Canker Sores

What are aphthae and how do they develop?

Aphthae are painful, mostly round mucosal lesions in the oral cavity. They typically appear as small, whitish-yellow erosions with a reddish inflammatory halo. They preferentially occur on the inside of the lips and cheeks, on the soft palate, under the tongue, or on the tongue mucosa. In medicine, they are called aphthous ulcers. They are among the most common inflammatory changes of the oral mucosa.

Possible triggers include, among others:

• Microtraumas of the mucous membrane (e.g., from hard toothbrushes, braces, poorly fitting dentures)
• Immune system reactions, especially with pre-existing immune deficiency or autoimmune diseases
• Stress and hormonal fluctuations, for example during menstruation or pregnancy
• Nutrient deficiencies, such as a deficiency in iron, zinc, folic acid, or vitamin B12
• Food intolerances, e.g., nuts, citrus fruits, tomatoes, or chocolate
• Certain dental care products, for example those containing sodium lauryl sulfate
• Systemic underlying diseases such as Behçet's disease, celiac disease, or chronic inflammatory bowel diseases

Aphthae are usually harmless and heal on their own within seven to 14 days. However, they can significantly affect quality of life as they cause severe pain when eating, drinking, or speaking. Particularly painful or frequently recurring aphthae should be examined by a dentist to rule out systemic causes or infections. Targeted local treatment, for example with a pain-relieving and anti-inflammatory gel, can promote healing and significantly relieve symptoms.

What types of aphthae are there and how do they differ?

Medically, aphthae can be divided into three main forms that differ in size, number, location, pain intensity, and healing process. This classification is mainly based on clinical criteria and is important for diagnosis and therapeutic assessment.

Important distinguishing features of aphthae:

• Minor aphthae occur mainly in younger people and account for about 80–90% of all cases. They are often well treatable and self-limiting.
  
• Major aphthae can be severely impairing, especially with recurrent courses. They mostly occur in chronic inflammatory underlying diseases (e.g., Behçet's disease, HIV).
  
• Herpetiform aphthae are very painful, occur more often in adults, and can be mistaken for herpes, but are not viral caused by.

In cases of recurrent or unusually severe forms, medical evaluation is advisable to rule out systemic diseases. Modern, non-antibiotic preparations like CANNEFF® DENTAL GEL with CBD can help relieve pain, soothe the mucosa, and accelerate healing.

What are the most common causes and risk factors for aphthae?

The exact cause of aphthae is not yet fully understood, but they are considered multifactorial.

How do aphthae manifest?

Aphthae are painful, round or oval mucosal lesions that usually appear on the inside of the lips or cheeks, on the edge of the tongue, or on the soft palate. They are not infectious but very uncomfortable, especially when eating, drinking, or speaking. They are characterized by a small, centrally whitish-yellow coating surrounded by an inflamed red halo.

Typical symptoms at a glance:

• Pain: Stinging or burning, especially on contact with food or drinks
• Appearance: Whitish or yellowish spot with a reddened border, usually < 5 mm in diameter
• Location: Often on movable mucosal sites (e.g., inner lips, tongue, soft palate)
• Single or multiple lesions: Aphthae can occur singly or in groups
• Accompanying complaints: In severe cases, possibly swollen lymph nodes, fever, or general malaise
• Healing process: Usually self-limiting, healing within 7–14 days without scarring

In cases of chronically recurring aphthae or severe pain symptoms, local treatment is advisable. Medical gels like CANNEFF® DENTAL GEL with CBD can positively influence the healing process due to their anti-inflammatory and pain-relieving effects, without the need for corticosteroids or antibiotics.

How is the diagnosis of aphthae made in dentistry?

The diagnosis of aphthae in dentistry is usually clinical, meaning based on the typical appearance and medical history. Since aphthae are visually easy to recognize and characterized by their distinctive shape, color, and location, further diagnostic measures are usually not necessary.

Overview of diagnostic steps:

1. Medical history: Questions are asked about duration, pain intensity, and recurrence (recurrent?), as well as possible triggers such as stress, food intolerances, hormonal changes, or injuries caused by dentures.

2. Clinical examination: During the clinical examination, the mucous membranes are checked for round or oval lesions with a central whitish-yellow coating and a reddened border. The tongue, inner lips, cheek mucosa, and palate are most commonly affected.

3. Differential diagnosis: Distinguishing from other oral lesions such as herpes simplex, fungal infections (e.g., Candida), lichen planus, leukoplakia, or autoimmune mucosal diseases. This is especially important in unusual courses or chronically recurring aphthae.
   

4. Laboratory diagnostics (optional): These are only performed in unclear or severe cases, for example to clarify vitamin deficiencies (e.g., B12, folic acid), iron deficiency, celiac disease, or immunological disorders.

In dentistry, the diagnosis of aphthae is primarily based on visual examination and targeted medical history. However, in recurring or therapy-resistant aphthae, interdisciplinary evaluation should be conducted. To support treatment, a locally effective anti-inflammatory preparation like CANNEFF® DENTAL GEL with CBD can be used to relieve pain and promote healing – especially for sensitive mucosa or mechanically induced irritation.

What are the differences between aphthae, herpes, and mucosal lesions?

Aphthae, herpes blisters, and other mucosal lesions can look similar externally but differ significantly in cause, course, location, and treatment approach. Correct differentiation is crucial for appropriate therapy – especially in dental practice. The following overview shows the main differences:

While aphthae are inflammatory, non-contagious mucosal ulcers of unclear cause, herpes is a contagious viral infection with blister formation. Other mucosal lesions can be caused mechanically, chemically, or systemically. Accurate differentiation is essential to avoid unnecessary or incorrect treatments. In unclear or recurring cases, dental or dermatological evaluation should be performed.

How can aphthae be effectively treated? – Conventional and supportive therapies

Aphthae are painful, inflammatory lesions of the oral mucosa that are usually harmless but highly disruptive. Treatment primarily aims to relieve pain, promote healing, and prevent recurrences. Since the exact cause is not clearly understood, therapy is usually symptomatic. The choice of treatment depends on the severity, frequency, and distress of the patients.

Conventional therapy options

Supportive therapies and medical gels

Treating aphthae requires a combination of targeted pain relief, anti-inflammatory action, and mucosal protection. The medical product CANNEFF® DENTAL GEL is especially recommended. It works on multiple levels through cannabidiol (CBD) and is suitable for daily use on sensitive mucous membranes. In cases of frequent occurrence or severe courses, medical evaluation should be done to rule out systemic causes.

What role do pain-relieving and anti-inflammatory gels play in aphthae?

Pain-relieving and anti-inflammatory gels play a central role in the local treatment of aphthous ulcers. Since aphthae are very painful and often affect those affected when eating, speaking, or brushing their teeth, the treatment primarily aims to relieve symptoms and support natural healing. The advantage of medical gels is that they can be applied directly to the affected area and act specifically there without burdening the entire body.

Due to their mucoadhesive properties, these gels adhere to the inflamed mucous membrane, form a protective barrier, and reduce contact with mechanical, thermal, or chemical irritants. This soothes the irritated area, reducing pain and promoting healing. Products like CANNEFF® DENTAL GEL combine anti-inflammatory effects with pain-relieving properties, particularly through the use of cannabidiol (CBD). CBD has been proven to have anti-inflammatory, antibacterial, and local analgesic effects. Additionally, the gel contains no irritating substances such as alcohol and is therefore suitable for sensitive mucous membranes.

Especially for recurring or multiple aphthae, such gels are an effective means to control symptoms in daily life, regenerate the mucous membrane, and prevent secondary infections without the need for corticosteroids or antibiotics.

How can aphthae be prevented? – Tips for everyday life, nutrition, and oral hygiene

Since genetic factors and immunological processes play a role, the development of aphthae cannot always be completely prevented. However, there are effective measures that can significantly reduce the frequency and severity of aphthae. Key factors include consistent oral hygiene, avoiding typical triggers, and a balanced diet.

Irritating foods such as spicy dishes, citrus fruits, pineapple, nuts, or highly acidic products should be avoided if they regularly trigger aphthae. Mechanical irritations from hard crusts, rough bread, or poorly fitting dentures can also contribute to their development and should be addressed early. Stress is considered a significant trigger – regular relaxation periods and sufficient sleep can have a preventive effect. It is also important to ensure adequate supply of vitamins, especially vitamin B12, folic acid, iron, and zinc, as deficiencies are often associated with recurring aphthae.

For oral hygiene, a soft toothbrush and a mild, alcohol-free toothpaste should be used to reduce mechanical stress on the mucous membrane. Certain surfactants (e.g., sodium lauryl sulfate) in dental care products are suspected of promoting the development of aphthae – switching to SLS-free products can be helpful. Additionally, regular use of anti-inflammatory mouthwashes or regenerating, mucoadhesive gels that strengthen the mucous membrane is recommended.

For targeted prevention, products like CANNEFF® DENTAL GEL with CBD are suitable, which have anti-inflammatory, antibacterial, and pain-relieving effects without containing irritating additives like alcohol. Daily use of such a gel can strengthen the mucosal barrier and significantly reduce the risk of new canker sores, especially in people prone to recurrent canker sores or with sensitive oral mucosa.

When should you seek medical help for canker sores?

Canker sores are harmless in most cases and heal on their own within 7 to 14 days. However, there are situations where medical evaluation is advisable or even urgently required – especially if the symptoms exceed the usual extent or there are indications of a systemic underlying disease.

You should seek medical help if:

• the canker sores are very large are (over 1 cm in diameter) or extend deep into the tissue,
  
• more than three canker sores at the same time occur or regularly appear in series,
  
• healing takes longer than two weekswithout noticeable improvement,
  
• severe pain are present that significantly impair eating, drinking, or speaking,
  
• fever, fatigue, or swollen lymph nodes occur – this may indicate a bacterial secondary infection or a systemic disease,
  
• canker sores occur very frequently or at short intervals (more than three episodes per year),
  
• suspected herpes or another viral infection are present (e.g., blistering outside the oral cavity or on the lips),
  
• Canker sores with other mucosal changes on the genitals or eyes occur – in this case, a systemic autoimmune disease (e.g., Behçet's disease) could be present.
  

Even in children, immunocompromised individuals, or patients undergoing oncological therapy, a doctor should be consulted at the first signs.

If canker sores are unusually severe, persist for an unusually long time, or recur repeatedly, the cause should be medically investigated and targeted therapy initiated. Modern medical gels like CANNEFF® DENTAL GEL with CBD can be used as a supportive treatment in consultation with healthcare professionals. However, they do not replace a medical diagnosis in severe cases.