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Don't stress out about canker sores
Here is a new one to add to the list of stress-related hazards: canker sores. No one has been able to pinpoint exactly what causes these painful little eruptions that appear inside the mouth, but it has been discovered that people with high-stress lifestyles are more prone to developing canker sores. Canker sores can also result from such minor injuries to the mouth as biting your cheek or experiencing irritation from braces. The good news is that canker sores often heal themselves and are not contagious. Nonetheless, there are nonprescription medications that, along with relaxation, help make the natural healing process a little less painful.
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What Is a Canker Sore?
It is not yet known exactly what causes canker sores, but there is a theory:
- Canker sores are thought to be an allergic reaction to bacteria within the mouth, not an infection.
- They can last anywhere from seven to 14 days, then disappear.
- People under stress tend to experience canker sores more frequently.
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Topical anesthetics
Topical anesthetics such as benzocaine and dyclonine are often used in nonprescription products to temporarily relieve the pain associated with canker sores and other oral discomforts. They relieve pain by inhibiting sensory neurons, leaving behind a dull sensation. Be aware that some people are allergic to these drugs.
Debriding agents
Oral cleansers release oxygen and can temporarily relieve the pain associated with canker sores. Hydrogen peroxide and carbamide peroxide are two cleansers commonly found in nonprescription products. Do not use for more than one week, and do not swallow these products.
Oral protectants
Based upon benzoin, protectants form a protective layer over such minor mouth abrasions as canker sores, preventing further injury and irritation.
| Topical Anesthetics | Ingredient | Description |
|---|
| Benzocaine | | Effective and very safe in adequate concentrations, and provides long-lasting relief (a single application may provide itch and pain relief for four to six hours). However, a small percentage of users experience some irritation or sensitivity. | | Benzyl Alcohol | | A local anesthetic effective in concentrations of 5% to 20%. | | Butacaine Sulfate | | Very effective in relieving pain after dental work and reducing the soreness and discomfort caused by braces and dentures. However, can be highly toxic if large quantities are absorbed through the gums. Should not be used in teething infants or children under age 12. Persons allergic to other "-caine" drugs should not use this. Not commonly found in nonprescription products. | | Dyclonine | | The most effective drug that can be safely used in the mouth and throat; carries less risk of side effects than "-caine" drugs. Also effective when used on mucosal surfaces. Not commonly found in nonprescription products. | | Hexylresorcinol | | While considered safe, this drug is not one of the most effective topical anesthetics. Less potent than benzocaine and shorter-acting than dyclonine. | | Menthol | | Widespread use of this drug attests to its safety and effectiveness, but relief is short-lived. | | Phenol | | Safe and effective in recommended doses, but highly toxic in large quantities. Should be used with caution. Not for use on children under age 6 unless recommended by a dentist or doctor. | | Phenolate Sodium | | Related to phenol, carries the same risks of toxicity in high doses. But the recommended dosage is safe and effective. Not commonly found in nonprescription products. | | Salicyl Alcohol | | No longer widely used, as relief is very short-lived. It is, however, safe and effective. | | Debriding Agents | Ingredient | Description |
|---|
| Carbamide Peroxide | | Generally considered safe and effective; can be used as a mouthwash. Should not be used on children under age 2. | | Hydrogen Peroxide | | Safe and effective for temporary use, but may cause gum irritation or gum damage if used in concentrations higher than 3%. Can be dripped onto affected areas or diluted and used as a mouthwash. Should not be used in children under age 2. | | Perborates | | Releases a small amount of hydrogen peroxide into the mouth. Safe and effective, but contains toxic boron so should not be used over the recommended dosage. Not commonly found in nonprescription products. | Oral Protectants | Ingredient | Description |
|---|
| Benzoin | | Made from the resins of pine trees. Effective at coating minor injuries, but its effects on healing have not been thoroughly evaluated. Nontoxic in small quantities. |
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FDA-Approved Uses
Debriding agents
- For temporary use in cleansing minor wounds or minor gum inflammation resulting from minor dental procedures, dentures, orthodontic appliances, accidental injury, or other irritations of the mouth and gums.
- For temporary use to cleanse canker sores.
- Assist in the removal of foreign material from minor oral wounds.
- Physically removes debris from minor oral wounds.
- Aid in the removal of phlegm, mucus, and other secretions associated with occasional sore mouth.
Topical anesthetics/counterirritants
- For the temporary relief of occasional minor irritation, pain, sore mouth, and sore throat.
- For temporary relief of pain due to minor irritation or injury of the mouth and gums.
Oral protectants
- Form a coating over a wound.
- Protect against further irritation.
- For temporary use to protect wound caused by minor irritations or injury.
- For protection of recurring canker sores.
Astringents
- For temporary relief of occasional minor irritation, pain, sore mouth, and sore throat.
Antiseptics
- First aid to help decrease the risk of infection in minor cuts, minor scrapes, or minor oral irritation caused by dental procedures, dentures, orthodontic appliances, or accidental injury.
Goals of Treating Canker Sores- Canker sores will heal on their own without your help.
- This takes between seven to 14 days; during this period, eating and drinking can be painful.
- Treatment is centered upon reducing the pain associated with eating, drinking, and cleaning your teeth.
Sore No More (Well, at Least Temporarily)- Dry the affected area with a cotton ball or swab.
- Place a small amount of ointment onto the lesion.
- This can be repeated every four hours for three days; then it may be applied as needed.
Counterirritant Controversy- Counterirritants such as menthol and camphor have been approved by the FDA for use in easing oral pain.
- However, they are not recommended by the American Dental Association because they are potentially irritating to mouth tissues.
- To avoid irritation, counterirritants should only be used for a limited amount of time.
Debriding Rinses- Rinses containing a bubbling oxidizing agent can be used to clean and irrigate your mouth.
- Follow the directions on the package for the various products.
- They can be used up to four times per day.
- Never swallow the rinse, and do not use more than the recommended amount.
Coating the Injury- Benzoin preparations are the only FDA-approved oral protectants.
- First, dry the affected area.
- Saturate a cotton ball with benzoin. Do not dilute.
- Coat the affected area.
- Use up to once every two hours or as needed.
- For children under six months, consult a physician before use.
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Warnings
Cleansers
Consult a physician before use or do not use if you have:
- Allergy to debriding or cleansing agents
- Large open sores or wounds
Or if you:
- Are administering to children under age 3
- Experience irritation, inflammation, or worsening of symptoms; consult a physician.
Counterirritants
Consult a physician before use or do not use if you have:
- Allergy to any counterirritant
Or if you :
- Plan to apply to wounds, lesions, broken, damaged, or sensitive skin.
- Experience irritation, inflammation, or worsening of symptoms; consult a physician.
- Accidentally ingest large amounts.
Oral protectants
Consult a physician before use or do not use if you have:
- Allergy to any oral protectant
Or if you:
- Are administering to a child under age 2.
- Accidentally ingest large amounts.
Topical anesthetics
Consult a physician before use or do not use if you have:
- Allergy to topical anesthetics or any other component of these products.
- Heart disease
- Liver impairment
- Methemoglobinemia
- Severe shock
Or if you:
- Are pregnant or a nursing mother.
- Are administering to a child under age 6.
- Plan to eat food within one hour; because of increased risk of choking.
Common Side Effects
Infrequent to Rare Side Effects
Cleansers
Counterirritants
- Allergic reaction
- Mouth irritation
Oral protectants
Topical anesthetics
- Allergic reaction
- Throat burning, itching, or stinging
Effects of Overdose
Cleansers
Counterirritants
Oral protectants
Topical anesthetics
- Excitation
- Low blood pressure
- Seizures
- Slow heartbeat
What to Do in Case of Overdose
Cleansers
- It is unlikely that an overdose of this medication will cause life-threatening symptoms. If you are still concerned, please seek the advice of your health professional.
Counterirritants
- It is unlikely that an overdose of this medication will cause life-threatening symptoms. If you are still concerned, please seek the advice of your health professional.
Oral protectants
- It is unlikely that an overdose of this medication will cause life-threatening symptoms. If you are still concerned, please seek the advice of your health professional.
Topical anesthetics
- If you suspect that you or someone you know has taken an overdose of this medication, immediately STOP USING THE MEDICATION and SEEK MEDICAL HELP.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Government Sources
- 1. Food & Drug Administration. Federal Register 9/24/91.
- 2. Food & Drug Administration. Federal Register 5/13/92.
- 3. Food & Drug Administration. Federal Register 7/26/83.
- 4. Food & Drug Administration. Federal Register 7/18/86.
- 5. Food & Drug Administration. Federal Register 2/9/94.
Books
- 1. Covington, TR et al. Handbook of Nonprescription Drugs, Eleventh Ed. American Pharmaceutical Assoc. Washington, DC 1996.
- 2. Kastrup EK et al. Drug Facts and Comparisons. Facts and Comparisons.
- 3. Inlander, CB and Slamans, S. The Over-the-Counter Doctor. Cader Books. New York, NY 1997.
Find more books on health and wellness at  barnesandnoble.com.
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