Canker Sores

Latest Edit: Hector 2014-04-10 (EDT)

Canker sores, or aphthous ulcers, are one of the most common mouth sores, especially for those individuals in their 20s and 30s. Canker sores occur on mucous membrane surfaces, typically inside the mouth and genital linings. They are shallow ulcers with a white or whitish/yellow base surrounded by a reddish border that occur on a periodic recurring basis. Canker sores are sometimes confused for cold sores which often occur on the outside of the lips. Unlike cold sores, canker sores are not contagious. However, they can be painful and can make eating and talking difficult. Canker sores occur due to increased susceptibility plus a trigger such as stress, food or trauma.

Naturopathic Assessment

Causal Factors

Canker sores are typically diagnosed by visual assessment of the lesions. The aim of a naturopathic assessment is to determine the factors that contributed to the outbreak and the reasons for any underlying susceptibility.

Lifestyle

• Dietary Factors:

• Food sensitivities and nutritional deficiencies increase the occurrence. Canker sores are also correlated with increased consumption of chocolate, coffee, peanuts, eggs, some cereals, almonds, strawberries, cheese or tomatoes.

& Acid foods tend to trigger canker sores.

• Food allergies are associated with increased number of relapses.
• Nutritional deficiencies, including iron, vitamin B12, folate and zinc may contribute to canker sores.

• Sleep

• Lack of sleep contributes to a weakened immune system which is associated with canker sore outbreaks.

Social

• Stress

• An outbreak of canker sores often correlates with times of increased emotional stress.,

Environmental

• Infections

• Helicobacter pylori, a common stomach bacteria, is associated with increased susceptibility to canker sores, especially recurring canker sores.
• Streptococcal organisms have been implicated in causing recurrant canker sores..

• Circulating levels of IgG against Streptococcus sanguis are increased in patients who get recurrent canker sores..

External

• Trauma

• Local trauma to the area of the mouth or recurring episodes increase a person’s susceptibility, such as sports injuries or falls.
• Dental work can sometimes cause minor trauma to the mouth area which may trigger canker sores.
• Overzealous brushing of the teeth can weaken the integrity of the mouth's mucous membranes.

• Personal Care Products

• Chemicals in toothpaste and other mouth rinses can result in canker sores.

• The primary chemical that appears to be a concern is sodium lauryl sulfate.

Medical Interventions

• Prescription Medications

• Treatment such as corticosteroids (dexamethasone and rarely prednisone) sometimes used to treat canker sores often make cold sores worse and spread .
• Corticosteroid use is also linked to thinning of the skin which can increase the risk of canker sores.
• A number of other medications, such as sirolimus and tacrolimus, increase the risk of canker sores.

Genetics

• Genetics

• There tends to be a familial link, which may be associated with common food intolerances or other intolerances.

Common Questions

When assessing canker sores your naturopathic doctor will examine your mouth or other affected areas and inquire about the following:

• When did the canker sores develop?
• How often do you have an outbreak?
• What treatments have you done in the past and how effective were they?
• Have you had any recent injuries or traumas to the mouth?
• Have you had any recent dental work?
• What types of food do you consume?
• What makes it better or worse?
• What are your symptoms like?
• What other symptoms are you experiencing?
• What are your other health concerns?
• What medications, supplements, herbs or other health products are you taking?

Related Symptoms and Conditions

• There tends to be an increase occurrence of canker sores when the immune system is compromised. Such as with bacterial or viral infections or with autoimmune diseases.
• H. pylori infection
• Celiac disease
• Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.
• For canker sores that are chronic or when the cause is not discernible it is important to rule out Behcet's Syndrome.

Characteristics

• Canker sores are characterized by a shallow round or oval ulcers on a mucosal surface of the mouth, including the inside surface of the lips or cheeks, the floor of the mouth, the ceiling of the mouth, the throat, or the tongue.
• Canker sores are round, oval and small, typically between 0.5 to 2.0 centimeters. They tend to be whit to gray to grayish yellow, with a white or yellow center surrounded by an inflamed red border.
• The outbreak of canker sores may be preceded by tingling or a burning sensation a day or two before the sores are actually seen, or they can appear very quickly in response to a known trigger.
• Typically the sores persist for less than 10 days and resolve without leaving a scar.
• Canker sores are usually painful. Depending on the size and location of the sores, the pain is generally worse with eating, drinking, swallowing, talking, or brushing the teeth.

There are 3 types of canker sore:

1. Minor canker sores occurs in 80% of cases and typically heal within 1-2 weeks. These sores are usually small and oval shaped.
2. Major canker sores, occurs in about 10% of cases. This type can be extremely painful, can last from 2-4 weeks and may cause scarring. The sores are larger and deeper and tend to have irregular edges.
3. Herpetiform canker sores occurs in about 10% of cases and usually develop later in life. These sores are pinpoint size, occur in clusters of 10 to 100, have irregular edges and generally progress similar to minor canker sores in that they heal within one to two weeks without scarring.

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Canker sores are considered an acute disease. The naturopathic treatment for canker sores involves addressing dietary triggers, providing effective quick relief, addressing other causal factors and areas of susceptibility in order to prevent re-occurrence.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Home Care

Home Care strategies include:

• Applying ice or sucking on ice cubes often provides relief.

• Oral Hygiene is critical both in the treatment and prevention of canker sores.

• Do a salt water or baking soda (disolve 1 teaspoon of baking soda in 1/2 cup of warm water) mouth rinse.
• Brush teeth gently and regularly with chemical-free toothpaste and soft brush.
• Natural, chemical-free mouth rinses provide relieve and can initiate healing of the sores.

• Herbs, for example Sage (Salvia officinalis) and Chamomile (Matricaria recutita) are often mixed to form an oral rinse or can be taken internally to support the whole system.

• If you have braces or other dental appliances ensure that they fit appropriately so as to avoid sharp edges that irritate the surface of the mouth.

Lifestyle

Lifestyle recommendations include:

• Dietary recommendations:

• Avoid spicy foods, acidic or salty foods, very hot or coarse foods as these can be chemically or physically irritating.
• Avoid alcohol.
• Address food sensitivities and avoid any food triggers.
• Consume plenty of fruits, vegetables, grains and lean protein in order to prevent nutritional deficiencies.
• Water. Ensure you drink adequate water.

• Stress

• Reducing stress is an important step in the both the treatment and prevention.

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

Naturopathic Therapies for canker sores include:

• Nutritional Foods include:

• Herbs and spices that can assist with canker sores include: peppermint.
• Fruits such as watermelon, star fruit.
• Other foods such as honey

• Clinical Nutritional Supplementation includes

• Vitamins such as B Vitamins, Vitamin C.
• Minerals such as Zinc.
• Amino Acids such as L-Lysine, L-glutamine.
• Other supplements such as Deglycyrrhizinated licorice, Quercetin.

• Herbs such as Chamomile (Matricaria recutita),

Calendula (Calendula officinalis), Sage (Salvia officinalis var. rubia), Echinacea (Echinacea angustifolia), Cleavers (Galium aparine), Burdock (Arctium lappa), Goldenseal (Hydrastis canadensis), Licorice (Glycyrrhiza glabra).

• Essential oils such as Peppermint (Mentha piperita).

• Homeopathy

• Classical homeopathics such as Arsenicum album, Borax, Calc carb.

Emergency

Most canker sores will heal on their own, yet there are times when it is necessary to seek immediate medical care such as:

• When the sores are unusually large and tend to persist without response to normal treatment.
• When new sores are developing even before the old one heal.
• When the sores extend into the lips themselves.
• If the sores are causing extreme difficulty with eating or drinking
• If the onset of the canker sores was associated with a high fever and general feeling of malaise.
• If the sores appear to be triggered or aggravated by dental appliances.

References

Reviewed by Iva Lloyd, BScH, RPE, ND [1]