Canker Sores (Aphthous Stomatitis)

Those CANKER SORES!
If you've experienced these painful mouth ulcers, you are in good company. Each year 20% of Americans suffer from canker sores, also known as aphthous ulcers or recurrent aphthous stomatitis (RAS). They frequently affect adolescents and women just prior to their menstrual periods. Women are twice as likely to get canker sores as men, and if your parents had them, you have a 90% chance of experiencing them yourself.

Symptoms
These mouth ulcers generally appear as small white or yellow sores that are surrounded by redness. There can be just one sore or several in a cluster that tend to irritate the tongue, inside of the lips, cheeks or gums. This condition ranges from mild to severe, with the size of a mouth sore being less than 3/8 of an inch in milder cases and larger than that in more severe cases. The outbreak can last from 10 days to several months and may leave scarring after healing. Pain can be severe and may interfere with talking, eating or sleeping.

Causes
The ultimate cause of canker sores is unknown, but there seem to be some contributing factors that can trigger them. Possible factors include:

• Irritating Toothpaste Ingredients - SLS (sodium lauryl sulfate), tartar control agents and others.
• Heredity - Children of parents who had mouth ulcers are at greater risk of having them, too.
• Nutrients - Deficiencies in lysine, iron, vitamin B12 and folic acid, or a combination of these, may encourage flare-ups.
• Foods - Strawberries, walnuts, tomatoes, chocolate, cereals, cheese, cow's milk and citrus fruits have been known to trigger outbreaks in some people.
• Mouth Trauma - Biting the inside of the mouth, a hard-bristled toothbrush, dentures or braces that cut or scrape the soft mouth tissues can also incite mouth ulcers.
• Stress seems to be a significant factor. Personality types that tend to be anxious, high-strung or perfectionistic seem to be at a higher risk for mouth ulcers. Specific stressful situations, such as a job interview, exam or giving a speech, can also trigger an outbreak.
• Heat - Hot weather or heat produced by physical exertion has also been known to cause trouble.

Combat Plan
If mouth ulcers are a problem, here are some suggestions to try:

• Switch to a toothpaste such as Squigle Enamel Saver®, Squigle Jr®, or Tooth Builder®, which do not contain SLS (sodium lauryl sulfate) and other irritants that can trigger canker sores.
• Apply Canker-Rid and/or Zilactin-B directly to painful canker sores.
• Keep mouth clean and healthy and see your dentist regularly.
• Stop biting the inside of your mouth and see your dentist if this is occurring.
• Pay attention to any foods that you think may be triggering an outbreak.
• Watch out for hard foods that may injure the inside of the mouth.
• De-stress your life as much as possible--anything you can do to reduce stress is often beneficial.
• Also see our Instruction Sheet for Canker Sores for the management of painful mouth ulcers.

When to See Your Doctor
Although canker sores are painful and irritating, they will usually run their own course without serious problems. However, since some mouth sores can indicate the presence of more serious diseases, it is advisable to consult your doctor in any of the following cases:

• If pain becomes severe or if you are unable to drink adequate fluids.
• If mouth ulcers increase to 4 or more in number, last longer than several weeks, or occur more than 2 or 3 times per year.
• If a fever develops.
• If something just doesn't seem right, or if you have any reason to believe you are experiencing something more serious than just canker sores, be sure to consult your doctor.

References
Beers, M.D., Mark H., and Robert Berkow, M.D. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NY: Merck Research Laboratories, Seventeenth Edition, 1999.

Burton Goldberg Group. Alternative Medicine-The Definitive Guide. Fife, WA: Future Medicine Publishing, Inc., 1995.

Editors of Prevention Health Books™. The Doctors Book of Home Remedies for Preventing Disease. Ed. Hugh O'Neill. Emmaus, PA: Rodale Press, Inc., 1999.

Editors of TIME-LIFE™ Books. The Medical Advisor-The Complete Guide to Alternative & Conventional Treatments. Ed. Robert Somerville. Richmond; VA: TIME-LIFE™, 1996.

Swartzberg, M.D., F.A.C.P., John Edward, and Sheldon Margen, M.D. The UC Berkeley Wellness Self-Care Handbook-The Everyday Guide to Prevention & Home Remedies. New York: Rebus, Inc., 1998.