Canker sore: mini-guide

Aphthae are small lesions of the skin. When they form inside the mouth, on the soft tissues of the oral mucosa (palate, cheeks, tongue) or at the base of the gums, they are called oral canker sores (or aphthous stomatitis or aphthous ulcer). To the eye, they resemble small abrasions a few millimeters in size, roundish or oval, whitish in color and surrounded by a red halo. They occur singly or in groups. They can be very painful, preventing eating or speaking, but normally heal within 1 to 2 weeks. In some individuals they tend to reappear with some frequency (recurrent aphthous stomatitis) creating considerable discomfort. Canker sores are not contagious.

Description

Canker sores are a very common type of ulceration, the most common of the oral mucosal afflictions. They affect 10% of the population, especially in pediatric age and with a higher prevalence in women. They consist of a rupture of the oral mucosa, which is often preceded a few days earlier by a sensation of mild discomfort, pain or burning. Canker sores (also referred to as aphthous stomatitis or aphthous ulcers) can affect other areas of the body besides the oral cavity, such as the male and female genital mucous membranes and semi-mucous membranes, i.e., foreskin and glans, labia minora and labia majora. Unlike blisters caused by Herpes Simplex on the labia, they are not contagious.
Typically, in the first stage, they are covered with a whitish patina composed of layers of a protein, fibrin, involved in blood clotting.

Causes

The origin and mechanism leading to the occurrence of mouth ulcers is not fully known. There may be multiple factors underlying the condition. The prevailing hypothesis is that mouth ulcers form in conjunction with episodes of psychophysical stress exactly as happens with Herpes Simplex or lip fever.
Many triggers are recognized such as:

• Contact with dirty objects and pets
• Minor mouth trauma, such as accidentally biting the cheek, vigorous toothbrush use, acidic or spicy foods
• Hormonal imbalances
• Menstruation
• Diet low in vitamin B12, zinc, folic acid (folate) and iron
• Helicobacter pylori infection
• Chronic inflammatory bowel disease (e.g., celiac disease, Crohn’s disease, ulcerative colitis)
• Immunodeficiency syndromes and immunosuppressive drugs

Symptoms

When you suffer from mouth ulcers you can feel it:

• Pain, even very severe pain, which becomes intense while eating or while talking
• Redness
• Burning
• Fever, if large and extensive mouth ulcers are present
• Swelling of the lymph nodes under the jaw

Diagnosis

A physical examination is often sufficient for diagnosis. No other diagnostic tests are generally necessary.

Treatment

Often canker sores, particularly oral ones, heal spontaneously within 1 to 2 weeks. When this does not happen and when the manifestation is particularly painful, interventions can be made with:

• Mouthwashes that form a protective film over canker sores that prevents contact with food
• Retinoic Acid touches that promote healing in fewer days
• Application of Dermasana, a product containing aluminium chloride, which stimulates the mucous membrane to regenerate.

Prevention

Prevention of mouth ulcers is achieved by consistent oral hygiene, using a soft-bristled toothbrush and toothpaste after every meal.
It is helpful to avoid acidic or spicy foods, including nuts, chips, some spices, pineapple, grapefruit, and oranges; eat plenty of fruits, vegetables, and whole grains; and drink plenty of fluids.
If you have dentures or braces, you should take care of their hygiene and inform your dentist of any discomfort or injury.
You should try to reduce stress.