Aphthous (canker sores)

Aphthous (canker sores)

Copyright 2006 Martin S. Spiller, D.M.D.

Canker sore located on the soft palate

Canker Sores (aphthous ulcers) are very painful ulcers occurring only on unattached oral mucosa. Unattached oral mucosa is the thin, pink "skin" in the mouth that is not directly attached to any underlying hard or firm tissues. Examples of unattached tissue such include the cheeks, the soft palate, the undersurface of the tongue, floor of the mouth and the vestibule, which is the place in the mouth where the lips and cheeks curve around to become the gums. They never occur on the top surface of the tongue, the hard palate (the roof of the mouth), or on the attached gingiva. No one knows what causes aphthous ulcers, but they seem to appear during or just after times of stress, or sometimes after physical trauma to the area. They are very common after dental visits. They appear to be an overreaction of the immune system to some sort of localized irritant, possibly a bacteria or a virus.

Aphthous ulcers are pinkish white erosions which are surrounded by a halo of red, inflamed mucosa. The one above is located on the soft palate and is especially painful during swallowing. Canker sores generally occur suddenly and will last between 10 an 14 days without treatment. The simplest and most effective treatment consists of applying a steroid cream such as Kenalog in Orabase® or Lidex® which are available with a prescription. When a steroid cream is applied several times a day, these lesions generally disappear within 2 or 3 days. Cauterization with Silver Nitrate or other cauterizing chemicals is also an effective treatment, but must be applied by a dentist or physician to prevent burning healthy tissue. The pain is caused by exposed sensory nerves in the open sore, so cautery literally burns the nerve endings and causes the ulcer to scab over.

Chlorhexidine mouth rinses have also been shown to decrease the intensity and shorten the duration of aphthous ulcers. Rinsing three times a day with Peridex® may be very helpful for persons who suffer from a condition known as major aphthous. In major aphthous, the patient suffers very severe recurring aphthous lesions which can be quite large (the size of a dime or larger). These patients can suffer multiple lesions at the same time, and they can be so severe that they actually cause scaring when they heal. Peridex is available with a prescription. Unfortunately, Chlorhexidine rinses, when used for long periods can cause a brown stain to cover the roots of the teeth. This stain can be professionally removed.

Copyright 2006 Martin S. Spiller, D.M.D. courtesy of Dr. Ed Cataldo

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Copyright 2000 Martin S. Spiller, D.M.D.

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