Oral Care: Aphthous Ulcers (Canker Sores)

Overview and Aphthous Ulcer Facts
An aphthous ulcer is a painful, open sore that forms in the mouth. About 1 out of 5 people experience an aphthous ulcer at one point during their life, with women slightly more likely than men to get them. Although aphthous ulcers can occur at any age, they are more commonly found in younger patients. 

Aphthous Ulcer Signs and Symptoms
There are 3 general classifications for aphthous ulcers based on appearance and size. General symptoms include:

• Painful red spot or bump that develops into an open sore
• White or yellow in the middle of the ulcer
• Diameter of <1 cm
• A bright red area surrounding the ulcer

Causes/Common Triggers
The cause of aphthous ulcers is not fully understood and cannot always be determined. There are, however, some known triggers including:

• Nutritional deficiency (lack of vitamin B12, folic acid, or iron)
• Emotional stress
• Local trauma to the mouth
• Autoimmune disorders
• Hormonal changes (eg, menstrual period)

Test and Diagnosis
Most aphthous ulcers are not caused by an underlying disease. A clinician can typically confirm a diagnosis by visually examining the sore. If sores are frequent and persistent, tests can be done to assess possible causes. A biopsy of the sore may be performed to differentiate between other causes of ulcers in the mouth.

Prevention
Patients can take steps to prevent aphthous ulcers taking the following steps:

• Avoiding trauma to mouth such as rough food or hard bristle toothbrushes
• Managing stress
• Repairing damaged dental surfaces
• Taking vitamin and mineral supplements (as directed by a physician and/or pharmacist)
• Consider switching to a different oral contraceptive

Day-to-Day Management
Patients can employ the following tips to manage an aphthous ulcer:

• Avoid hot or spicy food
• Avoid abrasive food that can irritate sores
• Brush teeth gently and floss daily (to prevent the sore from being aggravated)
• Use OTC medication or other remedies as directed by the physician and/or pharmacist

Treatment and Care
The best course of treatment should be determined by the physician and/or pharmacist. Most aphthous ulcers are resolved without any treatment in about 7 to 10 days. If the sore persists, a clinician can prescribe topical anesthetics or pain relievers to help manage the symptoms.

Homeopathic and Alternative Remedies
Many individuals prefer to use homeopathic treatments. Although study data on their effectiveness is limited, some health care providers may recommend the following:

• Natural herbal supplements
• Vitamin/mineral supplements
• Proper oral hygiene

Self-Care
A wide range of OTC medications are available to manage aphthous ulcers by treating pain or inflammation or soothing the ulcer, including ointments used for toothache, anti-inflammatory gels, and mouthwash to help temporary numb the lesions. Pharmacist should advise patients on the best OTC treatment option to meet their individual needs. Patients should inform the pharmacist of all prescription and other OTC medication being taken to avoid any drug interactions or contraindications.

Resources for Patients
The following resources may provide patients with more information on preventing and managing aphthous ulcers:

• American Dental Association
• Academy of General Dentistry
• National Center for Biotechnology Information