Canker Sores

Canker sores, also known as mouth ulcers or aphthous ulcers, are small superficial lesions that develop on the mucous membranes of the soft tissues inside the mouth (the inner surfaces of the cheeks and lips, the edges and dorsum of the tongue, the soft palate, or the base of the gums). They are not serious lesions, but they are very common and bothersome, usually healing on their own within one or two weeks. Canker sores have a round or oval shape, a red border, and a white or yellow center.

Canker sores are classified based on their presentation:

Minor canker sores: The most common form. These are small, oval, or round ulcers measuring between 2 and 5 millimeters in diameter. They are shallow with a red border. They frequently appear on the tongue, the inner cheeks, and the lips. While they can be painful, they usually heal on their own within one or two weeks without leaving scars. A single outbreak may include up to five small ulcers, all mild in nature.

Major canker sores: These can reach up to 10 millimeters in size and may appear singly or in multiple lesions. They are deeper and more destructive. They have a round shape with well-defined borders and can affect connective tissue, sometimes presenting a hemorrhagic base due to blood vessel involvement. After healing, they may leave a scar. They are less common and are often associated with underlying medical conditions.

Herpetiform canker sores or recurrent aphthous stomatitis: This syndrome is characterized by multiple ulcers, ranging from 5 to 100 lesions, spread throughout the oral mucosa. They typically measure less than 3 millimeters but can merge into larger, irregularly shaped ulcers. Their appearance resembles herpes-related lesions, but they are not caused by the herpes virus and are not contagious. They heal without scarring within one or two weeks. These are very rare.

Symptoms

The typical progression of canker sore symptoms is as follows:

• A burning sensation, pain, and localized tingling before the ulcer appears.
• Redness and swelling of the affected area.
• The formation of a small whitish lesion with well-defined borders.
• The ulcer grows until it reaches its maximum size.
• Pain and sensitivity in the affected area.
• In severe cases, fever, general discomfort, or swollen lymph nodes may occur.

Causes

The specific cause of canker sores is unknown, but it is believed to be a process involving multiple contributing factors:

Predisposing Endogenous Factors:

• Family history.
• Digestive, immune, or inflammatory disorders.
• Food allergies or hypersensitivity.
• Hormonal changes (especially during menstruation).

Triggering Exogenous Factors:

• Minor trauma from orthodontics, accidental bites, or aggressive brushing.
• Toothpaste and mouthwashes containing sodium lauryl sulfate.
• Certain medications, such as corticosteroids, anti-inflammatory drugs, or immunosuppressants.
• Emotional stress.
• Viral or bacterial infections.
• Deficiencies in iron, zinc, folic acid, or vitamin B12.

Risk Factors

In addition to the causes mentioned above, the risk of developing canker sores increases due to:

• Age: More common in teenagers and young adults.
• Sex: More frequent in women.

Complications

Canker sores typically heal on their own and do not cause serious complications. However, if they persist or worsen for more than two weeks, occur very frequently, or are accompanied by fever or severe pain, they may indicate an underlying medical condition.

Prevention

While canker sores cannot be entirely prevented, their frequency can be reduced by:

• Maintaining a balanced diet to avoid nutritional deficiencies.
• Avoiding irritating foods such as salt, spices, or acidic fruits.
• Practicing good oral hygiene with brushing and flossing.
• Using protective wax for orthodontic appliances.

Which Doctor Treats Canker Sores?

Canker sores are evaluated and treated by specialists in dentistry and stomatology.