Wednesday, December 12, 2007

Canker Sores

Canker sores or aphthous ulcers are small, painful, shallow ulcerations that occur on the soft tissues inside the mouth. Stress or tissue injury is believed to contribute to the development of canker sores, although the actual cause is unknown. Other possible factors include immune system dysfunction, vitamin deficiencies such as B-12, zinc, folic acid or iron, disease of the gastrointestinal tract, food allergies, or hormonal changes such as menstrual periods. There can also be a hereditary predisposition to developing these sores. They are not contagious and normally resolve without any intervention in 10-14 days.
Occasionally these sores can be recurrent or large and complex. For these cases there are several treatment options. Dr. Nasim Fazel makes the following recommendations.
  • Topical therapy - Steroid compounds such as flucinonide (Lidex) or clobetasol gel for lesions which are easily within reach or dexamethasone (Decadron) elixir (0.5 mg/5ml) to swish around in the mouth for lesions that are in the back of the throat.
  • Systemic therapy - Several immune system modifying medications may be used for the more severe cases. These include prednisone either in a short term therapy of 40-80 mg every day for 4-5 days or a long term dosing regimen with gradual taper; pentoxifylline (Trental) 400 mg three times a day for at least 3-6 months and usually for 1 year; colchicine 0.6 mg 2 to 3 times a day, dapsone 100-200 mg daily or azathioprine (Imuran) 50 mg twice daily for 2 weeks. Each of these medications has its own set of side effects which should be weighed against the benefits.
  • Pain control therapy - Zilactin which is an over the counter gel, sucralfate(Carafate) to provide a protective coating over the ulcer, or viscous lidocaine 2% to be taken about 20 minutes before meals to reduce the discomfort while eating.

What ever option you chose, please don't do this.

Photo: courtesy of kidshealth.


Anonymous said...

Sodium perborate works too. Put a little (my mom used to use what she could scoop on the flat end of a toothpick) on the sore, at bedtime. Usually one application is all it takes; rarely, you will need to do it the second night.
While the cause of ordinary canker sores may be unknown, you can, I am recently told, develop a similar sore if you (negligently,) repeatedly, park your sugarfree gum in the same corner of your mouth overnight.

Anonymous said...

Dr. Razavi, thank you for your informative blog. I am wondering if you'd be willing to dedicate a blog informing patients how to seek finding a primary care physician that we can trust and what things we should ask when seeking a physician. As a physician, what do you wish your patients would do or ask when they come to you? I feel stupid seeing a doctor unless I am dying so I delay going in when there are questions in my mind as to symptoms that may result in something that should be checked early. I figure that if there is something really wrong, I'll find out later. I just don't know if that is using wisdom in taking care of my health. I just always feel so stupid when I seek medical attention.

greeny said...

This is not a comment about canker sores although that was good info.
I wondered what advice you could give to a person about teenage depression in a female. I can't say she is over-wrought but I don't want to let it slide either in case it is worse than she is letting on.
Believe me when I say I am aware it is most likely hormonal but to what end, I am curious.
Also, this teenager, my daughter is rather high strung and emotional but through middle school until now at age 15, she and I have worked with mentally managing her stress and emotions in healthy ways such as exercise and bio feedback and positve attitude. This has helped a lot to the point she can head it off before it gets out of hand.
However she has a lot of crying and general empty sad feelings.

What things should we consider? Medication is not out of the question. I would like to help her without it if possible.

Do you have a post about this in your archives?

Dr. Taraneh Razavi said...

Greeny, I will put up a post on this topic in near future. I would like to check in with some specialists for their suggestions.

Dr. Taraneh Razavi said...

anonymous, you bring up an excellent question which I have been meaning to address in my posts. I will move this subject up on the lineup.

oh kids said...

thanks for the information.. you have a very authoritative site.

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Franz said...


I usually have between 20 to 30 cancer sores in my mouth at all times. I have been getting them for about 25 years now and they have been steadly getting been worse as I get older. I have been to many doctors and even to Shan's Hospital and I haven't gotten anywhere.I don't eat alot of acidy foods and I'm in pretty good health( never smoked cigerettes and I don't drink). The pain gets so bad that I have a hard time even speaking at times. Do you have any suggestions?