Ever found yourself dealing with tender and painful ulcers in and around the mouth and tongue area? If so, then you could be suffering with a canker, and although not particularly dangerous, they can be painful and can make your life quite unpleasant.

We all experience oral lesions in some form or another, be it from biting our cheek or tongue while eating, or scalding our mouths on burning food. Cankers are amongst the most common of these oral issues and can affect as many as 1 in 5 of us at some point in our lives.

Whereas there is evidence to suggest that canker sores could potentially be hereditary, gender also plays a key role as statistically, women are far more likely to suffer from a canker sore than men.

What are Canker Sores?

Canker sores (also known as mouth ulcers or aphthous ulcers) affect many individuals from time to time. These are inflammatory white-reddish patches that develop on the mucous membrane of the mouth.

The most frequent kind of inflammatory efflorescence of the oral mucosa is chronic recurrent oral aphthous ulcers, which have a frequency of 2% to 10% in Caucasian populations.

Two to four canker sores frequently appear at the same time. They are painful, but they usually heal on their own and do not create any issues. Some people get canker sores again after a few weeks, while others develop them months or years later.

Because it is unknown why these tiny, non-contagious inflammations arise, there is presently no therapy to prevent them from occurring. The symptoms can be alleviated by painkilling or anti-inflammatory gels, creams, or mouthwashes.

What are Cankers?

First and foremost, in order to find out how we can treat and prevent a canker sore on the tongue, or anywhere else in the mouth, we need to understand exactly what cankers are.

Basically, a canker is a small and painful sore that forms anywhere within the mouth or on the tongue.

Known officially as aphthous ulcers, these small and painful ulcers will usually be a light white, grey, or yellow colour, with a pink or red border around the outside.

Developing on the soft tissues in and around the mouth and gums, they should not be confused with cold sores. Though similar in terms of appearance and symptoms, cankers are not contagious and they do not form on the surface of the lips.

Just because they aren’t the same as cold sores, that doesn’t mean that they aren’t as painful as they can make talking, chewing, and even drinking, quite a painful ordeal.

Now, the somewhat positive news is that a lot of cankers do go away by themselves eventually and the body can naturally heal them within a week or two in a lot of cases, though sometimes they do stick around for longer.  

In some cases, cankers can be persistent, in which case the patient should consult a doctor or a dentist and seek professional medical care and advice.  

Symptoms 

Pain is the most common symptom of canker sores. While a canker sore is developing, the affected area of your mouth may tingle, burn, or feel unpleasant.

When consuming foods that irritate the inflamed lining of the mouth, such as bread crusts, acidic fruit, or spicy meals, the discomfort may worsen. The motions your mouth makes when chewing or speaking might further aggravate the pain.

Canker sores are round, white lesions on the lips or within the cheeks. They may occur on the gums, tongue, or roof of the mouth less often. The sores are typically a few millimeters broad, somewhat depressed, and with reddish, slightly raised borders. This kind is also known as a small canker sore.

Major canker sores occur when the patches are bigger (one to three cm in size). Herpetiform canker sores occur when there are a significant number of small (pinhead-sized) lesions.

For a few hours before a canker sore appears, you may experience tingling or burning. The affected region gets red, swells somewhat, and then begins to ache. Within one to three days, the swelling transforms into a white spot. After a few more days, the discomfort subsides, and the canker sore vanishes completely after approximately a week.

Major canker sores can pain more and for a longer period of time: they can take up to four weeks to cure. They frequently cause a scar in the mucosal membrane.

The number of recurrences and severity of illness determine the clinical appearance of aphthous ulcers. The frequency and size of ulcers are the two basic clinical criteria used to classify ulcers into three types: minor, large, and herpetiform. Simple aphthae are quite common and moderate, with 1-4 occurrences per year.

Prevalence of Canker Sores

Canker sores are one of the most frequent medical diseases affecting the mouth's mucous membranes. According to some experts, one out of every ten persons is impacted. However, it is impossible to estimate how many patients continue to have canker sores.

The majority of people acquire them for the first time as teenagers or young adults. They occur more frequently in women than in males.

The minor type is by far the most prevalent, accounting for 85 percent of all canker sores. Only 10% have severe canker sores, and 5% have herpetiform canker sores.

Canker sores affect the majority of people three to six times each year. However, it is not uncommon for years to pass before the next canker sore appears. The symptom-free periods persist longer as people age.

Women and girls are more likely than men or boys to develop recurring aphthous ulcers in childhood and certain adult groups.

The most frequent type of children recurrent aphthous ulcer is recurrent aphthous ulcer minor. Approximately 1% of American children may develop recurring aphthous ulcers that begin before the age of five. After the third decade, the percentage of patients who are afflicted diminishes. 

Recurrent aphthous ulcer major often begins after puberty and can last for the rest of a person's life, however episodes become considerably less prevalent in late adulthood.

Herpetiform recurrent aphthous ulcer appears in the second decade of life, with the majority of people experiencing it when they are younger than 30 years old. The frequency and intensity of episodes may grow in the third and fourth decades, then decline with age.

Canker Sore vs. Cold Sore

Canker and cold sores aren’t the same. Cold sores, also called fever blisters or herpes simplex type 1, are groups of painful, fluid-filled blisters. Unlike canker sores, a virus causes cold sores, and they’re highly contagious. Also, cold sores typically appear outside your mouth -- usually under your nose, around your lips, or under your chin -- but canker sores show up inside your mouth.

See also All you need to know about Herpes

How to distinguish candidiasis and canker sore?

Mouth sores occur for many different reasons, but bacterial infections, viruses, or funguses often trigger them.

Oral thrush is characterized by ulcers or sores in the mouth produced by Candida albicans, a yeast fungus. The lesions are unpleasant, somewhat elevated, and white in appearance, resulting in a dry mouth. Aphthous ulcers (canker sores) are quite prevalent.

See also Yeast Infection - All you need to know

What is the difference between canker sore and changes in the oral mucosa in diabetes?

Diabetes is linked to an increased risk of thrush, a fungal infection. Diabetes patients are also more prone to experience dry mouth. This has been linked to an increased risk of developing oral ulcers, discomfort, cavities, and dental infections.

See also Diabetes

Difference between canker sore and changes in the mucous membrane of the tongue in case of anemia

See also All you need to know about anemia

Different types of Canker sore

Not all canker sores are created equal, and although they are all similar, there are different types of canker sore which we should familiarize ourselves with.

These include the following:

Minor canker sores

The first type of canker sore we’re looking at today is a minor canker sore. These sores are very small and are typically around 3mm – 10mm in size.

The good news is that these sores nearly always heal within 14 days at the most, and heal fully without any scarring or permanent damage.

Major canker sores

If you experience what is known as a major canker sore, this is when you should consult a doctor or medical expert as they can cause lasting damage.

These sores will take several weeks, or even months to heal, and they will likely cause lasting damage in the form of a scar.

Usually these are at least 10mm in size, though some can be much bigger than that, along with an irregular shaped border.

Herpetiform sores

If you experience what are known as herpetiform sores, you should most certainly consult with your doctor and seek medical advice.

Ulcers in this rare type (5% of cases) are generally 1-2 mm in diameter. Aphthae typically appear in clusters or crops of 10-100 lesions. Clusters might be tiny and isolated, or they can be dispersed across the oral cavity's soft mucosa.

Locations of  Canker sore

• Canker sore tongue
• Canker sore in throat
• Canker sore roof of mouth 
• Canker sore tonsil
• Canker sore on side of tongue

Canker sore or cancer

Canker sore causes

It's unclear why some people have canker sores and others don't. They are thought to run in families and to be impacted by a number of other variables such as stress, a weaker immune system, and hormonal changes.

One of the most common misconceptions surrounding canker sores is that they are caused by an infection or disease. This is actually not the case at all.

In reality, experts are not quite sure what causes canker sores, though they do have their suspicions.

These include the following:

 

1. Mouth injuries

One of the main apparent causes of canker sores in the mouth is injury to the mouth.

Whether you damage your cheek through vigorous tooth brushing, or if you bite your tongue while eating some food, this could potentially cause damage to the tongue or mouth, resulting in a canker sore. 

 

2. Consuming acidic foods

Experts aren’t sure whether acidic foods trigger canker sores, or if they simply exasperate them and make them worse, but acidic foods have been linked with canker sores and canker sore symptoms.

3- Hormonal changes

Hormonal changes may be linked with canker sores which seemingly form without any prior warning.

4- Stress

Stress has been linked with canker sores on the tongue and cheeks, though this could potentially be due to a weakened immune system brought on by cortisol and stress hormones.  

5- Vitamin and mineral deficiencies

Another potential cause of canker sores is a deficiency in certain vitamins and minerals. Diets lacking B vitamins, Zinc, and Iron have often been linked with canker sores, though experts again aren’t quite sure why.

6- Inflammatory bowel disease

A condition, such as chronic inflammatory bowel disease or Behçet's disease, may produce inflammations in the mouth that resemble canker sores.

Diagnosis

The look, growth, and symptoms of canker sores are frequently so similar that they can be diagnosed without the need of any specific testing.

However, if a sore hasn't healed within two weeks or the irritation is severe, you should consult a doctor or dentist. They will carefully inspect the lining of your mouth and ask you about any other symptoms you may be experiencing as well as your eating habits.

If doctors suspect another illness is causing the sores, a swab test, blood test, tissue sample, or inspection of specific organs (such as the intestines) may be required.

Laboratory Studies

The following laboratory studies may be helpful:

• CBC to rule out cyclic neutropenia
• Measurement of erythrocyte sedimentation rate 
• HIV status
• Iron, ferritin, total iron-binding capacity, folate, homocysteine, and vitamin B-6, B-12, B-1, and B-2 levels are all measured.
• Antiendomysium antibody in serum and transglutaminase test (positive in celiac disease).
• Tzanck smears and viral cultures: If the patient is highly immunocompromised, such as with advanced HIV illness, these tests may be required to rule out herpes simplex virus infection.

Canker sore treatment and prevention methods 

Canker sores typically heal on their own without the need for treatment. The symptoms can be alleviated by using painkilling or anti-inflammatory gels, lotions, or mouthwashes.

If the symptoms are tolerable, no therapy is required. This is almost certainly true for the more frequent mild canker sores: This kind, which is the mildest, affects 85 out of every 100 persons who have canker sores. Minor canker sores are only a few millimeters broad, uncomfortable for three to five days, and totally disappear after approximately two weeks.

• Try to avoid sharp foods

One of the simplest and most effective strategies for people who are looking to treat and prevent canker sores on the tongue is to watch what you eat.

• Avoid acidic foods like we spoke about earlier, and avoid sharp or rough foods such as potato chips or overly crispy and crunchy foods as they could damage your tongue and the inside of your mouth.

• Eat healthy foods

Another potential cause of canker sores on the tongue or mouth is nutritional deficiency.

The best way to avoid potential nutritional deficiencies is to consume plenty of fresh, healthy, and nutritious produce.

Fresh fruits, vegetables, whole grains, and healthy fats and protein sources should all be consumed in an abundance.  

If you believe that particular meals or oral hygiene products promote the development of canker sores, try to avoid them. However, there is a scarcity of solid data on whether a particular diet helps prevent the creation of new canker sores.

Try to relax and avoid stress

Stress is another potential cause of canker sores on the tongue and cheek, and although we can’t always avoid stress constantly, there are things we can do to relax more and potentially avoid stressful situations.

If you feel stressed, try to find out what is causing it and do whatever you can to rectify it and make it more manageable.  

Take a bath in the evening, listen to calming music, meditate, read a book, or do whatever else it takes to help you relax and unwind.

Practice good oral hygiene  

Even though moving your mouth might aggravate the discomfort, you should wash your teeth as thoroughly as you would when you don't have a canker sore. A soft brush can assist to avoid gum damage, which can increase the likelihood of new canker sores forming.

Cleaning the gaps between your teeth may be done in a variety of ways, such as using an interdental brush or dental floss. You can seek guidance from your dentist to help you choose the best solution for you.

In reality, good oral hygiene shouldn’t just be practiced purely to avoid canker sores, as it is something which we should practice for optimal health and wellness. 

Try to brush your teeth twice per day, floss, and use an antibacterial mouthwash.

Remember, certain foods may trigger these sores and if you find that there are remnants of these foods still in your mouth and stick between your teeth after you eat, this could trigger a canker sore flare up.

It is also critical to examine the components in oral hygiene products: Alcohol-containing mouthwashes, for example, may aggravate the discomfort. Some people are also sensitive to toothpaste containing sodium lauryl sulfate.

Pain medication

Okay, whereas pain relieving medication might not actually cure or prevent canker sores, it can certainly help to relieve the symptoms.

If canker sores on the tongue or cheek are causing pain and discomfort for you, over the counter pain relieving medication may be used.

When using these medications, please remember that they aren’t actually curing or preventing the issues at all, they are simply masking the problems instead.

 What can help relieve the symptoms?

Canker sores can be treated with a variety of medicines. They come in the form of a gel, cream, paste, or spray that may be administered to the sores. Some are also available in the form of mouthwash or lozenges:

• Local anesthetics: Local anesthetics such as lidocaine or benzocaine can help to alleviate discomfort. They are generally administered as a gel or cream to the sores.
• Anti-inflammatory drugs: Some medications contain the NSAID diclofenac, a pain reliever. Diclofenac has the ability to alleviate pain and decrease inflammation.
• Antiseptic drugs: Mouthwashes with germ-killing chemicals such as chlorhexidine or triclosan are used to prevent germs from developing in the wound and delaying or exacerbating the healing process.
• Plant-based remedies (astringents): Some people benefit from tinctures prepared from myrrh or rhubarb root. These plant-based treatments are thought to alleviate pain by narrowing the blood vessels in the mucous membranes.

What can you do if these things don't help?

Canker sore healing time varies from one patient to another. If treating canker sores with local anesthetics, pain relievers, or antiseptic medicines does not work, steroid creams can be used. If those don't work or if the sores are really painful, you should consult a doctor or dentist. They can cauterize the inflammatory tissue by employing a silver nitrate solution or laser therapy, for example.

When are tablets needed?

Around 15 out of every 100 persons who continue to have canker sores have severe inflammations or a high number of them. Some of them experience such extreme agony that they are unable to eat, drink, or sleep - especially if the canker sores heal slowly or repeatedly.

In these rare, severe situations, taking pills in addition to a local therapy , for example, steroid tablets – may be a smart option. They have an impact on both the membranes that line the mouth and the rest of the body (systemic treatment). However, adverse effects may be more prevalent.

• Corticosteroids

The first-line treatment is topical steroids. They are used to reduce immune- and inflammatory-mediated ulceration assaults. They are used to treat autoimmune diseases that are both idiopathic and acquired.

When should you speak to a doctor?

Okay, canker sores may not be life threatening, but they can be painful and they can affect your overall quality of life, which is why you may wish to seek medical attention and speak to a doctor.

If you find that you experience any of the following, consult your doctor and they will be able to offer you advice and possible treatment options:

• Larger than usual canker sores
• Recurring canker sores
• Unusually painful canker sores
• A fever along with canker sores
• Canker sores which affect the mouth, tongue, cheeks, and the lips
• Difficulty eating and drinking
• Sores which last longer than 2 weeks

Conclusion

Canker sores are benign affections of the oral mucosa which heal spontaneously, the symptoms are dominated by pain and oral discomfort. Some topical treatments can help manage these symptoms without preventing the recurrence of the canker sore. Recourse to the doctor and general treatment is necessary in certain severe and recurrent cases.