Canker sore

  • Definition
    • A canker sore is a painful, open sore in the mouth. Canker sores are white or yellow and surrounded by a bright red area. They are not cancerous.

      A canker sore is not the same as a fever blister (cold sore).

  • Alternative Names
    • Aphthous ulcer; Ulcer - aphthous

  • Causes
    • Canker sores are a common form of mouth ulcer. They may occur with viral infections. In some cases, the cause is unknown.

      Canker sores may also be linked to problems with the body's immune system. The sores may also be brought on by:

      • Mouth injury from dental work
      • Cleaning the teeth too roughly
      • Biting the tongue or cheek

      Other things that can trigger canker sores include:

      Anyone can develop a canker sore. Women are more likely to get them than men. Canker sores may run in families.

  • Symptoms
    • Canker sores most often appear on the inner surface of the cheeks and lips, tongue, upper surface of the mouth, and the base of the gums.

      Symptoms include:

      • One or more painful, red spots or bumps that develops into an open ulcer
      • White or yellow center
      • Small size (most often under one third inch or 1 centimeter across)
      • Gray color as healing starts

      Less common symptoms include:

      Pain often goes away in 7 to 10 days. It can take 1 to 3 weeks for a canker sore to completely heal. Large ulcers can take longer to heal.

  • Exams and Tests
    • Your health care provider can often make the diagnosis by looking at the sore.

      If canker sores persist or continue to return, tests should be done to look for other causes, such as erythema multiforme, drug allergies, herpes infection, and bullous lichen planus.

      You may need further testing or a biopsy to look for other causes of mouth ulcers. Canker sores are not cancer and do not cause cancer. There are types of cancer, however, that may first appear as a mouth ulcer that does not heal.

  • Treatment
    • In most cases, the canker sores go away without treatment.

      Try not to eat hot or spicy foods, which can cause pain.

      Use over-the-counter medicines that ease pain in the area.

      • Rinse your mouth with salt water or mild, over-the-counter mouthwashes. (DO NOT use mouthwashes that contain alcohol which can irritate the area more.)
      • Apply a mixture of half hydrogen peroxide and half water directly to the sore using a cotton swab. Follow by dabbing a small amount of Milk of Magnesia on the canker sore afterward. Repeat these steps 3 to 4 times a day.
      • Rinse your mouth with a mixture of half Milk of Magnesia and half Benadryl liquid allergy medicine. Swish mixture in the mouth for about 1 minute and then spit out.

      Medicines prescribed by your provider may be needed for severe cases. These may include:

      • Chlorhexidine mouthwash
      • Stronger medicines called corticosteroids that are placed on the sore or are taken in pill form

      Brush your teeth twice a day and floss your teeth every day. Also, get routine dental check-ups.

  • Outlook (Prognosis)
    • Canker sores almost always heal on their own. The pain should decrease in a few days. Other symptoms disappear in 10 to 14 days.

  • When to Contact a Medical Professional
    • Call your provider if:

      • A canker sore or mouth ulcer does not go away after 2 weeks of home care or gets worse.
      • You get canker sores more than 2 or 3 times a year.
      • You have symptoms with the canker sore such as fever, diarrhea, headache, or skin rash.
  • References
    • Chattopadhyay A, Shetty, KV. Recurrent Aphthous Stomatitis. Otolaryngological Clinics of North America. 2011;44(1):79-88. PMID: 21093624

      Daniels TE, Jordan RC. Diseases of the mouth and salivary glands In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 425.