Thursday, February 18, 2016

Canker Sores: Causes, Remedies & Prevention

The good news is that the pain and discomfort of canker sores can be reduced by readily available prescription and non-prescription treatments and home remedies.
Simple cases of occasional canker sores are self-limiting; they will heal over and disappear without intervention.
No remedies are proven to change the course of aphthous ulcers themselves or the recurrence of the condition - treatments mostly just reduce pain, discomfort and complication.
Few treatments marketed for aphthous ulcers have been the subject of robust clinical testing.
When the sores are not associated with other conditions, science has so far failed to explain what causes them, and their management is focused on treating symptoms, reducing inflammation, and promoting the healing process by countering secondary effects that could slow this down, such as bacterial involvement.

Home remedies for canker sores

Even before reaching for any one of a large array of pain-relieving mouthwashes, gels or tinctures that can be bought from stores, one home remedy that may be possible with items already perhaps in the bathroom cabinet has been suggested by the US Library of Medicine.
Mouthwash poured into a cap.
Mouthwash can be useful in the treatment of canker sores.
This procedure can be followed three or four times a day:
  1. Rinse with mild, over-the-counter mouthwash or salt water (with either, do not swallow)
  2. Make a mixture that is half hydrogen peroxide and half water
  3. Use a cotton swab to apply some of the mixture directly to the sore
  4. Finally, dab a small amount of milk of magnesia on the canker.
So-called alternative therapies may be worth trying at home. A review of the management of aphthous ulcers written for the journal American Family Physician, published in 2000, listed a number of options, although it noted that there had been no randomized controlled trials to robustly test safety and efficacy:
  • Anecdotes of relief and better healing from sucking on zinc gluconate lozenges (sold for the common cold)
  • Vitamin C, vitamin B complex and lysine "may speed healing when taken orally at the onset of lesions"
  • Sage and chamomile mouthwash 4-6 times a day may help - infuse equal parts of the two herbs in water
  • Echinacea (herbaceous flowering plant) may have an immune modulatory effect to reportedly speed healing
  • Carrot, celery and cantaloupe juices "have been reported as helpful."

Prescription therapies for canker sores

As mentioned at the beginning of this section on treatments, most aphthous ulcers are self-limiting, eventually healing without intervention. Treatment can only ease the pain and irritation, and help prevent complication.
More severe or persistent cases of canker sores need to be checked by a doctor to rule out associated conditions (such as inflammatory bowel disease, compromised immunity, allergies and nutritional deficiency) or to access prescription treatments. Again, any treatments aimed at the ulcers themselves are not certain to change their course but can ease the symptoms.
Antibiotics such as tetracycline may be prescribed to minimize inflammatory irritation by preventing bacterial aggravation.
Anesthetics, as well as being available in consumer products for canker sores, may also be prescribed as topical preparations to ease irritation and pain.
Other prescription treatments that may be used against problematic canker sores are tried empirically - without firm evidence, that is, but with the aim of seeing if they might help based on a theory (and assuming the safety considerations of prescribing the remedy).
The American Academy of Oral & Maxillofacial Pathology, for example, cites an association between recurrent cases of aphthous ulcers and an overactive immune system, so topical suppressant medications may help, such as locally applied cortisone.
With a similar mode - and again with limited evidence against aphthous ulcers - topical corticosteroids are a class of drugs often considered by doctors, including clobetasol ointment, dexamethasone rinse, fluocinonide gel (Lidex) and triamcinolone (Kenalog - in Orabase paste).
A bowl of curry.
Avoiding spicy foods can help prevent the aggravation of canker sores.
Side effects are an important consideration with prescription drugs, and doctors should help with weighing these up when considering any potential benefit in the more difficult cases of canker sores.
One possible side effect of using corticosteroids against canker sores is a fungal infection in the mouth.
Particularly severe or recurrent cases of aphthous ulcers may be referred to oral specialists, who may consider systemic rather than locally applied (topical) drugs. These specialists may also be needed to make a more specific diagnosis - some rare cases of recurrent aphthous ulcers are diagnosed as Sutton disease, for example.

Prevention of canker sores

The question of what can be done to prevent canker sores in the first place has no clear answer. However, there are ways to prevent aphthous ulcers from getting or feeling worse.
Prevent aggravation of aphthous sores by avoiding:
  • Abrasive foods or those that can stick in the mouth (potato chips, for example)
  • Spicy, acidic or hot foods and drinks
  • Traumatizing the ulcers (through harsh contact with toothbrush bristles, for example).