Canker sores

Alternative names:

aphthous ulcer; ulcer - aphthous

Treatment:

Treatment is usually not necessary. In most cases, the condition is self-limited and healing is spontaneous.

Severe mouth ulcers (larger than 1 cm or lasting longer than 2 weeks) may require evaluation and treatment. In these cases topical or oral (by mouth) Tetracycline suspension may be given, with instructions to hold it in the mouth for 2 to 5 minutes before swallowing. Tetracycline is usually not prescribed for children until after all the permanent teeth have come in; if they swallow the tetracycline suspension, it can permanently discolor teeth that are still formingHerpetic stomatitis which produces multiple painful mouth ulcers is usually treated with one of the antiviral agents such as acyclovir.
Topical or oral corticosteroids are rarely used but may reduce inflammation. Dexamethasone suspension may be given with instructions to rinse the mouth and spit out; or dexamethasone, prednisone, or other corticosteroid may be given systemically.

Avoid hot or spicy foods to minimize discomfort. Mild mouth washes such as salt water or over-the-counter mouth washes may aid in hygiene and increase comfort. Over-the-counter topical (applied to a localized area of the skin) medications for canker sores may reduce discomfort and soothe the ulcerated area.

Maintain good oral hygiene to prevent bacterial infection. This includes thorough brushing and flossing of the teeth and regular professional cleaning. The easiest home remedy is to apply hydrogen peroxide (1 part hydrogen peroxide and one part water with a cotton swab) on the canker sore. Then dab a small amount of milk of magnesia on the canker 3-4 times a day. This is not only soothing, but appears to help healing.

Expectations (prognosis):

Canker sores usually heal spontaneously. The pain usually decreases in 3 or 4 days. Other symptoms disappear in 10 to 14 days.

Complications:

• secondary bacterial infections (cellulitis, Ludwig's angina) (rare)
• oral cancer ( cancer is not a complication but in ulcers lasting more that 2 weeks cancer may actually be the cause of the ulcer. Therefore, any ulcer lasting over 2 weeks should be evaluated by a physician)
• oral thrush or other Candida infections may occur following the use of antibiotic treatment for cankers

Calling your health care provider:

Apply home treatment and call your health care provider if symptoms of canker sores persist or worsen, or canker sores recur more often than 2 or 3 times per year.

Call your health care provider if symptoms are associated with other problems such as fever, diarrhea, headache, or skin rash.