Canker Sores and Cold Sores | Something hurts!

You woke up and noticed, and felt, something sore on your face or lips or inside your mouth. Should you be concerned? Usually, the answer is no. Most often that lesion, is a canker sore or a cold sore caused by a fungal or viral infection. Though quite different, they both typically resolve in a few weeks with or without attention.


How do I know if I have a problem?

The first step is to raise awareness. After all, we take time to brush and floss our teeth, do our hair, and apply makeup. We look at ourselves in the mirror numerous times each day. But, are we only looking to see if our clothes and hair are in place as we go out in public? It’s important to really look. Do we notice changes? Does something look or feel different around your mouth? Inside your mouth? Do we know what to look for? Use an illuminated magnifying mirror. Look inside at the surface of your cheeks, the top of your tongue and under your tongue. Does the area feel sore? Is there a different texture or color in one area? Is there swelling? Are there patches that are white, red, gray or yellow?

Canker Sores / Mouth Ulcers

Canker sores are not contagious. They look like an ulcer with a red border and a white or yellowish center and a center depression. They can pop up inside your mouth or on your tongue. And they usually cause discomfort. The most common canker sore, called a Minor Aphthous Ulcer, is small, under .4”, and is round or oval and typically heals in less than two weeks. Less common are Major Aphthous Ulcers; they are larger, deeper, more painful, take longer to resolve and can scar. When canker sores appear in clusters, from 10 to 100, they are called Herpetiform Ulcers. Not to be confused with herpes, they too are not contagious and heal quickly.


Cold Sores / Fever Blisters

Caused by Herpes Simplex Virus 1, cold sores, also called fever blisters, are contagious. They are seen in clusters of red, fluid-filled raised blisters around lips or underneath the nose or chin. For many patients there is awareness, before the breakout. There may be a tingling feeling, itching, or even a burning sensation before the blisters are visible.


What causes Canker & Cold Sores?

As mentioned, cold sores are manifestations of the Herpes Simplex Virus 1 (HSV-1 – oral herpes) a person-to-person transmitted viral infection that, once contracted, remains in the body. It is so easily contracted – by kissing, sharing utensils, and even using someone’s chapstick – it is estimated that around two-thirds of adults have this virus even though they may remain symptom free. For others cold sores may erupt infrequently with years between outbreaks or they may be frequent occurrences.


Canker sores, on the other hand, result from a variety of causes such as:

  • Daytime habits: chewing on the inside of your cheeks
  • Nighttime habits: biting the cheeks while sleeping
  • Prosthesis, dentures and partials, and retainers that are ill-fitting and cause irritations
  • Teeth that have fractured that have sharp edges or fillings that are not smooth
  • Brushing too aggressively or using a toothbrush with hard bristles that irritate the gums
  • Spicy foods, acidic foods, and hot foods can irritate or burn delicate tissues; hard foods such as chips or pretzels have sharp edges can catch on the tissue
  • Sensitivity to toothpastes with sodium lauryl sulphate (SLS toothpastes)
  • Side effect of medications
  • B12 or iron vitamin deficiencies
  • GI diseases such as Crohn’s and Coeliac Disease
  • Weakened immune systems
  • Smoking
  • Heredity


And stress! With a list this long it can be challenging to determine which, if any, of these caused your canker sore. And, if it resolves in a short time, under 2 weeks, and occurs infrequently, there’s no need to determine causality. However, if the sore does not resolve, or you frequently have canker sores, it is time to see Dr. Hochberg or Dr. Diora to determine if there is an identifiable and resolvable contributing factor or an underlying medical problem that requires attention.


How to reduce the discomfort from canker sores and cold sores?

If you have a cold sore, there are topical, medicated lip balms specifically formulated to help reduce the discomfort of those with HSV-1. When persistent or frequently reoccurring, Drs. Hochberg and Diora can provide prescriptions, including anti-viral medications and rinses, once a diagnosis has been confirmed. If you have a canker sore, watch irritants (the spicy, acidic, or hot liquids and foods) that can aggravate the sore. A saltwater rinse with lukewarm water helps as well. Corticosteroids and cauterization of canker sores are also options that your dentist may offer.


Beyond Canker Sores & Cold Sores

However, canker sores or cold sores are not the only causes for lesions or changes around or inside the mouth. There are manifestations of other diseases that are seen intra-orally and are not to be taken lightly. If there are gray patches, white patches, red patches, a mixture of red and white, or changes in the appearance of the tissue, there is the possibility that a serious problem could be the cause. Most often, pre-cancerous tissue does not cause pain as do canker or cold sores, lulling patients a false sense of being okay and ignoring the visual changes. But, don’t discount warning signs. When a symptom, or change, does not resolve in a short time frame – seek a professional’s opinion. And remember, your periodic visit to your dental hygienist at Colony Square Dental Associates not only results in clean teeth, it’s an opportunity for your dentist and hygienist to provide an oral cancer screening and see if any changes in the intra-oral tissue has occurred.


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