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                                                        DR. DAN PETERSON

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CANKER SORES
Mouth Sores

Symptoms Treatment
Cause Products for Treatment
Canker Sore Self Test Canker Sore Updates

You may hear your doctor say you have "aphthous stomatitis"...canker sores or mouth ulcers!  

Aphthous stomatitis occur in 80% of the population between the ages of 10-20 years of age, most often in women.  The occurrence is thought to be related to the individual's immune system.

There are two types of canker sores:
  1. Simple canker sores. These may appear three or four times a year and  last up to a week.
  2. Complex canker sores. These are less common and occur more often in the people who have previously had them.

These are usually found on the movable parts of the mouth such as the tongue or inside linings of the lips and cheeks.  They are found IN the mouth. They begin as:

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Small oval or round reddish swellings, that generally tingles and  that usually burst within a day. 

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The ruptured sores are than covered by a thin grey, white or yellow membrane edged by a red halo.

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Usually one quarter inch in diameter, 1-2mm wide

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Occur on non-keratinized mucosa inside the mouth: the inner side of the lips, the tongue, the back and floor of the mouth and the wall of the cheeks

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They do not occur on the gums or the hard roof of the mouth

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They generally heal within 4-14 days.  

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They may leave scares.  

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Recur monthly or several times per year.

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20% of the population suffer from recurring cancer sores

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They are not associated with other diseases.  

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You will usually have only a few at a time.  

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They first appear around ages 10-20.

Canker Sores

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Factors that cause these reactions:

bulletSodium Lauryl Sulfate (SLS): is the foaming agent found in most toothpaste and mouthwash formulations..  Foaming agents fill the mouth with suds, sending a signal to users that their mouths are clean.  Ulcer may be caused by using SLS because it causes excessive sloughing of oral mucosa and dries the protective layer of oral tissues which causes underlying tissues to become damaged.  People with canker sores have fewer outbreaks and less pain if they use SLS free products made by Rembrandt Extra Whitening Toothpaste Formulated for Cold Sore Sufferers, Tom's of Maine, Oxyfresh, TheraBreath Products, Breath RX products, Squigle Enamel Saver Mouth Friendly Toothpaste.
bulletWomen are more susceptible than men due to their menstrual cycles.  Fatigue, stress or allergies increase your likelihood of getting cancer sores.  People with intestinal problems such as ulcerative colitis and Crohn's disease are more susceptible. They usually heal in a week or two.

Canker Sore Self Test

      Canker or Cold Sore Self Test:

Question? Cold Sore? Canker Sore?
Where does it strike: Outside the mouth Inside the mouth
What does it look like? Tiny, clear fever blisters usually on the lips or under the nose Small ulcer with a white or gray base and red border
What triggers it? Flare-up of herpes simplex virus Trauma-biting cheek, jabbing gum
How long does it last? About a week One or two weeks
Is it contagious? YES No
How do I treat it?  Aloe Vera, OTC topical anesthetics to cut pain

OTC medications or prescription antiviral drugs as needed

Rinse with antimicrobial mouthwash or warm water with salt

OTC oral anesthetics

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    Treatment:

  1. Visit your doctor to determine the reason for them, I.E. nutritional  deficiency or an allergic reaction to foods.

  2. Use a numbing ointment such as benzocaine

  3. Anti-inflammatory steroid gel like Denalog, Decadron rinse or Lidex gel

  4. Mouth rinse containing tetracycline can reduce the unpleasant symptoms of canker sores and speed healing by preventing bacterial infections in the sores.  This mouth wash, used several times a day, relieves pain for 24 hours and allows complete healing in 5-7 days.  Tetracycline is not to be used by young children or pregnant women due to  staining of teeth.

  5. Use a  antimicrobial mouthrinse to help reduce the irritation.

  6. Avoid abrasive foods like potato chips and pretzels; acidic drinks such as lemonade or orange juice; chocolate, nuts, lemons, figs, tomatoes, apples, pineapples, strawberries, shellfish, soy vinegar and beer that trigger canker sores in susceptible people .

  7. Avoid toothpastes containing sodium lauryl sulfate Sodium lauryl
    sulfate (SLS) is an irritant detergent commonly found in toothpaste.
    People with recurrent canker sores may benefit by switching to a
    brand of toothpaste that does not contain SLS, which is believed to
    abrade the protective mucus layer in the mouth and increase the
    likelihood of developing canker sores. ***

  8. Avoid hot, spicy or acidic foods from further irritating the sore.

  9. Brush your teeth gently so as not to  irritate the area.

  10. DGL is the herb licorice that has had the glycyrrhizic acid removed,
    the portion that can increase blood pressure.  A mouthwash made of powdered DGL mixed with water. Alternately, DGL tablets can be chewed with water, swished in the mouth and swallowed***

  11. Avoid things you know can trigger this condition.

  12. Eat a healthy diet.

  13. Identify and eliminate food sensitivities with an elimination and challenge diet.  Food sensitivities, especially to gluten-containing foods (wheat, rye, barley, oats), have been found clinically to be associated with recurrent canker sores.***

  14. Consider a vitamin supplement. Thiamin (vitamin B1) deficiency has been linked to an increased risk of canker sores. Other nutrients that have been found to be low in people with recurrent canker sores include riboflavin (vitamin B2), pyridoxine (vitamin B6) and iron. A health practitioner can assess nutrient status.

  15. Cured and processed meats, such as bacon, sausage and ham, are high in nitrites.**Vitamin C works directly against viruses, in addition, it inhibits the formation of nitrosamines from dietary nitrites, found in bacon, ham, sausages and other processed meats, and from dietary nitrates, found in vegetables and other foods.

  16. Maintain excellent oral hygiene care.

  17. Reduce stress.

  18. Try Apthasol medication.

  19. Avoid injury to the inside of the mouth caused by toothbrushing, hard candy, hard food or chewing o  pen caps and other objects.

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You should call your dentist if you have:
  1. Unusually large sores
  2. Sores that are spreading
  3. Sores that last 3 weeks or longer
  4. Intolerable pain despite avoiding trigger foods and taking over-the-counter pain medication
  5. Difficulty drinking enough fluids
  6. A high fever with the appearance of the canker sore(s)

Products for Treating Aphtous Ulcers
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OTC:
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Debacterol,~ a topical treatment that, with a single application, completely stops the pain of canker sores.

Debacterol is the only canker sore treatment available that chemically cauterizes the oral lesion in just ONE treatment, eliminating pain associated with the lesion without harming healthy surrounding tissue.

 A single application of Debacterol with a cotton swab has been found to stop canker sore pain in just five seconds, sealing damaged oral mucosal tissue and aiding the natural healing processes.. Healing time of the lesion is reduced as well. 70 percent of the lesions treated with Debacterol had complete healing by day six, compared with other treatments, which needed more than 10-16 days for complete healing.

It is now been cleared for Over-the-Counter Sales by FDA. Northern Research Laboratories at 4225 White Bear Parkway, Suite 600,
St. Paul, Minn. 55110 or by calling 651-653-3380.  Debacterol.com
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Produces without SLS: CloSYSH: rowpar.com; TheraBreath TheraBreath.com

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Barrier Protection: Soothe-N-Seal  ColgateProfessional.com; Zilactin  Zila.com; ORA5 Liquid  SaveYourSmile.com

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Numbing: Orabase B  ColgateProfessional.com  Orajel  orajel.com

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Antibacterials: Copper sulfate or iodine

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Cleaners: Peroxyl Oral Rinse  ColgateProfessional.com  Glyoxide  gsk.com

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Home remedies: 1 tsp Milk of Magnesia and 1 tsp. Benedryl Allergy.  Swish and expectorate 4-6 ties a day to help minimize pain.

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Prescription Medications:
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Anti inflammatory Rx: Apthasol (Amlexanox); Kenalog in Orabase; Synthetic Corticosteriod; Lidex (fluocinonide); Diprolene (betamethasone); Temovate (clobestasol).

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Collagenase Inhibiting: Tetracycline; Chlorhexidine Gluconate.

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Nutrition- A lack of specific vitamins may lead to canker sores: lack of Vitamins B1, B2, B6, B12, and C, zinc, folic acid, iron, selenium and calcium.

Aloe vera anti-viral and anti-inflammatory properties, aloe vera provides additional benefits to the skin, such as amino acids, B1,B2,B6 and C vitamins.**

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Canker Sore Updates

Valacyclovir (Valtrex) has just been approved for one day treatment of cancer sores.  It shortens outbreaks of these painful sores by about one day.-acyclovir pills (Zovirax) and penciclovir cream (Denavir) and docosanol (Abreva) need to be used for four days or more and the creams must be applied throughout the day.

At $26.00 per treatment (two 2gram doses) is costs significantly less than Zovirax which runs about $71 per course or ($53 for generic).  The creams are about $23 for a course of penciclovir and $14 for docosanol.

If you have recurrent sores, ask your doctor to prescribe Valacyclovir or other treatments you can keep on hand to use at the START of an outbreak.  Or ask about taking acyclovir regularly, which can reduce the number of episodes by more than 80%.
Consumer Reports on Health pg 7 August 2003

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~We have no financial investment in this product.
Resource: A.D.A., National Center for Dental Research.

***References

Ulcer Management; Ms McManus, Ms Pittman, Dentistry Today pg 47-51 January 2004.

Herpes simplex and aphthous ulcerations: presentation, diagnosis and management; Dr. Sciubba ; General Dentistry pg 510-515 January 2004.

Chart Dentalnotes pg 2 Spring 2003
1. Lininger S, Gaby A, Austin S, Brown DJ, Wright JV, Duncan A. The Natural Pharmacy, 2nd Edition. Prima Health and Healthnotes, Inc.,1999.
2. Murray M. Dr. Murray's Total Body Tune-Up. New York, New York. Random House, Inc.; 2000
3. Murray MT, Pizzorno JE. Textbook of Natural Medicine, Vol 1 and 2. Churchill Livingstone. Edinburgh, 1999
4. Rogers MA, Vaughan TL, Davis S, Thomas DB. Consumption of nitrate, nitrite, and nitrosodimethylamine and the risk of upper aerodigestive tract cancer. Cancer Epidemiology Biomarkers Prev 1995 Jan-Feb; 4(1):29-36.
5. Tannenbaum SR, Wishnok JS, Leaf CD. Inhibition of nitrosamine formation by ascorbic acid. Am J Clin Nutrition 1991 Jan;53(1 Suppl): 247S-250S.

** AGD September 29,01

~Common Mouth Sores, JADA, Vol. 132, November 2001

Zila

 

  

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September 14, 2007

                                

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