What Causes Canker Sores?

Q. What causes canker sores? Why would I have a sudden outbreak of canker sores in the mouth?

A. There are several theories about what leads to canker sores, those painful ulcers that form inside the mouth, on the tongue or inside the cheek or lips, though medical experts say they don’t know the precise cause. They are distinct from cold sores, which form on the outer lip and are caused by infections with the herpes simplex virus.

Anyone can get a canker sore, though they occur more often in teens and young adults and may be more common in people with underlying medical conditions that cause inflammation or weaken the immune system.

“It’s just one of those things where the exact cause has yet to be determined,” said Dr. Sally Cram, a dentist and spokeswoman for the American Dental Association.

Among the possible culprits are viruses, bacterial infections, food allergies, poor nutrition, a weakened immune system, an injury or trauma to the mouth and stress. Hereditary factors may also play a role.

Several studies have found that people tend to have outbreaks of canker sores when they experience stress, which can take a toll on the immune system.

“A lot of people get canker sores if they have had a cold, been sick or really stressed at work, haven’t been eating properly or haven’t been getting enough sleep,” Dr. Cram said. Patients have also frequently told her they developed sores after a trauma to the mouth, such as from accidentally biting one’s cheek.

Most canker sores resolve on their own within one to two weeks. There is no cure, but over-the-counter anesthetic ointments or gels will ease the pain; you can find them in the toothpaste aisle of the drugstore. Avoiding irritants like alcohol, spicy food and foods with sharp edges, such as crackers, can also help ease discomfort.

See a dentist if you’re concerned, and be frank about your medical history and medications. If you’re having frequent or persistent outbreaks, get many canker sores all over your mouth or the sores are very large, you may want to investigate further. See your regular physician for a checkup to determine if you have an underlying illness, like diabetes or H.I.V. infection, that may be weakening your immune system.

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