canker sore is an interesting link, but needs more study.

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 have a dream that one day this nation will rise up and live out the true meaning of its creed: We hold these truths to be self-evident, that all men are created equal." Great men dream of making the world better a better place. Lazy boys dream of handles on chairs. I told Emily about my Lazy Boy handle dream. She said, "Wow, you really are an exciting guy, aren't you?" That's me. The lazy boy of anemic and small dreams. I should get that on a business card! Ah, maybe later. I'm kinda comfy in my chair.

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.


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