Recurrent aphthous stomatitis (canker sores, aphthous ulcers) is small, painful sores inside the mouth that typically begin in childhood and recur frequently.

• Mouth injury, stress, and some foods may trigger an attack.
• People feel burning pain, and a day or so later an ulcer develops on the soft tissue of the mouth.
• Doctors make the diagnosis because of the pain and the appearance of the ulcers.
• Treatment is with mouth rinses and sometimes corticosteroids.

Recurrent aphthous stomatitis (RAS) is very common. The cause is unknown, but the disorder tends to run in families. Many factors seem to predispose to or trigger attacks. Such factors include injury to the mouth; stress (for example, a college student may get canker sores during final exam week); and certain foods, particularly chocolate, coffee, peanuts, eggs, cereals, almonds, strawberries, cheese, and tomatoes. People with AIDS often have large canker sores that persist for weeks.

People who have RAS get canker sores repeatedly. Some have only one or two sores a few times a year. Others have almost continuous outbreaks. For unknown reasons, pregnant women, people who are taking oral contraceptives, and people who are using tobacco products are less likely to develop sores.

Symptoms and Diagnosis

Symptoms usually begin with pain or burning, followed in 1 to 2 days by an ulcer. There is never a blister. Pain is severe—far more so than would be expected from something so small—and lasts 4 to 7 days. The ulcers almost always form on soft, loose tissue such as that on the inside of the lip or cheek, on the tongue, on the floor of the mouth, on the soft palate, or in the throat. Ulcers appear as shallow, round or oval spots with a yellow-gray center and a red border. Most ulcers are small, less than ½ inch (1¼ centimeters) in diameter, and often appear in clusters of two or three. They usually disappear by themselves within 10 days and do not leave scars. Larger ulcers are less common. They are irregularly shaped, can take many weeks to heal, and frequently leave scars.

People with a severe outbreak may also have a fever, swollen lymph nodes in the neck, and a generally run-down feeling.

A doctor or dentist identifies RAS by its appearance and the pain it causes.

Treatment

Treatment consists of relieving the pain with the same general measures used for other mouth sores. In addition, doctors often recommend chlorhexidine mouth rinses. If there are many ulcers, doctors sometimes also recommend a corticosteroid such as dexamethasone applied as a rinse. If there are fewer ulcers, doctors recommend other corticosteroids such as fluocinonide or clobetasol applied as an ointment or mixed in a protective carboxymethylcellulose paste. People who have repeated outbreaks of canker sores may start using the mouth rinse as soon as they feel a sore developing. If the corticosteroids that are applied directly to the affected area do not work, prednisone tablets may be taken by mouth. However, before prescribing a corticosteroid, a doctor ensures that the person does not also have oral herpes simplex infection, which can be further spread by corticosteroids. Corticosteroid rinses and tablets are absorbed by the body more than are corticosteroids given in gel form, so the side effects may be a concern (Joint Disorders: Corticosteroids: Uses and Side Effects). Sometimes stronger immune-suppressing drugs are needed.

Last full review/revision October 2006 by Robert B. Cohen, DMD