Definition

Aphthous ulcers are also known as canker sores. They are painful, temporary sores that may occur anywhere in the mouth. The sores can occur one at a time or as a group. Canker sores are generally not serious.

Causes

No one knows exactly what causes canker sores. They are thought to result from an overreaction of the immune system.

Canker sores are not a form of the herpes virus. Unlike herpes, canker sores cannot spread from one person to another.

Risk Factors

Canker sores tend to occur more often in women than in men. The tendency for these sores may also run in families.

The following may increase your chance of a canker sore:

• Stress or trauma in the mouth, such as biting the tongue, trauma from falls, or toothbrushes
• Certain foods (especially acidic foods, such as tomatoes and pineapples)
• Changes in hormone levels

Medical conditions that may increase your chance of canker cores include:

• Deficiencies of iron, vitamin B12, or folic acid
• Bacterial infections, such as stomach ulcers caused by the bacterium, Helicobacter pylori
• Inflammatory bowel disorders, such as Crohn’s disease or ulcerative colitis
• HIV infection
• Behcet’s syndrome

Symptoms

Canker sores can be various sizes. They typically occur on the inner surface of the cheeks and lips, and on or under the tongue. Canker sores are an open, shallow grayish sore. It may have a slightly raised, yellowish-white border that is surrounded by a red border.

Some people get canker sores 2-3 times per year. Others develop sores continually one after another. Usually the most painful phase is the first 3-4 days. The sores begin to heal after 3- 4 days.

Minor sores may last for a total of 7-14 days. They often heal without scarring. Major sores can last for several weeks or even months. They may leave a scar after they heal.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will most likely be able to tell the difference between a canker sore or more serious mouth sore by looking at it. To rule out other problems your doctor may do the following:

• Biopsy —a small sample of the sore will be sent to a lab for closer examination
• Blood culture or tests—to look for signs of an infection or other systemic health conditions

It is especially important to examine mouth sores that do not heal within 2 weeks. They may be a sign of cancer.

Treatment

Canker sores usually heal on their own within 1-2 weeks. Treatments for these sores are not usually necessary.

If your canker sore is especially painful or is taking a long time to heal, your doctor may recommend the following:

Prevention

It is not always possible to prevent canker sores. To help reduce your chance of canker sores:

• Chew food carefully. This may prevent biting your tongue or cheek.
• Avoid acidic foods that may promote canker sores. Tomatoes or pineapples are 2 foods that may cause problems.
• Talk to your doctor about how to get enough iron, vitamin B12, or folate in your diet. Low levels of these nutrients may contribute to canker sores.

Mouth Healthy—American Dental Association http://www.mouthhealthy.org

The College of Family Physicians of Canada http://www.cfpc.ca/ForPatients

Beers MH, Berkow R. The Merck Manual. 17th ed. West Point, PA: Merck and Co; 1999.

Canker sores. American Academy of Family Physicians Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/canker-sores.html
Accessed December 7, 2012.