Aphthous Ulcer (Canker Sore)

Overview

What is an Aphthous Ulcer?

Aphthous ulcers (canker sores) are painful, round or oval shallow ulcers that develop on the non-keratinized oral mucosa. They are the most common type of oral ulceration, characterized by a white or yellow center surrounded by a red halo.

• Affects approximately 20% of the population
• More common in women and younger individuals
• Recurrent in many patients (recurrent aphthous stomatitis)
• Usually heal within 1-2 weeks without scarring
• Not contagious

Overview of the Condition

Aphthous ulcers occur on movable oral mucosa including the inner cheeks, lips, tongue, soft palate, and floor of mouth. They are classified as minor, major, or herpetiform based on size and presentation. The exact cause is unknown but involves immune dysregulation.

References

• NCBI - Aphthous Stomatitis
• Mayo Clinic - Canker Sore

Symptoms and Causes

Symptoms

• Painful round or oval ulcer
• White or yellow center with red border
• Burning or tingling sensation before ulcer appears
• Pain worsens with eating, drinking, or speaking
• Usually 3-10mm in diameter (minor type)
• Major ulcers can be larger than 10mm
• Herpetiform type presents as clusters of tiny ulcers
• May cause difficulty eating

Causes

• Exact cause unknown
• Immune system dysfunction
• Minor trauma (biting cheek, dental work)
• Stress and anxiety
• Hormonal changes
• Nutritional deficiencies (B12, iron, folate)
• Food sensitivities (citrus, chocolate, nuts)
• Sodium lauryl sulfate in toothpaste
• Genetic predisposition
• Underlying conditions (celiac disease, Crohn's, Behçet's)

Diagnosis and Treatment Options

Diagnosis

• Clinical examination of ulcer appearance
• Patient history of recurrence
• Rule out other causes of oral ulcers
• Blood tests if nutritional deficiency suspected
• Biopsy rarely needed unless atypical or persistent

Treatment Options

• Topical anesthetics (benzocaine, lidocaine)
• Topical corticosteroids (triamcinolone paste)
• Antimicrobial mouthwashes (chlorhexidine)
• Protective pastes or gels
• Systemic corticosteroids for severe cases
• Vitamin supplementation if deficient
• Cauterization for rapid pain relief

Non-Surgical Care

Conservative Management

Most aphthous ulcers heal spontaneously within 7-14 days without treatment. Management focuses on pain relief and promoting healing. Identifying and avoiding triggers can reduce recurrence.

Home Care Recommendations

1. Rinse with salt water or baking soda solution
2. Apply over-the-counter topical treatments
3. Avoid spicy, acidic, or abrasive foods
4. Use a soft toothbrush
5. Try SLS-free toothpaste
6. Apply ice to reduce pain
7. Maintain good oral hygiene

Surgical Care

When is Surgery Needed?

Surgery is not typically indicated for aphthous ulcers. Chemical or laser cauterization can provide rapid pain relief for severe ulcers. Biopsy may be performed for persistent ulcers to rule out other pathology.

Anatomy and Affected Areas

Anatomy Overview

Aphthous ulcers occur on non-keratinized mucosa, which is the softer, more movable tissue in the mouth. Keratinized tissue (attached gingiva, hard palate) is rarely affected.

Affected Areas

• Inner cheeks (buccal mucosa)
• Inner lips (labial mucosa)
• Tongue (lateral borders, ventral surface)
• Soft palate
• Floor of mouth
• Tonsillar pillars

Frequently Asked Questions

Frequently Asked Questions

QuestionAnswerAre canker sores contagious?No, aphthous ulcers cannot be spread to others.How long do canker sores last?Minor ulcers typically heal in 7-14 days.What is the difference between canker sores and cold sores?Canker sores occur inside the mouth and are not viral; cold sores occur outside and are caused by herpes virus.Can stress cause canker sores?Yes, stress is a common trigger for outbreaks.Should I see a doctor for canker sores?See a doctor if ulcers are very large, don't heal in 3 weeks, or are accompanied by fever.Can I prevent canker sores?Avoiding triggers and maintaining good nutrition may help reduce frequency.

Prevention Tips

Prevention Strategies

• Identify and avoid personal triggers
• Manage stress effectively
• Maintain balanced nutrition
• Use a soft-bristled toothbrush
• Try SLS-free toothpaste
• Avoid irritating or abrasive foods
• Protect mouth from accidental biting
• Consider B-vitamin supplementation

Related Conditions

Related Conditions

• Behçet's disease (systemic with oral ulcers)
• Celiac disease
• Crohn's disease
• HIV/AIDS
• Nutritional deficiency anemias

Additional Treatments

For patients with frequent or severe recurrences, investigation for underlying systemic conditions is warranted. Colchicine, dapsone, or other immunomodulatory drugs may be considered for refractory cases under specialist supervision.