Canker Sores

Canker sores occur inside the mouth. They are common and are likely not related to CdLS. They usually occur on the tongue, mucosa or lining of the mouth, including the lips, cheeks and even the throat. They are often called aphthous ulcers. They are shallow craters with a red hallow around them. They usually heal within two weeks. Fevers are rare with these lesions and no other major disease is associated with the sores. First time they are seen can be as early as 18 months of age but usually are initially experienced between 10 and 20 years of age. Canker sores are thought not to be bacterial or viral in nature. They appear to be more related to the state of the patient's immune system. When the immune system is low, the presence of canker sores seems to increase. The sores can be an allergic reaction to certain foods. I know that you mentioned that you have changed tooth pastes, etc. but you could also look at diet. Acidic and spicy items will have more of a tendency to bring up sores. Tomato paste, orange juice, etc. are foods of concern. Abrasive foods like potato chips can irritate the oral tissues and open the surface for the canker sore to develop. Some people have episodes on a yearly basis and some people have attacks every month. It can be frustrating when it is frequent and overwhelming.

There are also studies that have tied gastrointestinal or digestive tract problems with the presence of canker sores. We know that children with CdLS can have many of these problems on a routine basis.  Emotional stress can also trigger outbreaks.

Some recent research has speculated that 20% of the patients with canker sores have nutritional deficiencies. Lack of vitamin B12, folic acid and/or iron are the main things the researchers noted that were of concern. Many physicians have recommended that patients with frequent outbreaks be given blood and allergy tests to determine if their sores are caused by a nutritional deficiency or an allergy. If vitamin deficiencies are a problem, specific supplements can be prescribed. If an allergy is discovered, alterations in dietary intake can be made.

Topical benzocaine or other pain reducers can be used to alleviate the discomfort. Anti inflammatory steroid mouth rinses or gels can also be prescribed for patients with severe sores. Peridex, chlorahexadine oral rinse can help tissues heal faster and prevent subsequent infections. Tetracycline mouth rinses can reduce the time it takes for the sores to heal and the discomfort. We do not recommend tetracycline rinses for pregnant women and young children since this medication can stain the developing teeth in children. Patients with severe recurrent canker sores may need to take steroid or other immunosuppressant drugs orally. There are a lot of side effects with these drugs so that they need to be given under the supervision of dental and medical care.

Canker sores are not contagious. Fever blisters are contagious. They are formed by the herpes 1 virus. The two conditions are not to be equated. Fever blisters are on the outside of the mouth or on "tied down" tissues of the mouth–gums, etc.

RM/ TK 7-13-10