What is a canker sore?
Aphthous ulcer, or aphthous stomatitis, is a small ulcer that can appear in almost any part of the oral cavity: tongue, lips, gum, throat, uvula, etc. They are oval, whitish (sometimes yellowish) lesions, shallow and clean, that is, they do not have pus, bacteria or other signs of infection.
Canker sores are very painful and often hinder simple activities such as talking, eating and kissing. Fortunately, the lesions are benign and do not usually cause major problems beyond this discomfort. However, some more serious diseases of the oral cavity may manifest with very similar ulcerated lesions, which may cause some confusion. An example is cancer of the oral cavity, which in the early stages may look like a cold sore.
Everyone has had at least one cold sore throughout their lives and 20% of the population suffers from recurrent canker sores. They are more common in pre-adolescents, adolescents and young adults, tending to decrease their incidence over the years.
Most canker sores last on average one to two weeks and usually heal without scarring. Thrills that take the longest time to heal are those that arise in places where there is constant contact with teeth or with food, suffering repeated trauma throughout the day.
Some people have large canker sores, called major canker sores , larger than 1 cm deep. These take up to six weeks to disappear and can leave scarring. There is also the herpetiform aphid, formed by multiple small ulcers that come together and become a large lesion. These cancers may be accompanied by lymph nodes in the neck (anus) and sometimes of low fever and malaise.
However large and numerous, canker sores do not usually cause bad breath .Causes
Canker sores are not contagious, but their causes are not fully understood. They seem to be triggered by imbalances in the immune system. Some of the known triggers are:
Local trauma, such as accidental bites.
Few hours of sleep.
Helicobacter pylori , the same bacterium that causes gastric ulcer.
Some toothpaste containing sodium-lauryl sulfate.
Gastroesophageal reflux .
Foods such as chocolate, coffee, soft drinks, tomatoes and pineapples.
Hormonal changes during the menstrual cycle.
Deficiency of some vitamins and minerals, such as vitamin B12, vitamin C, zinc, iron or folic acid.
Medications: anti-inflammatories , rapamycin, captopril, methotrexate, aspirin and atenolol.
Some people who have the habit of lying down shortly after the last meal may have recurrent canker sores. This fact is probably related to some degree of gastroesophageal reflux, which leads to an increase in the acidity of the oral cavity. Canker sores usually appear one or two days later, causing patients often not to relate one fact to another.
A genetic predisposition for the development of recurrent canker sores is strongly suggested by the fact that 40% of the patients have a positive family history, with frequent canker sores since childhood.Treatment
There is no miracle remedy for cold sore. No substance heals the ulcer from one day to the next. As the cold sore usually lasts up to two weeks, the current treatments aim to accelerate the healing process of the lesion.
It is important to distinguish ointments containing only anesthetics, which serve only for symptomatic relief, those with corticosteroids and anti-inflammatories in their formula, which can effectively accelerate healing.
Remedies for cold sore
The two most commonly used drugs to accelerate the healing of canker sores are:
Amlexanox (Aphthasol® or Aftaid®).
Triamcinolone acetonide (OMCILON-A ®).
Amlexanox is the one that has presented the best results in scientific work. Unfortunately, until the last update of this article, I did not find any pharmacies that sold Amlexanox in Brazil. Apparently, the drug is not yet available in the country. In Portugal, the drug is already available and is sold under the trade name Aftaid.
The cauterization of the canker with silver nitrate is another option able to reduce the pain that the injury causes.
All other remedies sold in the pharmacies against canker sores are basically a variation of topical anesthetics with bicarbonate and antibiotics.
Drugs that have anesthetics such as lidocaine, benzocaine, or procaine may help because they can temporarily eliminate pain, which may be helpful for patients whose canker sores cause difficulty in eating.
On the Internet it is very easy to find countless homemade recipes to treat canker sores. Care should be taken with what is applied to the lesion so as not to increase inflammation and worsen the condition.
The problem with home treatments is that many of them have never been studied in scientific work and therefore have no scientific proof of their efficacy or safety.
Some acceptable options are:
Bochechar solution made with a spoonful of milk of magnesia or baking soda diluted in a glass of water.
Dilute hydrogen peroxide into regular water and apply with cotton swab directly on the cold sore.
Mix Difenidramine (Benadryl®) with milk of magnesia and rinse.
Avoid direct contact with pure abrasive substances such as alcohol, salt or baking powder.
Alcohol swabs may also irritate the cold sore and worsen the condition. When using dilutions for mouthwash, always spit the liquid at the end, never swallow it.
Toothpaste is not meant to treat thrush and can even make it worse because several brands contain sodium lauryl sulfate.When to worry about a canker sore ?
Although benign in the vast majority of cases, the cold can be a manifestation of systemic diseases or can be confused with serious lesions, such as neoplasias of the oral cavity.
An appointment with the dentist or stomatologist should be evaluated when:
The sore is exceptionally large.
Canker sores are recurrent, with new lesions appearing soon after the first ones have healed.
The cold sore takes more than three weeks to heal.
There are signs of infection in the area of the cold.
There are systemic symptoms, ie: fever, tiredness, malaise, weight loss, loss of appetite or any other symptom that suggests the presence of a disease behind the canker sores.
There are also ulcers in the genitals.
What are the diseases that occur with canker sores or similar lesions?
Usually, oral ulcers caused by systemic diseases are multiple and recurrent. They usually have some characteristics different from the common aphthas and appear accompanied by other symptoms. Some examples:
In patients with lupus , canker sores are often painless and accompanied by skin lesions and joint pain, as well as some systemic symptoms such as low fever and tiredness.
In Behcet's disease, which is also an autoimmune disease , canker sores are multiple, recurrent, and often accompanied by ulcers in the genitals. In Behçet's disease it is also common to have eye injuries.
In celiac disease and Crohn's disease , canker sores come together with intestinal symptoms such as diarrheaand bloody stools .
Neutropenia, which is the fall in the number of neutrophils (a type of white blood cell) in the blood, is also a cause of oral ulcers. Normally, neutropenia appears as a side effect of chemotherapy, but it can occur in some diseases that attack the immune system.
Some cancers of the oral cavity may present as ulcerations, being initially confused with common canker sores. Therefore, any cold sore that it takes to heal should be evaluated by a doctor, especially if the patient is a smoker.
Several infections can cause mouth ulcers similar to canker sores, are some examples:
The HIV virus can cause oral ulcers in advanced stages of the disease, when there are already criteria for AIDS , but also in the acute phase of virus infection .
Infection with Coxsackie virus(herpangina), very common in children, can lead to sore throats, fever, small oral ulcers and lesions on the palms and soles of the feet.
The syphilis , both the primary stage and the secondary, can be associated with oral ulcers. Thrush is usually multiple and takes a long time to heal.
The cold sore appears as blisters that can turn small ulcers after breaking up. The appearance is not much like sore throat, but can be confused by lay people. Despite having similar lesions, herpes and cold sores are two different diseases with different etiologies and treatments.