What is a Mouth Sore (Canker Sore)?

That sharp, uncomfortable ache that almost everyone experiences at some point in their lives: mouth sores. "Aphthous ulcer" or simply "canker sore", as it is called in the medical literature, can turn even the most basic functions such as eating, speaking and swallowing into an ordeal despite its small size. Although this small but powerful enemy is usually harmless and follows its own path, sometimes it can stay with us for weeks with its stubborn nature or it can be a symptom of a deeper underlying health problem that has surfaced. That's why it's vital to recognize it properly, understand its causes and know when to seek professional help.

Mouth Sores Diagnosis: Appearance and Differences from Other Lesions

The right treatment always starts with the right diagnosis. Canker sores can usually be easily diagnosed with a clinical examination by an experienced dentist. However, it is important to know that not all white lesions are canker sores.

Types of Intraoral Wounds: Minor, Major and Herpetiform Aphthae

Aphthae are divided into three main categories according to their clinical appearance and behavior:

• Minor Aphthae: The most common type affecting 80-85% of the population. They are less than 1 cm in size, usually round or oval. Although they are extremely painful, they heal completely within 7 to 14 days without leaving any scars. They usually appear on mobile mucosa, such as the inside of the cheeks and lips.

• Major Aphthae (Sutton's Disease): This type, which is much rarer, is larger than 1 cm, deep and crater-like. The pain is so severe that it can severely interfere with eating and speaking. The healing process can take weeks, sometimes even months, and tends to leave a prominent scar where it heals.

• Herpetiform Aphthae: Although often confused with herpes because of the similarity in name, these lesions have nothing to do with viruses and are not contagious. They are characterized by numerous (sometimes 10-100) pinhead-sized small ulcers that come together to form a large, irregularly shaped and very painful area.

Differential Diagnosis: What can a canker sore be confused with?

When diagnosing canker sores, a dentist will rule out other possible oral lesions. This is especially critical for sores that do not go away.

• Traumatic Ulcer: These are ulcers caused by the stinging of a hard food or biting the cheek. They are usually single and the cause is known. It heals quickly once the cause is removed.

• Herpes (Herpes Simplex Virus): Unlike aphthae, it usually occurs in the fixed and bony parts of the mouth, such as the palate or around the lips. It starts as small water bubbles (vesicles), bursts into ulcers and is contagious.

• Lichen Planus: It is a chronic condition that causes a web-like, white, lacy appearance inside the cheek. Sometimes it can turn into an erosive form and cause painful sores.

• Oral Cancer (Squamous Cell Carcinoma): This is the most serious possibility. It usually takes the form of a single ulcer with hard, raised, painless (initially) edges that do not heal for weeks or months. It is vital not to confuse it with aphthae.

Why does canker sores occur?

Although the exact cause of canker sores is still shrouded in mystery, modern medicine believes that a kind of "short-circuiting" of the immune system is the main mechanism. The factors that trigger this short circuit are as follows:

The Role of Nutritional Deficiencies: What Is Your Body Trying to Tell You?

Which vitamin deficiency causes mouth sores?

The oral mucosa is one of the fastest regenerating tissues in the body. Certain vitamins and minerals play a critical role in this regeneration process. When they are deficient, the protective barrier weakens and aphthae formation is invited:

• Vitamin B12 and Folic Acid: Essential for cell division and DNA synthesis. In their deficiency, the mucosa cannot regenerate itself and is easily injured.

• Iron: The building block of hemoglobin, which carries oxygen. Iron deficiency anemia triggers aphthae by causing insufficient oxygen supply to the tissues and mucosal atrophy (thinning).

• Zinc: A critical mineral for immune system regulation and wound healing. Zinc deficiency both impairs the immune response and delays wound healing.

Echoes of Systemic Diseases in the Mouth

Sometimes aphthae is not just an oral problem, but the earliest or most obvious sign of a disease affecting the whole body:

• Behcet's Disease: This rheumatic disease, characterized by inflammation of the blood vessels (vasculitis), is classically characterized by a triad of recurrent canker sores, genital ulcers and eye inflammation (uveitis).

• Inflammatory Bowel Diseases (Crohn's and Ulcerative Colitis): Chronic inflammation in the intestines can cause inflammatory reactions elsewhere in the body. In addition, malabsorption in these diseases can lead to the vitamin and mineral deficiencies mentioned above, indirectly triggering aphthae formation.

• Sodium Lauryl Sulfate (SLS) Factor in Toothpastes: SLS, which is used as a foaming agent in many toothpastes, can thin the protective layer of the oral mucosa (mucin) in some sensitive people, making it more vulnerable to irritation and canker sores. If you suffer from frequent canker sores, it may be worth trying "SLS-free" toothpastes.

How does a mouth sore heal?

The treatment strategy is based on relieving pain, allowing the wound to close faster, preventing secondary infections and, most importantly, reducing recurrences.

Home Remedies for Instant Relief

• Therapeutic Mouthwashes: Gargling with saline or carbonated water 3-4 times a day reduces the bacterial load on the wound, balances the pH and relieves pain by dissolving edema.
• Cold Compress: Applying a cold compress to the painful area from the outside or moving a small piece of ice around the mouth temporarily numbs the nerve endings and provides instant relief.

Medical Treatment: Medicines, Creams and Mouthwashes

Over-the-counter (OTC)

Products available from a pharmacy are usually aimed at managing symptoms. Barrier-forming gels cover the wound, protecting it from physical contact. Sprays with local anesthetics temporarily relieve pain.

Prescription Treatments

For persistent, large or very painful canker sores, your dentist may recommend stronger treatments. Topical corticosteroid creams reduce inflammation and pain by suppressing the excessive immune response in the wound area. These medications must be used under the supervision of a dentist.

Laser Treatment A Modern and Fast Solution for Mouth Sores

Low-level laser therapy (LLLT) is a revolutionary approach to aphthous treatment. This technology is applied painlessly to the wound area and takes effect within a few minutes:

• Instant Pain Relief: Laser light calms the nerve endings, greatly or completely eliminating the sensation of pain.

• Accelerates Healing: By increasing energy production (ATP) at the cellular level and stimulating blood circulation, it accelerates the tissue's self-repair process by up to 50%.

Mouth sores that won't go away: When to Worry and See a Doctor?

While most canker sores are harmless, some symptoms are "red flags" that should not be ignored. These signs may indicate a more serious underlying condition.