✅ Summary
Mouth sores are common lesions that can appear on the oral mucosa and often cause discomfort when eating, speaking, or brushing. Among these, canker sores (aphthous ulcers) are the most frequent.
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✅ Introduction
Oral ulcerations are a frequent complaint in dental and medical practice. Canker sores, medically known as recurrent aphthous stomatitis (RAS), affect approximately 20% of the general population (Scully & Porter, 2008). These lesions are non-contagious, unlike herpes labialis, and usually heal spontaneously within 7–14 days.
The accurate identification of oral lesions is essential since they may be early signs of systemic conditions such as Crohn’s disease, celiac disease, or autoimmune disorders. Understanding their etiology and therapeutic options helps clinicians manage pain and reduce recurrence.
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The exact cause of canker sores remains unclear, but several predisposing factors have been identified:
▪️ Local trauma (e.g., toothbrush injury or orthodontic appliances)
▪️ Nutritional deficiencies (vitamin B12, folate, iron)
▪️ Hormonal fluctuations
▪️ Stress and anxiety
▪️ Food sensitivities, particularly to acidic or spicy foods
▪️ Genetic predisposition
▪️ Immune dysregulation
In contrast, cold sores (herpes labialis) are caused by the Herpes Simplex Virus type 1 (HSV-1), which remains dormant in the trigeminal ganglion and can reactivate under stress or immunosuppression.
✅ Pharmacologic Management
Treatment focuses on symptom relief, promoting healing, and preventing recurrence.
1. Topical medications
▪️ Chlorhexidine mouthwash (Peridex® 0.12%) – reduces bacterial load and secondary infection.
▪️ Corticosteroid gels such as triamcinolone acetonide 0.1% (Kenalog in Orabase®) – decreases inflammation.
▪️ Lidocaine 2% gel (Xylocaine®) – provides local anesthesia and pain relief.
2. Systemic therapy (for severe cases)
▪️ Colchicine (Colcrys®) or Dapsone for recurrent major aphthae.
▪️ Thalidomide (in immunocompromised patients) under strict supervision due to teratogenic risks.
3. Nutritional and preventive therapy
▪️ Supplementation with vitamin B12 (cyanocobalamin), iron, and folic acid may reduce recurrence.
▪️ Avoiding acidic foods, sodium lauryl sulfate toothpastes, and stress is strongly recommended.
📊 Comparative Table: Differential Diagnosis of Oral Ulcers
| Condition | Key Features | Distinguishing Signs |
|---|---|---|
| Canker Sores (Aphthous Ulcers) | Painful, shallow ulcers with red border; appear on movable mucosa. | Non-contagious; heal within 1–2 weeks. |
| Cold Sores (Herpes Labialis) | Grouped vesicles that crust; often on lips or fixed mucosa. | Caused by HSV-1; contagious; preceded by tingling sensation. |
| Oral Lichen Planus | White reticular patches with occasional erosions. | Chronic autoimmune condition; confirmed by biopsy. |
| Oral Candidiasis | White curd-like plaques that can be wiped off. | Associated with Candida infection; responds to antifungals (Nystatin®). |
| Traumatic Ulcer | Solitary ulcer with irregular borders. | Linked to local mechanical injury. |
💬 Discussion
Differentiating canker sores from other oral lesions is essential to avoid misdiagnosis and inappropriate treatment. Many patients mistake them for herpes infections, which leads to unnecessary antiviral use. Topical corticosteroids and antiseptics remain the first-line management for aphthous ulcers, while antivirals such as acyclovir (Zovirax®) are reserved for herpetic infections.
New research explores low-level laser therapy (LLLT) as a non-invasive method to reduce pain and accelerate mucosal healing (El-Sharkawy et al., 2022).
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▪️ Use topical corticosteroids at the first sign of ulceration.
▪️ Maintain good oral hygiene with alcohol-free mouthwashes.
▪️ Avoid trigger foods and manage stress levels.
▪️ Refer persistent or atypical lesions (>2 weeks) for biopsy to rule out malignancy.
✍️ Conclusion
Canker sores and other mouth ulcers share similar symptoms but differ in etiology, contagiousness, and treatment. Early identification and evidence-based management help patients achieve faster healing and reduced recurrence. Dental professionals play a key role in differential diagnosis, prevention, and patient education.
📚 References
✔ El-Sharkawy, Y. H., Ibrahim, M. A., & Abd El-Moniem, A. S. (2022). Effect of low-level laser therapy on pain and healing in recurrent aphthous stomatitis: A randomized controlled trial. Journal of Clinical and Experimental Dentistry, 14(6), e491–e498. https://doi.org/10.4317/jced.59158
✔ Scully, C., & Porter, S. R. (2008). Recurrent aphthous stomatitis: Current concepts of etiology, pathogenesis, and management. Journal of Oral Pathology & Medicine, 37(5), 258–267. https://doi.org/10.1111/j.1600-0714.2007.00586.x
✔ Woo, S. B. (2019). Oral Diseases: Diagnosis and Treatment. Springer.
✔ Ship, J. A., & Chavez, E. M. (2010). Management of recurrent aphthous stomatitis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 110(3), 337–347. https://doi.org/10.1016/j.tripleo.2010.04.008
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