Canker sores (aphthous ulcers)

Many people suffer with canker sores at irregular intervals. These are inflamed lesions (open wounds) in the lining of the mouth that are creamy-white and reddish in color. Two to four canker sores often occur at the same time. Although painful, they usually clear up on their own without any complications. Some people experience canker sores that recur after just a few weeks, while others may not see a recurrence for months or years.

The cause of these small, non-contagious sites of inflammation in the lining of the mouth is unknown. As a result, it is not yet possible to prevent canker sores. 

Pain-relieving, anti-inflammatory gels, creams, or mouth rinses provide relief. In the event of very large, inflamed sores or several sites of inflammation that are not healing naturally, it is important to consult a doctor or dentist. 

A doctor or dentist should also be consulted in the event of any other symptoms, such as halitosis (bad breath) or swollen lymph nodes. The doctor/dentist will then determine whether another condition may in fact be causing symptoms similar to those of canker sores.

Canker sores usually form as round, creamy-white sores on the lips or the insides of the cheeks. They occur less frequently on the roof of the mouth, gums, and tongue. 

First and foremost, canker sores are painful. When a canker sore forms, the affected area may also produce tingling and burning sensations or feel raw.

The pain can be exacerbated by food that further irritates the inflamed mucous lining of the mouth, such as crusty bread rolls, sour fruit, and spices. Chewing and speaking may also exacerbate the pain.

Canker sores are usually only a few millimeters wide and slightly sunken. They have a red border that is slightly raised. 

When the sores are small, they are referred to as minor (or simple) canker sores or minor aphthous ulcers. Sores that are between one and three centimeters in size are known as major canker sores. Multiple pinhead-sized sores are referred to as herpetiform canker sores.

The precise reason why some people get canker sores and others don’t remains unclear. However, experts suspect that a genetic predisposition plays a role, in combination with other factors, such as stress, a weakened immune system, or hormonal fluctuations.

Factors such as these may also cause canker sores to recur after a symptom-free period. It is suspected that deficiencies, such as an iron or vitamin B deficiency, and injuries to the lining of the mouth may also trigger canker sores.

In addition, certain diseases may produce inflamed areas in the mouth that are very similar to canker sores. Examples include chronic inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis or Behçet’s disease – a rheumatic vascular disease.

Canker sores are among the most common diseases to affect the lining of the mouth. Some researchers estimate that one in ten people are affected. However, the precise number of people who suffer from recurring canker sores is unknown.

Most people develop canker sores for the first time as adolescents or young adults. Women are more susceptible to canker sores than men.

85% of canker sores are minor canker sores, making them the most common type. Around 10% of canker sores are major canker sores. Herpetiform canker sores are the rarest kind, accounting for 5% of all canker sores.

Tingling or burning sensations may be experienced in the first few hours of a canker sore developing. The affected area becomes red, swells slightly, and starts to be painful. Over a period of one to three days, the swelling develops into a pit in the tissue with a creamy-white coating. The pain begins to ease a few days later. The canker sore disappears entirely after approximately one week.

Major canker sores may last longer and be more painful. It can take up to four weeks for them to heal and they often leave scarring on the mucous membrane.

Most people experience recurring canker sores between three and six times per year. However, some people do not develop sores for years. The intervals between recurrences become longer with age.

Severe cases are rare. In such instances, major canker sores may last much longer than usual or be so painful that the sufferer can barely still eat or drink. Severe cases may also be accompanied by sores on the mucous membranes of the sex organs.

The appearance, progression, and symptoms of canker sores are usually so typical that they can be diagnosed immediately without any special tests.

If a canker sore fails to heal within two weeks or if the inflammation is very pronounced, it is wise to consult a dentist or an ENT practitioner. They will take a close look at the lining of the mouth and ask, for example, about symptoms and eating habits.

If there is any suspicion that another disease could be causing the inflammation, additional tests may be necessary – for example, a swab, blood test, tissue sample, or an examination of certain organs, such as the bowel.

Most canker sores heal on their own without treatment. For pain relief, gels or creams, for example, can be applied to the inflamed sores. Mouth rinses may also help. It is only advisable to use other treatments – such as laser therapy or anti-inflammatory tablets – in severe cases.

For more detailed information, e.g., on the treatment of canker sores, see gesundheitsinformationen.de.