Why Do I Keep Getting Canker Sores?
Exploring Possible Causes and Solutions
Medically reviewed by Brian T. Luong, DMD
Canker sores are small sores that form in the mouth. They're usually white or yellow with a red border and can appear inside the cheeks and lips or on the gums or tongue. Also known as mouth ulcers or aphthous ulcers, canker sores can cause tingling, burning, and pain. They are not the same as cold sores, which appear on the outside surface of the lips.
Anyone can develop a canker sore, but they're most common between the ages of 10 and 20. Women are twice as likely to get them as men, and about 1 in 5 people get them on a regular basis. A sore generally takes one to three weeks to heal, though larger sores can take longer.
They usually go away on their own, but there are ways to prevent and treat canker sores. This article discusses common reasons you keep getting canker sores and what you can do about them.
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Injury
Anything that injures the delicate membranes in the mouth can trigger canker sores, such as:
Accidentally biting your cheek or tongue
Rough braces, poorly fitting dentures, or other dental work
Using a hard-bristled toothbrush or brushing too vigorously
Foods or drinks that are too hot
Nutritional Deficiencies
You may be at greater risk of developing canker sores if deficient in certain vitamins. One potential cause of recurrent canker sores is vitamin B12 deficiency.
Recurrent canker sores can also occur due to other nutritional deficiencies in nutrients such as the following:
Zinc: Zinc is an essential mineral that enhances the immune system and is important to wound healing.
Folate (folic acid): Folate, or vitamin B9, is important to cell division.
Iron: Iron is a mineral that supports growth, development, and healthy blood.
Dental Hygiene
Good oral hygiene and dental care can help keep your mouth healthy. Brush and floss at least twice a day and see a dentist for routine cleanings and checkups. A balanced diet, limiting sugary foods and drinks, and not smoking or using tobacco products can also help.
Hormones
The hormones that regulate the menstrual cycle and pregnancy can affect oral health. Each person's symptoms are different, but you may notice a pattern of developing canker sores or cold sores related to your menstrual cycle.
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Stress
Psychological and emotional stress and anxiety can affect health in many ways, including causing recurring canker sores. Canker sores can be painful and make it difficult to eat and talk, which can increase stress even more, leading to a stress-canker cycle.
Autoimmune Disorders and Other Conditions
Sometimes, oral symptoms are the first sign of an autoimmune disorder, a condition in which the immune system mistakenly attacks the body's own tissues. These and other conditions can make recurrent canker sores more likely.
Weakened Immune System
A weakened immune system makes you more vulnerable to infections and illnesses, including mouth sores. Things that can weaken your immune system include drinking alcohol, smoking, lack of sleep, poor nutrition, and stress. Immune system disorders and drugs used after an organ transplant and also lead to a compromised immune system.
HIV/AIDS
Due to a weakened immune system, canker sores are fairly common in people with human immunodeficiency virus and AIDS. Some other oral health problems associated with HIV/AIDS are chronic dry mouth, gum disease, and fever blisters.
Lupus
Lupus is an autoimmune disease that can affect any organ, including joints, skin, lungs, heart, nervous system, blood vessels, and liver. Lupus can also involve oral signs and symptoms. Among the most common oral problems associated with lupus are canker sores and reduced saliva production (hyposalivation).
Some mouth lesions are a sign of disease activity. And about 40% of people with lupus develop mouth lesions as a reaction to a drug used to treat lupus or another condition.
Behcet's Disease
Behcet's disease is a rare multisystem inflammatory disorder that can affect many parts of the body. Painful canker sores are often the first symptom. Though they usually heal within a few days to a week, they frequently recur. Other symptoms include eye inflammation, skin lesions, and recurring genital ulcers.
Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease (IBD) is an umbrella term for conditions involving chronic inflammation of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. IBD is also associated with symptoms outside the gastrointestinal tract. Oral lesions affect 5% to 50% of people with IBD, either due to the disease or drugs used to treat it.
Celiac Disease
Celiac disease is an autoimmune disease in which the immune system overreacts to gluten, a protein found in grains such as wheat, rye, and barley. Although the main symptoms revolve around gastrointestinal problems, celiac disease can affect any part of the body.
In some cases, the first sign of celiac disease is oral symptoms such as recurrent canker sores and dry mouth syndrome.
How to Treat Canker Sores
Unlike cold sores, canker sores are not contagious. Most of the time, they go away without treatment within a week or two. Some remedies can help you feel better while you heal.
Maintaining Good Oral Hygiene
Tips to maintain oral hygiene include:
Brush and floss after meals using a soft-bristle toothbrush that won't irritate your mouth and gums.
If you have braces or other devices, use orthodontic wax to cover sharp edges.
Rinse your mouth with salt water.
Consider using a toothpaste containing a foaming agent called sodium lauryl sulfate (SLS) that, research suggests, may help prevent recurring canker sores.
Avoiding Trigger Foods and Beverages
Certain foods, including spicy, acidic, or abrasive foods, can trigger pain in canker sores. Also, food allergies may trigger the development of a canker sore. Keeping a food diary can help you determine which foods to avoid.
Managing Stress Levels
Of course, you can't avoid stress entirely. But if it contributes to recurrent canker sores, practice stress-reduction techniques, such as:
Getting enough sleep is also important, so create a smooth transition from daytime activities to sleep time and make sure your bedroom is dark, cool, and quiet.
If you continue to have high stress levels, consider seeking help from a mental health professional.
Over-the-Counter (OTC) Topical Medications
OTC mouth sore gels and pastes such as Orajel and Anbesol can temporarily relieve pain. You can also try mixing equal parts hydrogen peroxide and water. Then, use a cotton swab to apply it to the sore before dabbing with a bit of Milk of Magnesia. Repeat three or four times a day.
Prescription and OTC Mouthwashes
Alcohol-based mouthwashes can irritate the mouth, so it's best to avoid them. But you can use other mild mouthwashes. You can also try rinsing your mouth with equal parts Milk of Magnesia and Benadryl liquid allergy medicine. Swish for about a minute, then spit it out.
Chlorhexidine is a prescription-strength antiseptic mouthwash with antimicrobial effects. Healthcare providers may prescribe it to treat various oral problems, including canker sores. If you have many canker sores, a provider may recommend a mouth rinse that contains a corticosteroid, such as dexamethasone.
Oral Medications
OTC medications like Advil and Motrin (ibuprofen) or Tylenol (acetaminophen) can help relieve pain. In severe cases, your provider might prescribe oral corticosteroids. Sometimes, acid-reducers can also ease discomfort.
Nutritional Supplements and Multivitamins
Your healthcare provider can help determine if you have any nutritional deficiencies. If so, changes in diet or taking the appropriate dietary supplements may help reduce recurrence.
Cauterization of the Sore
Canker sores generally heal in a short time, so cauterization isn't needed. In some cases, your provider may want to cauterize a severe mouth sore to help ease pain. This may involve applying a chemical substance to the sore to destroy the tissue.
What to Do If Your Canker Sores Are From an Underlying Health Condition
When canker sores stem from an underlying health condition, treating that condition may cut down on recurrence. Discuss new or recurrent outbreaks of canker sores with the healthcare provider treating your underlying condition.
When to Contact a Healthcare Provider
It's not always clear what causes them, but canker sores are usually temporary. However, they're sometimes associated with underlying disease. Contact a dentist, dermatologist, or a primary care healthcare provider if:
The sore is unusually large, or you have many.
The sore lasts more than two weeks.
You have trouble eating and drinking.
You also have fever, diarrhea, skin rash, or headache.
You have frequently recurring canker sores.
Summary
Almost everyone gets a canker sore from time to time. But even without treatment, they tend to go away within a week or two. In the meantime, OTC products such as mouth rinses and gels can provide some relief.
If you have recurrent cankers or other symptoms, see a healthcare provider. This can be a sign of an underlying illness that should be treated.
Read the original article on Verywell Health.
