Canker sores are annoying, but usually benign

Posted8/1/2015 7:00 AM

Usually very healthy and active, the young teen wasn't used to being slowed down by illness.

He also couldn't afford to be sick just as he and his relatives were dealing with a death in the family. So, the boy toughed it out and didn't complain of his sore throat until several days had passed and life started to return to the new "normal."


When it still hurt to swallow, the boy informed his mother who set up an appointment with an ear, nose and throat specialist. The ENT did a thorough exam, and wasn't overly concerned when he found a small sore on the teen's uvula, that little dangling finger-like structure in the back of the throat.

The physician didn't put a lot of stock in advertised canker sore treatments and felt the lesion would resolve on its own in a week or two. Further work up, included biopsy, would be considered if the sore persisted.

Fortunately, as predicted, the spot disappeared one week after the office visit.

Canker sores are annoying and painful, but usually benign findings. Specialists at the American Academy of Oral Medicine explain that the lesions are not infectious and not contagious.

While the cause of canker sores is not known, AAOM experts state they are felt to be the result of "an immune system malfunction that causes white blood cells to temporarily attack the mucosal cells lining the mouth."

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Patients suffering from recurrent canker sores, also known as recurrent aphthous ulcerations or stomatitis (RAU or RAS), are advised to keep a journal to see if lesion outbreaks can be linked to an individual's dietary choices or lifestyle practices.

In their article in the online Medscape Reference, Dr. Michael Plewa and colleagues report that about 20 percent of the population experiences recurrent aphthous ulcers, with the lesions typically starting in childhood or adolescence. RAU is a bit more common in females and appears to be more prevalent in affluent countries and among members of higher socioeconomic classes.

The sore begins as small firm red raised lesion and develops into an ulceration with a central gray film and a surrounding red halo. Most -- 80 to 85 percent -- of RAUs are termed "minor," measure one to 10 mm in diameter, and resolve without treatment in seven to 10 days.

Dr. J. Preeti and her dental team, writing in the Journal of Oral and Maxillofacial Pathology, find that multiple factors may predispose an individual to RAU. Genetics seem to play a role, as about 40 percent of patients have a positive family history of RAU.


Other factors with possible links to RAU occurrence include trauma such as tooth brush injury, drugs such as the anti-seizure medication phenobarbital, deficiencies of iron, vitamin B12 and folic acid, hormonal changes and menstrual cycles, times of psychological stress, and the use of toothpaste containing the common ingredient and detergent sodium lauryl sulfate.

RAU can also be seen in patients with underlying medical conditions such as celiac disease and the inflammatory bowel diseases ulcerative colitis and Crohn's disease.

The dental authors stress that since there is no definitive cure for RAU, treatment goals are pain reduction, acceleration of healing, and lengthening the time between ulcer recurrences.

Members of the American Academy of Oral Medicine note that many over-the-counter canker sore treatments can be used to coat, relieve pain, and cleanse but, "there is no perfect product."

The group cautions that if a canker sore does not resolve within two weeks, the patient should seek medical help to rule out the presence of a pathologic oral lesion or a serious systemic condition.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights

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