One of the most distressing oral problems people face is the appearance of a canker sore. These uninvited guests often show up during life's most stressful times and stick around for a week or more. Common questions we in the dental profession encounter are: What causes them? Is it the same as a cold sore? How do you treat them, and can they be avoided?
It's important to know the difference between canker sores, also called apthous ulcers, and cold sores.
Canker sores are ulcer-like spots on the inside of the mouth on the soft tissue and are not contagious.
They typically have a round, white appearance with an inflamed red border. They are usually caused by some form of trauma and followed by a bacterial infection.
Cold sores are typically on the outside of the mouth on the border where the lower lip and skin meet, and usually brought on by stress, too much sunshine, dry winter weather etc, and will have a tingling sensation in the area before an outbreak. Cold sores are caused by type 1 herpes simplex virus, and are quite contagious.
There are a number of causes of canker sores but generally they develop in susceptible people when the tissue has been traumatized by biting sharp foods such as nuts, corn chips or uncoordinated efforts to bite apples or carrots that result in biting the lip.
Dental devices such as dentures and braces can also rub and cause irritations leading to canker sores.
For reasons that aren't clearly understood not everyone develops canker sores after trauma but there seem to be triggers that result in the sores. They are reportedly more frequent during stressful periods of a person's life and are thought to be regulated by hormones and the body's immune response.
They are almost certainly allergy related for some individuals. Nutritional deficiencies play a role as well.
So far the most promising technique for reducing canker sores appears to be vitamin B12 supplements. In one study people taking 1000 mg of B12 had a 75 percent reduction in events.
A common allergy culprit is a toothpaste additive called sodium lauryl sulfate or SLS. Although not particularly common, there are a number of SLS-free toothpastes that are beneficial for those who are susceptible. These include Rembrant tooth paste for canker sores, Orajel and Biotene "dry mouth" toothpastes, and natural products like Tom's of Maine.
If you develop these sores frequently your dentist can prescribe a topical paste such as Aphthasol, Triamcinolone Acetonide, or Kenalog with Orabase, which are specifically for treatment of sores.
These work best when applied just as the sore is starting. If the sore has progressed for a few days and is very tender, your dentist can place a medication called Debacterol on the area, cleaning and taking away the sensitivity of the sore. Another treatment that is showing a lot of promise for developed sores is use of a soft tissue laser.
The technology is becoming more available and that may be something your dental office is able to use to relieve acute discomfort. If you develop multiple sores your dentist will probably send you to a specialist for further evaluation as this could mean a more serious problem with your immune system.
For those who suffer from canker sores, you can reduce the number and severity of these events with a few simple changes. Try a vitamin B12 supplement, change your toothpaste to one that contains no sodium lauryl sulfate, cut up apples, carrots, and other similar foods into smaller portions to allow easier chewing, and avoid nuts if they trigger these events for you.
Dr. Eric Gustavsen practices dentistry at Southpoint Dental Center, 1129 S. Second Ave. More information on his practice can be found at www.southpointdentalcenter.com.