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Friday, September 18, 2020

Aphthous Ulcers: Symptoms, Causes and Treatment

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Aphthous ulcers are also called canker sores, and they are small, shallow lesions that develop in the mouth or at the base of the gums on soft tissues. Unlike cold sores, aphthous ulcers do not form on the surface of your lips and are not contagious.

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They can be painful, however, and they can make it difficult to eat and talk. Most of the aphthous ulcers go away on their own without treatment within a week or two.

Check with the doctor or dentist if you have abnormally large or painful sores or that don’t seem to heal. 


The majority of aphthous ulcers are round or oval with a white or yellow centre and a red border. They develop inside the mouth — on or below the tongue, inside the lips, cheeks or on the soft palate or at the base of the gums.

One might notice a burning or tingling sensation a day or two before the pain actually appears. 

There are numerous types of aphthous ulcers, which can include herpetiform, minor, and major sores.

Minor aphthous ulcers

Minor aphthous ulcers are the most prevalent and:

  • They are usually small 
  • Are oval with a red region  
  • The ulcers heal without scarring in 7 to 14 weeks. 

Major aphthous ulcers

Major canker sores are less common 

  • Are wider and deeper than the minor Aphthous ulcers  
  • They are usually oval with defined borders but could be irregularly shaped when very large. 
  • It can be excruciatingly painful 
  • It can take about six weeks to heal and leave large scarring. 

Herpetiform aphthous ulcers

Herpetiform aphthous ulcers are uncommon and usually develop later in life, but they’re not caused by herpes virus infection. These aphthous ulcers:

  • Are the size of the pinpoint 
  • They often occur in clusters of 10 to 100 sores, but they can form one major ulcer. 
  • Have an irregular edge 
  • Healing without scarring in one to two weeks. 


The exact causes of aphthous ulcers remain uncertain, although scientists assume that a variety of factors contributes to the outbreak, even in the same person. Possible triggers for aphthous ulcers include:

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  • A small injury to the mouth from dental work, overaggressive brushing, sporting mishaps, or unintentional cheek bite. 
  • Toothpaste and mouth rinse found to contain sodium lauryl sulfate 
  • Food sensitivities, in particular, chocolate, coffee, strawberries, eggs, nuts, cheese and spicy or acidic foods 
  • A diet lacking vitamin B-12, zinc, folate or iron 
  • An allergic reaction to specific bacteria in the mouth 
  • Helicobacter pylori, the same bacterium that causes peptic ulcers 
  • Hormonal shift during menstruation
  • Emotional stress 

Canker sores can also develop because of certain diseases, such as:

  • Celiac disease, a severe intestinal disorder caused by a sensitivity to a protein found in most grains called gluten.
  • Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease.
  • Behcet’s disease, an uncommon condition that causes inflammation in the whole the body, including the mouth.
  • A malfunctioning immune system that fights healthy cells in the mouth instead of pathogens, such as viruses and bacteria
  • Conditions that suppress the immune system like HIV/AIDS. Unlike cold sores, aphthous ulcers are not associated with herpes virus infections.


Tests aren’t needed to diagnose aphthous ulcers. A doctor or dentist can easily identify them with a visual exam. In some cases, one may have tests to check for other health problems, especially if the case of aphthous ulcers are severe and ongoing.


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Treatment isn’t necessary for minor aphthous ulcers, which usually clear on their own within a week or two. But severe, persistent or unusually painful sores often need medical care.

A number of treatment options exist.

Mouth rinses

If one has several aphthous ulcers, the doctor may prescribe a mouth rinse that contains the steroid dexamethasone (dek-suh-METH-uh-sown) to alleviate pain and inflammation or lidocaine to suppress the pain.

Topical products

Over-the-counter and prescription products (liquids, creams, gels or pastes) can help relieve pain and hasten to heal if applied to the ulcers as soon as each breakout. Some products have active ingredients, like;

  • Hydrogen peroxide (Peroxyl, Orajel Antiseptic Mouth Sore Rinse)
  • Benzocaine (Anbesol, Kank-A, Orabase, Zilactin-B)
  • Fluocinonide (Lidex, Vanos)

There are several other topical products for aphthous ulcers, that can include those without active ingredients. Inquire on which may work best from the doctor or dentist. Oral medications may be used when aphthous ulcers are severe or do not respond to topical treatments.

These may include:

  • Medications not specifically intended for the treatment of aphthous ulcers, such as intestinal ulcer treatment with sucralfate (Carafate) utilized as a coating agent and colchicine, which is normally used for the treatment of gout. Oral steroid drugs when severe aphthous ulcers do not respond to other treatments. But they’re usually the last resort because of serious side effects. 
  • Cautery of sores: An instrument or chemical substance is employed to sear, burn, or destroy tissue during cautery.
  • Debacterol is a topical solution formulated to treat gum problems and aphthous ulcers. By cauterizing canker sores with chemical substances, this medication can reduce healing time to about seven days.
  • Silver nitrate: Another alternative to chemical cautery of canker sores — hasn’t been proven to speed healing, but it can help relieve canker sore pain.
  • Nutritional supplements: The doctor may prescribe a nutritional supplement if one consumes low amounts of essential nutrients, such as zinc, folate (folic acid), vitamin B-6, or vitamin B-12.
  • Related health problems: If your aphthous ulcers have a more serious underlying health problem, your doctor will address the underlying condition. 

Lifestyle and home remedies

To help alleviate pain and hasten to heal, consider these tips:

  • Rinse your mouth with saltwater or baking soda rinse (dissolve a teaspoon of baking soda in 1/2 cup of warm water).
  • Swab the sores with a small amount of milk of magnesia a few times a day.
  • Stay away from abrasive, acidic or spicy foods that can result in further irritation and pain.
  • Apply ice to your sores by allowing ice chips to dissolve over the ulcers slowly.
  • Brush your teeth carefully and gently, employing a soft brush and foaming-agent-free toothpaste such as Biotene or Sensodyne ProNamel.

When to see the doctor 

Check with the doctor if you have experience;

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  • Recurrent sores, with new ones continuing to develop before old ones heal, or periodic outbreaks 
  • Persistent ulcers, lasting two weeks or more 
  • Sores that expanded to the lips(a vermilion border) 
  • Pain and discomfort that can’t be controlled with self-care measures 
  • Extreme difficulty in drinking or eating 
  • Aphthous ulcers accompanied by fever  
  • It is advisable to talk to the dentist if one has sharp tooth surfaces or dental appliances that seem to cause sores

Preparing for your appointment

A doctor or dentist can diagnose an aphthous ulcer based on its appearance. Here is some information to help you prepare for your appointment. Before your appointment, make a comprehensive list of:

  • Symptoms you have been experiencing, including when you first noticed them and how they have gotten better or worsened over time
  • All medications, including over-the-counter medications, vitamins or other supplements, and their doses you have been taking 
  • Any other medical conditions, to see if they match your symptoms
  • Personal information that can be key to making your diagnosis, including any changes or emotional stressors you have experienced recently in life.

Questions to ask your doctor or dentist to make your visit more effective. 

Here are some basic questions that need to be asked:

  • Do I have pain with the canker sores? 
  • If so, what factors might have contributed to its development? If not, what else could it have been? 
  • Do I need to have any tests? 
  • What kind of treatment do you recommend, if any? 
  • What kind of self-care steps can I take to relieve my symptoms? 
  • Is there anything I could be doing to speed up the healing process? 
  • When do you predict my symptoms to improve? 
  • Is there anything that I can do to help prevent a recurrence? 
  • Do not hesitate to ask any other questions during your appointment. 

What to expect from your doctor or dentist

Be ready to answer questions from your doctor or dentist, such as:

  • What symptoms are you experiencing?
  • When did you first notice these symptoms?
  • How severe are the pains you are experiencing?
  • Have you had any similar ulcers in the past? If so, did you notice that something, in particular, appears to trigger them? 
  • Have you been treated for similar ulcers in the past? If so, what was the most successful treatment? 
  • If you’ve had any recent dental work? 
  • Have you experienced major stress or major life alterations recently? 
  • What’s your typical daily diet? 
  • Were you diagnosed with any other condition? 
  • What medicines are you taking, including vitamins, prescription and over-the-counter medicines, herbs and other supplements? 
  • Do you have a family history of canker sores? 

Risk Factors

Anybody can develop canker sores. But they occur very often in adolescents and young adults and are more common among females.

People with recurrent aphthous ulcers often have a family history of the disorder. This may be due to inherited or shared environmental factors, such as some foods or allergens. 

Preventing aphthous ulcers often recur, but you’d be able to reduce their frequency by following the following tips:

  • Watch what you’re eating. Try to avoid food that seems to irritate your mouth. They can include nuts, chips, pretzels, certain spices, salty foods and acidic fruits such as pineapple, grapefruit and oranges. Evite any food you are sensitive to or allergic to. 
  • Eat healthy to help avoid nutritional deficiencies, eat plenty of whole grains, fruits, and vegetables.
  • Follow good oral hygiene habits by brushing after meals and flossing once a day can keep the mouth clean and free of foods that can trigger an ulcer. Use a soft brush to help avoid irritating delicate mouth tissues, and avoid toothpaste and mouth rinses that contain sodium lauryl sulfate.
  • Protect your mouth. If you wear braces or any other dental appliances, ask the dentist about orthodontic waxes to cover sharp edges.
  • Reduce your stress. If your aphthous ulcers seem to be related to stress, learn and use stress-reduction techniques, such as meditation and guided imagery.


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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Jennifer Aigbini
I am a language enthusiast, studying Linguistics at the University of Benin, in Nigeria.
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