Canker Sores

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Did you ever accidentally bite the inside of your cheek, and then find yourself doing it again and again in the same spot because it is so vulnerable? This can be very annoying, and is also a common way that a canker sore can form. Why is it that some people seem to get them often, while with others canker sores are a rare occurrence? There are many factors involved in the formation of these mouth ulcers, so let’s see if we can make some rhyme and reason of it all.

What Are Canker Sores?

Canker sores are officially a form of ulcers that have the medical name apthous ulcers or apthous stomatitis. They appear most often on the inside of the mouth, typically being found inside the lips, cheeks, gums, or on the soft palate (the rear of the roof of the mouth). Occasionally they will even appear on the tongue.

In some cases, canker sores will form in clusters, but most of the time they appear individually. They are typically very painful, and sensitive to the touch. That’s why it is so easy to re-aggravate existing ones when talking or eating. They are generally small, no more than a ΒΌ inch in diameter, and usually last several weeks before disappearing as mysteriously as they showed up. The first sign that you may be getting a canker sore is often a tingling sensation that may be slightly itchy at first. After 1-2 days, a grayish-white ulcer will begin to visibly appear, surrounded by a red inflamed ring. At this point they can begin to be very painful.

Canker sores are experienced by almost everyone at one time or another. It is estimated that about 20% of the population in the United States has a problem with recurring canker sores that can afflict them anywhere from once a month to no more than once or twice per year. They are more common in females than in males, and seem to strike women more often during their menses.

One condition that is often confused with canker sores is cold sores. These may appear similar, but they usually are found on the outside of the lips, on the gums, or on the hard palate (the firmer tissues of the roof of the mouth). It is important to distinguish between these two, because while canker sores are not contagious, cold sores are caused by the same virus that is responsible for herpes, and cold sores are very contagious. If you suspect cold sores, there is a diagnostic test that can positively identify them.

What Causes Canker Sores?

Despite much research to seek the answer to that question, the cause of canker sores is not known for certain. However, there are an abundance of theories that seek to explain the occurrence of canker sores. Here are some of the leading ones:

  • Repetitive injuries: This may occur due to many factors including biting your cheek, abrasions from teeth or dental appliances, consuming certain foods that may occasionally damage the mouth, or vigorous teeth brushing, especially with a hard-bristled brush. Once an area has been damaged, it is easier for a canker sore to form there, and recurring ones tend to form in the same area.
  • Immune System Dysfunction: Many illnesses have remained a mystery for thousands of years, with no specific explanation for their cause. In recent decades, scientists have been looking in greater depth at the role of the immune system in both wellness and disease in our bodies. It seems that the immune system plays a much more far-reaching role in the functions of the body than we once thought, especially when it comes to any type of infection. Thus, it is suspected that canker sores are somehow related to the performance of the immune system. It is known that individuals with certain conditions that compromise the immune system, such as diabetes or HIV / AIDS, are more susceptible to infections of all kinds, and canker sores are no exception.
  • Food Allergies: The effects of food and other types of allergies is also a field of study that has undergone much scrutiny in recent decades. While no particular food allergies have been linked directly to the formation of canker sores, it has been discovered that individuals who have significant struggles with food allergies, will also have an increased risk for canker sores. This too may be due to the connection between allergies and the immune system.
  • Nutritional deficiencies: Studies have shown that people who do not get ample amounts of iron, folic acid, or B-complex vitamins in their diets, are more likely to suffer from canker sores. On the contrary, supplementation with these nutrients has shown to improve existing cases of canker sores. Perhaps the reason women tend to get more canker sores during their periods is because of potential iron deficiencies.
  • The wrong toothpaste: Certain toothpastes contain an ingredient called sodium lauryl sulfate, which tends to destroy and strip the mucous membranes of the mouth. These mucous membranes serve as a protective layer in the mouth, and if they are compromised, it becomes easier for canker sores to form in many individuals.
  • Stress: It has also been verified in clinical studies that folks who are under stress, whether it be physical trauma such as recovery from surgery or a serious illness, or emotional trauma, have a higher incidence of canker sores than the general population.
  • There is also some evidence, although it has not been studied extensively, that people with poor gastrointestinal health are also more likely to be afflicted with canker sores. The reasons for this are not known for sure, but it may have something to do with the colon and related organs not being able to get rid of toxins in an efficient way.
  • Family history: Canker sores, like so many other conditions, seem to run in the family. If your family of origin commonly has or had canker sores, there is a good chance that you will as well. Again, the exact reason for this connection is not known for certain.

Can Canker Sores Be an Indication of Other Medical Problems?

Most of the time canker sores are nothing to be concerned about. However, if you experience any of the following symptoms along with your canker sores, you may want to investigate further the possibility that you may have other health problems:

  • Fever, especially if it is high and lingers for more than a few days.
  • Persistent canker sores, that last unusually long (three weeks or more) and recur on a continual basis. These would be considered chronic canker sores.
  • Intense pain associated with canker sores that make eating or drinking difficult or impossible.
  • Unusually large canker sores.

Any of these symptoms are not normal for everyday canker sores and could be linked to other potentially serious illnesses, especially if you already have a compromised immune system due to another condition. If your immune system is weakened, any infections, even seemingly minor ones, can become dangerous.

How Can I Best Treat or Prevent Canker Sores?

Canker sores are generally not anything to be too concerned about, and they must normally just run their course. However, there are some things you can do to lessen the pain and discomfort of canker sores, and some of these tips will help them heal faster as well.

  • Ice: Applying an ice cube or sucking on chips of ice is a great way to numb the pain of canker sores.
  • Salt-water: Rinsing the mouth with salt-water is a great natural cleanser that can improve the environment of your mouth, and help to avoid canker sores and heal existing ones faster. Even though it may sting a bit, it is still good for your canker sores.
  • Hydrogen peroxide: This substance works wonders for all kinds of mouth problems, including canker sores. Try dipping a q-tip in diluted hydrogen peroxide, and applying it to the canker sore. You will notice a foaming action, and perhaps a bit of a sting, but the peroxide will help to relieve the pain and heal the wound faster.
  • Some folks swear by milk of magnesia as a cure-all for their canker sores. Use a q-tip and apply in the same way as hydrogen peroxide.
  • Good dental hygiene: Keeping your mouth clean is always a good idea to help prevent canker sores and other mouth problems. Floss daily, and use and brush thoroughly, but gently, so as not to irritate the mouth. A brush with softer bristles may be a good idea, especially if you are prone to recurring canker sores.
  • Avoid foods or drinks that are abrasive, either physically (such as nuts or chips, which can cause cuts in the mouth) or due to their composition. The latter might include acidic or spicy foods, or carbonated beverages that can be very irritating to the mouth for some people.

Officially, there is no cure for canker sores, but we have discussed many factors in this article that can and do minimize the occurrence of these painful ulcers. While there is not a cure, I do not believe that canker sores are “normal,” in the sense that they should be tolerated as something some people just have to put up with. They may never lead to any further health conditions, but they are still a symptom of a body that is not operating at optimal efficiency.

It intrigues me just how much we have learned in the past few decades about how inter-related so many functions (and dysfunctions) of our bodies are. Something as simple as canker sores can be a window into an immune deficiency problem, or a clue to the negative effects of allergies in our system. The more we understand the complexity of the body and how all our parts network together, the harder it is to overlook something as seemingly insignificant as a canker sore, without seeing a deeper meaning behind it. Wellness is not defined by the health of any individual body system, but as a larger perspective of how all the pieces of the puzzle fit together. We are truly greater than the sum of our parts.

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