So what’s a Canker Sore?

Canker sores, known in the medical world as recurrent aphthous stomatitis, are fairly common mouth ulcers that have various presentations.  Not to be confused with oral herpes, these lesions only present inside of the mouth.   According to medical texts, around 20% of the general population suffers from this ailment.

How do canker sores appear in the mouth?

Canker sores can appear as small (ranges from 3 mm to 3 cm in diameter) gray or white round lesions surrounded by a red border. Its appearance is due to an actual destruction of the mucosa by the immune system, primarily T lymphocytes.   These lesions can appear on the inside of the cheek, floor of the mouth (under the tongue), roof of the mouth (palate), or on the tongue only.

What are the symptoms?

A burning, tingling, or itching sensation may occur in the area before the sore appears.  Once present, the lesion is usually painful when eating, drinking, or even talking.  Any type of movement may initiate the pain.  Depending on the classification of the ulcer, a fever or swollen lymph nodes may also appear.

What causes the sores?

Though one definitive cause has yet to be identified, several factors can contribute to the appearance of canker sores including:

• Stress
• Allergies
• Family history (can possibly be hereditary)
• Nutritional deficiencies
• Direct trauma or agitation
• Major hormonal changes (i.e. puberty)
• Can be associated with major systemic disease

Which type of canker sore do I have?

There are several types of canker sores.  The charts below summarize the three types of clinical variants and two types of classifications.

Type	Appearance	Symptoms	Duration	Other Facts
Minor	3-10mm Circular shape Usually leave no scar when healed	Very painful Have burning or itching sensation before appearance 1-5 lesions per episode	Usually appear for 7-14 days Begins in childhood or adolescence	Most common Surrounded by red border Women affected more than men
Major	1-3 cm in diameter (larger than the two other forms) Irregular shape	Painful 1-10 lesions per episode	Usually associated with hormonal changes and may develop shortly after puberty Can last from 2-6 weeks
Herpetiform	1-3 mm Heals with no scar	Many lesions (up to 100) per episode	Begins in adult life Lasts 7-10 days	Has the most frequent occurrences of all 3 forms

Types of Canker Sores

Simple

• Usually associated with pain
• Heals in 1-2 weeks
• Few lesions
• Doesn’t occur that often

Complex

• Associated with severe pain
• Never completely heals. Lesions always present.
• Numerous lesions present

Treatment for Canker Sores

• If mild, the doctor or dentist may prescribe topical corticosteroid cream to apply to the area.
• If in a hard to reach area, like on the tonsils, a beclomethasone dipropionate may be prescribed.
• Anti-virals such as acyclovir
• Vitamins, especially zinc sulfate

Many cold sores are minor and will disappear on their own.  However, if your cold sore does not resolve on its own, or is reoccurring, please visit your dentist or physician for assistance.

Embarrassing Cold Sore on your Lips: Get the Facts!

Do you Have a Bump on the Lip or Inside the Mouth?

Cold sores (Fever Blisters), better known as herpes simplex virus type 1 (HSV-1), are small, irregular shaped, yellow or white ulcerations/sores located in the mouth, lips, or surrounding skin.  The sores typically start off as red, then collapse to form a yellowish ulcer.  These lesions are usually painful.

The first breakout of HSV-1 is more severe than recurrent episodes.  The initial breakout is oftentimes seen in children between 6 months and 5 years and is known as acute herpetic gingivostomatitis.

Recurrent breakouts usually appear on the lip or surrounding skin and are known as herpes labialis.  15-45% of the population has a history of herpes labialis.

What are the symptoms of Cold Sores?

The following symptoms will occur 6-24 hours before a breakout:

• Itching
• Burning
• Tingling
• Pain
• Redness of the skin

Shortly after, multiple small red lesions will appear.  The sores rupture within 2 days, crust over, and generally fully heal in 7-10 days.

If this is an initial breakout, the following symptoms may also occur:

• Sore throat
• Fever
• Muscle pain
• Headache

What causes cold sores?

The sores are caused by a DNA virus known as herpes simplex virus.  Unfortunately the virus remains in the system even when no breakout is present.  Breakouts can also be provoked by the following factors:

• Stress
• Ultraviolet light
• Pregnancy
• Trauma
• Respiratory illnesses
• Allergies
• Other diseases
• Menstruation

Is there treatment for cold sores [herpes labialis]?

Unfortunately there is no known treatment that can completely cure the disease.  However, there are several treatments that can be used to decrease or temporarily alleviate the symptoms of herpes.  These treatments include:

• Anti-viral medications such as Acyclovir
• Nonsteriodal anti-inflammatory medications (NSAIDS) such as ibuprofen, to alleviate the pain
• Over the counter topical anesthetic gels can also help to decrease pain and discomfort