The Bowdoin Orient

April 13, 2001
Volume CXXXII, Number 21

Ask Dr. Jeff

by JEFF BENSON, M.D., DUDLEY COE HEALTH CENTER

Dear Dr Jeff: What exactly are canker sores? Where do they come from? Can they be avoided? Can you get rid of them? What can be done to soothe them when they pop up? B.L.

   Dear B.L.: Canker sores are benign, open sores that appear on the inner mucous membranes of the mouth. They may occur at any age but usually begin in adolescence. They apparently occur more often in women than in men. Although their cause is unknown, many researchers have attempted to identify an infectious agent, and some suspect an as yet unidentified member of the Herpesvirus family. They seem to be triggered by other illnesses, stress, dietary deficiencies (especially iron, folic acid or vitamin B12), food allergies, and hormonal changes (especially menstrual).
   Canker sores usually begin with a tingling or burning sensation, followed by painful, red spots or bumps which ulcerate, forming open sores, often in clusters. Their centers appear white or yellow, and they are often surrounded by raised, reddened edges.
   After 4 to 7 days or so, they become covered with gray-colored membranes, and are less painful. Complete healing may take an additional 1 to 2 weeks. Recurrence is frequent and almost universal.
   Uncommonly, canker sores are accompanied by more generalized systemic symptoms as fever, malaise, fatigue and swollen lymph nodes. In this setting, canker sores are clinically indistinguishable from the lesions of Herpetic stomatitis, an illness of infants and young children clearly caused by Herpes Simplex Virus. Unlike Herpes, however, canker sores do not seem to respond to antiviral medications and they do not seem to be contagious.
   Prolonged or severe mouth ulcers may be a sign of other problems as well, such as allergic drug reactions and dermatologic diseases like pemphigoid, lichen planus and rarely squamous cell carcinoma. Mouth ulcers can be very extensive and slow-healing in people who are receiving chemotherapy or immunosuppression or who have AIDS.
   Usually, however, the vast majority of canker sores are pretty clearly garden-variety canker sores and require no special evaluation or treatment. People have tried a variety of home remedies with some success in reducing symptom severity.
   A variety of mouth washes seem to help. Try warm salt water, 3 or 4 baby aspirin dissolved in warm water, or my favorite, liquid Benadryl mixed with an equal amount of Mylanta. Rarely, and really only for very extensive and slow healing sores, oral tetracycline or dexamethasone washes can be prescribed. The herbal remedy Goldenseal has also proved helpful, used in suspension as a wash or as an applied paste.
   No proven preventive measures for canker sores have been found. Good oral hygiene and overall good health and nutrition no doubt help. Fortunately, canker sores are relatively short-lived and almost always resolve spontaneously.

Jeff Benson, M.D.
Dudley Coe Health Center

Please address any questions or comments you may have related to medical care, public health, preventive medicine, health policy, health center services, or any other issue involving health or wellness, to jbenson@bowdoin.edu - and see your answer appear here in the Features section!