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What Is a Mouth Sore or Canker Sore and What Are the Causes?

People often use the terms "canker sores" and "cold sores" interchangeably. While both are very painful, a canker mouth sore is found on the inside of the mouth and is not contagious; cold sores are located on the inside or outside of the mouth and are contagious.

Canker Sores:

These sores are found inside the cheeks, on your tongue or the bottom of your mouth, and sometimes on your gums. They range from the size of a tiny pinhead to a penny. The sores are grayish-white in the center and circled with a red inflammation. Since it's an open mouth sore, it hurts when touched by anything, including saliva. They can burn and itch, too.

Canker sores might be called the "stress sores," because they are caused by different types of stress:

• Emotional stress;
• Physical stress, such as biting your tongue, burning your mouth, or an abrasion from braces or loose dentures; or
• Chemical stress producing changes in your body, perhaps resulting from an illness or change in eating habits (such as medications, or too much of acidic foods such as tomatoes, grapefruit, or lemons).

About one in five people get them. Women in the 20-to-50 year age group get them more often. Once you get them, you're likely to experience them again. However, they usually go away after seven to ten days, although some can be longer-lasting.

An antimicrobial mouth rinse may lessen the irritation. Temporary relief can be provided by over-the-counter topical anesthetics. Pain relief varies with different products. Some medications provide a protective film that physically blocks contact with food and saliva, lessening irritation.

Good oral hygiene and a healthy diet are preventive measures for reducing the frequency of outbreaks.

Cold Sores

Also known as fever blisters, cold sores are caused by the virus herpes simplex. These are painful blisters that usually break out around the lips and sometimes under the nose or chin and normally heal within one week. They are very contagious. The virus stays in the body, causing recurrent lesions prompted from a fever, sunburn, skin abrasions, or stress.

They can be treated by your dentist with the same topical anesthetics to relieve pain and irritation as for canker sores. Prescription antiviral drugs can be effective in reducing viral infections that cause flare-ups.

Additionally, there are new topical medications (ointments) now available that shorten the duration of a breakout, when applied immediately after the cold mouth sore is noticed. All antiviral medications work best in the prodromal or early stage of the lesion. If the wound is open and sore, these medications are of little use as the healing time is still the same.

Be sure to consult with your dentist when any mouth sores do not heal.

By Brian J. Gray, DDS, MAGD, FICO

What Occurs In Your Mouth During A Dental Care Examination

During a dentistry examination, the dentist examines the mouth mucosa (soft tissues) for any abnormalities or pathology (including oral cancer), the teeth for tooth decay (dental caries) or defects, the gum tissues for periodontal (gum) disease, the neck for swollen lymph nodes, the amount of plaque, tartar (dental calculus), and debris on teeth, as well as the need to replace any missing teeth or dental prostheses.

The dental examination begins with a complete dental care and medical history, including medications the patient currently is taking. The skin of the face and neck is examined for any abnormalities, especially pigment changes. The lymph nodes in front and behind the ears, under the floor of the mouth and chin, and the midline of the neck, sides, and back of the neck are palpated to determine if any swelling or tenderness is present.

Inside of the mouth, the lips, cheeks, gums, and roof of the mouth are inspected and palpated. During this process, the tip of the tongue is placed on the roof of the mouth just behind the upper teeth for inspection of the front floor of the mouth and sides of the tongue.

The back floor of the mouth, the area behind the lower wisdom teeth, and the back sides of the tongue are inspected by grasping the tip of the tongue with a small gauze sponge and pulling the tongue forward and toward the opposite side of the mouth.

To inspect the back of the throat, soft palate, and tonsil area (sides of the throat), the tongue is depressed with a dental mirror or tongue blade and then a deep breath is taken by the patient.

To detect swelling on the floor of the mouth, the area inside the mouth is felt with the finger of one hand while a finger of the other hand feels below the chin. Salivary gland enlargement, saliva flow, or xerostomia (dry mouth) are determined by milking the major salivary glands to assess the quantity and consistency of saliva.

Today's dentist has many analytic tools available to pinpoint dental and oral diseases. The basic tools are the dental instruments, lights, and radiographs (X-rays). Depending upon the dentist and the individual's dental needs, additional diagnostic tests are available. Testing for essential proteins and buffering capacity can evaluate the protective ability of saliva.

To determine mouth caries risks, microbiological testing of saliva can measure the level of caries-producing organisms. Periodontal susceptibility tests, which test for the DNA of gum disease-producing organisms, can be performed to assess an individual's risk for gum disease.

If removable dentures are present, they are checked for bite, retention, stability, and overall fit. Dental impressions or models also may be taken to study the mouth and tooth structures to initiate fabrication of prostheses. Photographs may be exposed for a variety of reasons, including before and after treatment comparisons.

The level of oral hygiene and home care practices are assessed and reviewed. Recommendations for home care devices and products may be made. Instruction and methods for maintaining a good oral hygiene regimen can also take place.

Once basic information about oral health status is gathered, the dentist will be better able to discuss dental treatment alternatives that are available.

By Denise J. Fedele, DMD, MS

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