Canker Sores: Types, Causes & How To Get Rid of Them

What are Canker Sores? Where Do They Form?

Canker sores (aphthous ulcers) appear as small, painful swellings on the lips or inside the mouth.

The painful sores are covered by a mixture of fluids, white blood cells, and bacteria. They typically have a white, gray, or yellowish film with a red border.

In the beginning stages, the sores may appear as small red dots. In some cases, they can be as large as a quarter. As a canker sore is forming, it is not uncommon to feel irritation, tingling, and burning sensations around the infected area.

Canker sores can also cause swollen lymph nodes in your neck. This is especially true if you get recurrent aphthous stomatitis (canker sores or mouth ulcers).

Canker sores do not develop outside of the mouth. Rather, the sores can develop in a few different areas in and around the mouth, including:

• The base of the gums
• Inside of the cheeks
• Inside of the lips (inner lip)
• On the soft palate (back of the roof of the mouth)
• On or under the tongue

Tongue sores are typically caused by mouth injuries, braces, dental work, sports accidents, or brushing your teeth too hard.

Symptoms of a Canker Sore

The most common signs of a canker sore include:

• A round, painful sore inside your mouth that is white or gray with a red border
• Tingling or burning sensation prior to sore development
• Fever, sluggishness, and/or swollen lymph nodes (severe cases only)

3 Types of Canker Sores

There are three types of canker sores, including minor sores, major sores, and herpetiform sores. They are distinguished by their size, shape, and pain level:

1. Minor Sores

Minor canker sores are the most common type, affecting more than 80 percent of sore sufferers. Characteristics of minor canker sores:

• Typically less than 5 mm in diameter
• Do not require treatment
• Heal in 7 to 14 days ⁵
• Do not scar

2. Major Sores

Major canker sores are more severe and appear less commonly than minor canker sores. Characteristics of major canker sores:

• They are much bigger than minor canker sores (over 1 centimeter in diameter)
• Often require treatment
• Do not heal for two or more weeks
• Can last for weeks or months ⁵
• Typically extremely painful
• May form a scar

3. Herpetiform Sores

Herpetiform sores are the least common type of canker sore. Characteristics include:

• Appear as a cluster of small sores
• May require treatment
• Individual sores are less than a few millimeters in diameter
• Small sores often form into larger ulcers
• Typically extremely painful
• Heal in about one month ⁵

What Canker Sores Look Like (Pictures)

Medical Images of Canker Sores

Canker Sores vs. Cold Sores (Herpes)

Canker sores are not cold sores. They are noncontagious inflammations, rather than infections.

The herpes simplex virus type 1 (HSV-1) is a highly contagious infection that causes cold sores (fever blisters). Cold sores are small, fluid-filled blisters that usually appear on the hard part of the gums or the outside of the lips.

HSV-1 spreads through close personal contact, such as kissing, hugging, handshakes, sharing drinks, and sharing utensils. Herpes is a lifelong disease with no cure.

Are Canker Sores Contagious?

Canker sores are not contagious. You cannot get a canker sore by sharing food, utensils, drinks, or kissing an individual who has a canker sore.

A cold sore (HSV-1) is contagious if an oozing blister is present. However, the sore is not contagious if it has completely scabbed.

What Causes Canker Sores?

Common causes of canker sores include:

Poor Oral Hygiene

Brushing twice a day, flossing at least once a day, and rinsing the mouth regularly kills bacteria and keeps the mouth healthy. To avoid them, it is also important to limit hard, crunchy, unhealthy, or irritating foods (acidic).

Oral Injuries

Canker sores may develop after having dental work done. Sports injuries, brushing the teeth excessively, small cuts, and accidental cheek biting can also cause them. Braces, poor-fitting dentures, fillings, and fractures can also cause canker sores.^{3, 5}

Food Allergies

Acidic foods, spicy foods, coffee, strawberries, eggs, nuts, eggplants, cheese, tomatoes, and gluten may cause allergic reactions in some people. These reactions can lead to the formation of canker sores.

Toothpaste

Toothpaste containing sodium lauryl sulfate (SLS) can cause canker sores. The ingredient is known to irritate the tissues inside the mouth and gums. If ulcers are recurrent, toothpaste is likely the culprit.

Nutritional Deficiencies

Excessive intake of sugar, processed foods, and citrus fruits can cause aphthous ulcers. It is recommended to eat salads with raw onions because they contain sulfur, which has antibacterial effects.

Hormonal Imbalances

Puberty, menopause, and menstrual cycles can increase inflammation in and around the mouth.

HIV Infection

Canker sores are not a symptom of HIV (human immunodeficiency virus), which is a virus that breaks down cells in the immune system. Although, people with HIV/AIDS may develop severe sores more frequently than those without the virus.

Stress and Fatigue

Emotional or physical stress can cause canker sores in some people because excessive stress increases inflammation.

Diseases

Frequent canker sores are associated with certain diseases and chronic health conditions. These health conditions include, but are not limited to:

• Inflammatory bowel diseases – such as Crohn’s disease and ulcerative colitis
• Celiac disease – a severe intestinal disorder caused by gluten intolerance
• Behcet's disease – causes inflammation around the entire body (including the mouth)
• Lupus – an autoimmune disease that causes your body to attack its own organs and tissues
• A compromised immune system – when someone has a reduced immune response to fighting off infections

Vitamin Deficiencies

To avoid canker sores, the body needs a proper balance of acidity, minerals, and alkalinity. Iron, zinc, vitamin B12, and folic acid deficiencies have been linked to canker sores. ^{3, 4} Calcium deficiencies also cause canker sores and can even make the sores worse.

What Gets Rid of Canker Sores Fast?

Minor canker sores typically go away on their own within a week. Although, if major canker sores develop, it is important to seek treatment. Over-the-counter products are usually recommended, including:

• Fluocinonide – Lidex (Fluocinonide) and Vanos mouth rinse
• Hydrogen peroxide products – Orajel Antiseptic Mouth Sore Rinse™ and Colgate® Peroxyl®
• Tetracycline – if you get frequent canker sores, your doctor or dentist may prescribe you tetracycline. However, one possible side effect of this medication is a fungal infection called oral thrush. Thrush, ironically, can lead to mouth sores.
• Ibuprofen – you can take ibuprofen or other over-the-counter (OTC) pain relievers to reduce swelling, discomfort, and pain

Natural Canker Sore Remedies

Canker sores usually disappear on their own within 7 to 10 days. There are a few natural home remedies that can be used to help speed up the healing process and decrease irritation.

Natural remedies for canker sore speed healing include:

• Suck on ice chips and/or Zinc lozenges to relieve pain and discomfort
• Use a mouth rinse and toothpaste that does not contain sodium lauryl sulfate
• Mix liquid Benadryl with magnesia and use it as a mouth rinse
• Rinse your mouth a few times each day with warm salt water or a baking soda rinse (1 teaspoon per 1/2 cup of warm water). Swish it around for a couple of minutes and then spit it out in the sink.
• Eat salads that contain raw onions
• Drink chamomile tea to soothe canker sore discomfort (German chamomile contains anti-inflammatory and antiseptic properties)
• A medication called Orabase can help keep your canker sore from becoming more painful when brushing your teeth, eating, or drinking

When to See a Doctor

Consult your doctor if your canker sore is large and lasts for longer than two weeks. Also, visit your doctor if the pain worsens and you can't seem to control it with home remedies.

Diagnosing Canker Sores

Tests are not needed to diagnose a canker sore. Your dentist or doctor may recommend blood work if the ulcer(s) does not disappear on its own or there is a severe breakout present. You may also benefit from a vitamin deficiency test if you experience frequent sores.

Are Canker Sores Harmful?

Canker sores normally do not have any complications or risks if they are caused by natural factors. In rare cases, canker sores can be an early sign of oral cancer (mouth cancer). Ulcers caused by oral cancer are typically painful, thicken over time, and do not disappear on their own.

7 Ways to Prevent Canker Sores

In most cases, canker sores are a natural part of life. However, if you develop sores frequently, there are ways to prevent them from developing. Prevention tips include:

1. Avoid or limit your intake of spicy foods, acidic fruits, and other acidic drinks (e.g., coffee and fruit juices)
2. Take a multivitamin every day
3. Take a 1000 mcg dose of vitamin B-12 at night to reduce and prevent canker sore breakouts
4. Do not use dental products that contain sodium lauryl sulfate
5. Chew less gum to prevent irritation
6. Brush and floss your teeth regularly to remove bacteria, food particles, and plaque in your mouth
7. Use a soft-bristled toothbrush and try to brush after each meal (if you get canker sores often)

Potential Complications of Canker Sores

Some possible complications of canker sores include:

• Fatigue
• Cellulitis (a bacterial skin infection)
• Fever
• Sores that appear outside of the mouth
• Pain while brushing your teeth, eating, and/or talking

Common Questions and Answers

Here are some frequently asked questions about canker sores: