Canker Sores: Can a doctor help treat or limit the duration of a canker sore better than what I'm doing on my own?

September 10, 2009 5:26 AM

Canker Sores: Can a doctor do anything or prescribe anything that will treat or limit the duration of a canker sore better than what I'm doing on my own?

I'm in Day 4 of a cluster of 4 canker sores of the "why god why" variety, at the base of my tongue. (As distinct from a cold sore, btw, for those who have advice related to cold sores.) Eating and talking are near-impossible, and I'm doing as little as possible of either.

In response to the advice in these threads, I got some Kanka and some hydrogen peroxide last night and will be trying those.

If you have any other advice for canker sores, of the treat-the-pain or limit-the-duration or prevent-future-sores varieties, lay it on me.

My main question is, though: can a doctor do anything to help? I'm willing to see one if they have some magic up their sleeves -- prescribe a real doozy of a topical pain reliever that will actually stay on a tongue, or do something to the canker sore itself to, you know, make it melt away screaming "NOOooooooooo". Anyone have any experience with professional medical treatment of a canker sore?

posted by palliser to Health & Fitness (30 answers total)

I assume you've tried OTC medication (Orajel)?
posted by mpls2 at 5:44 AM on September 10, 2009

Best answer: Yes, doctors can help. The first thing they can do is prescribe oral cortisone gel, which is approximately three billion times more effective than anything you can buy without prescription (like Orajel). As long as you dry the area first, it sticks like glue and completely kills the pain. It's about the only way for me to eat a comfortable meal when I'm having an outbreak. They can also prescribe a hexetidine-based mouthwash which seems to help some people (but doesn't help me). You can actually buy hexetidine off the shelf in a weaker form if you want to try it -- it's branded where I live as "Steri/sol."

The second thing doctors can do is get you tested for an underlying cause (like celiac disease). If you find out why you're getting them and deal with that directly, you may never have them again.
posted by hayvac at 5:54 AM on September 10, 2009 [1 favorite]

I've heard that Listerine can do more to numb/kill the pain (my husband recently had one under his tongue as well) than the gel stuff can.

We never got to try it though, as he seems to have a habit of purchasing something to treat what ails him and then, possibly through some strange placebo effect, never actually using it. I find unopened packages of medicine after he's been sick all the time; right now there's a tiny unopened bottle of Listerine on his dresser.

Canker sores suck--hope yours get better soon!
posted by miratime at 5:54 AM on September 10, 2009

Best answer: I once was at the dentist with a large sore just behind my teeth. He squirt a couple drops of some acid on it to cauterize it. It had been getting worse for a week. After the treatment it healed to the point I couldn't feel it in a day. It was different any the canker sore I got towards my front teeth, but I would imagine treatment would be the same.

So ask your dentist. He said that I could drop back in anytime for a quick treatment to cauterize anything like that again.
posted by FuManchu at 5:55 AM on September 10, 2009

An old Pennsylvania Deutsch folk remedy is to put a small poultice of powdered alum (like you get in the baking aisle) on the sore. Obviously, this is not medically sound advice, but I've found it useful.
posted by mrmojoflying at 5:55 AM on September 10, 2009

If you can reach them directly, one topical aid that I rely on is pulverized aspirin, applied as a powder to the wound. For me this appears to have accelerated healing & reduced pain (yay, twin benefits). It may also be a placebo, or it may be no better than baking powder/alum, but I swear by it.

Try to keep the powder on there for a while (ie, be careful eating). If your sore is especially bad, the aspirin may form something of a shield over the sore (an actual physical barrier) by combining with saliva etc. This is a good thing; do not try to peel it off because it may tear the skin. The shield layer will dissolve by itself, and in the meantime it makes life a lot easier.

Also, Lysine. Won't fix it immediately, but definitely speeds healing. I can usually intercept a developing sore; when I first notice the spot, I start taking Lysine.

Be aware that Kanka/Anbesol can be blindingly painful when it's first applied. Maybe it's just me, but when I used it on an unusually bad sore, well, my god, I thought my knees might give out. And I'm a guy that's been stabbed.
posted by aramaic at 6:04 AM on September 10, 2009 [1 favorite]

IANAD, but I do know how incredibly painful canker sores can be. I know a few people who take L-Lysine as a herbal supplement to reduce/prevent canker sores. I've been told rather enthusiastically it has helped them quite a bit. I have taken it when I've had a canker and it seems to resolve faster, but this is purely anecdotal. Other than spending a few bucks, I don't think there would be any harm in trying it. Good luck!
posted by katemcd at 6:07 AM on September 10, 2009

Best answer: I too have been a long time suffer of canker sores.
The best treatment when I have bad one or a group of them, as you have, is called Zilactin. (The worst I ever had were 5 gigantor ones along the roof of my mouth - just where it begins to become the throat. Every time I swallowed I wanted to die)

It is over the counter and can be found near the ora-jel and kanka etc... it burns like all hell when you first apply it. Then it dries and forms a little skin over the top of the ulceration. The pain is basically gone once it dries. Talking is so much easier. Just be a little careful when you eat as the combination of saliva and food and mouth movement can knock of the little "skin" and that can be a little painful.

Throughout the course of a day you can feel the "skin" deteriorating and then you can reapply the medication. This is by far the best thing I do for a canker sore, and I have tried everything you can buy in that little section of the drugstore.

Cold Milk will help soothe some immediate pain, but the effect is short lived. Also just an observation I have made in my life but not sure if there is any real correlation, any time I have gone swimming in a chlorinated pool with one in my mouth and gotten the water in my mouth it feels better and seems to last a shorter time.

I did talk to a doctor about them once, she is the one that referred me to the zilactin. We talked about the probable causes, and she suggested the best prevention was immune support.

Hope this helps, and good luck. I know what you're going through.
posted by fogonlittlecatfeet at 6:17 AM on September 10, 2009

Yogurt is also good. I was prone to canker sores as a kid, and my father would scoff whenever my mother gave me yogurt for them -- because it was a folk remedy. Then he got a canker sore once, and proudly announced he was going to get REAL medicine for it. He consulted with our neighbor who was a nurse, and she said oh, yes, there was something she could get him -- she snuck him home a packet of what she said was a canker sore treatment.

He proudly brandished it before my mother and I. "See, now THIS is the real stuff," he said, reading the label out loud. "Acidophilous powder. 'Directions: mix contents into milk and drink.'"

My mother and I stared at him a moment until I said, "In other words...you make yogurt." Dad just blinked, grumbled something at me and left.

Long story short -- if acidophilous is enough of a remedy that it was actually kept on stock in nurse's offices, then it's probably good.
posted by EmpressCallipygos at 6:24 AM on September 10, 2009 [2 favorites]

I find rinsing with Hydrogen Peroxide every night helps to keep the canker sores from coming back. Rinsing with it after every meal and then applying Orajel will help speed curing. Also, avoiding anything with citric acid in it might help. For me anyway, soda, OJ, etc seems to irritate the hell out of the sores when I have them.
posted by COD at 6:37 AM on September 10, 2009

I feel like I've been getting them less often since I switched to toothpaste with the built in hydrogen peroxide/baking soda. (Also exercise, eating right and reducing stress help if you can swing those.) For treatment, it's the aforementioned hydrogen peroxide for me.

I don't think I've ever had them in clusters *and* on my tongue though, so you really have my sympathy.
posted by and hosted from Uranus at 6:41 AM on September 10, 2009

I've taken Lysine before and I have not found it to be helpful. However, the last two times I've had canker sores starting I've crushed up Lysine and packed it directly onto the burgeoning sore for about 15 minutes. They were mostly gone by the next day, while typically they would last for a week or more.

Canker sores suck.
posted by OmieWise at 6:46 AM on September 10, 2009

Put a lot of salt on it. Wait as long as you can. Rinse your mouth out.

Hurts like a $%#! but will speed healing and cause some temporary pain relief.
posted by sid at 6:46 AM on September 10, 2009

I had canker sores a lot until I stopped eating things with artificial sweeteners in them. I read somewhere that artificial sweeteners cause them, so just to test it out I stopped chewing artificially sweetened gum, and diet sodas. This is just my personal experience, but on the rare occasion that I indulge, the sores appear.
posted by effluvia at 6:51 AM on September 10, 2009

This works for me... mix together 2 teaspoons benadryl, 2 teaspoons maalox & half teaspoon hydrogen peroxide, swish around mouth then spit out. I do this once in the morning and once at night, for a day or two, then I'm on the mend.
posted by maloon at 6:55 AM on September 10, 2009

I used to get them on my uvula, which (like yours) pretty much meant eating and speaking were extremely painful. Someone mentioned that one of the things that increases your susceptibility is low intake of Vitamin B12 - I started taking supplements and had few problems after that.

I am a bit skeptical about L-Lysine - it's proven to help with anything related to the various herpes virsuses - I would guess that people who have had this recommended are a victim of the time-honoured confusion between canker sores and cold sores.
posted by scrute at 7:03 AM on September 10, 2009

I am a bit skeptical about L-Lysine

Wright EF. Clinical effectiveness of lysine in treating recurrent aphthous ulcers and herpes labialis. Gen Dent Jan/Feb 1994:40-2

28 patients received lysine 500 mg daily for prophylaxis which was increased to 1000 mg 4 times daily at the earliest sign of an outbreak. Nearly everyone reported that lysine reduced the number of recurrences, although a few required 1000 mg daily for effective prophylaxis. When an episode occurred, the high dosage of lysine reduced their duration by 25% to 50%.

...but it's only one study, so mileage probably varies.
posted by aramaic at 7:17 AM on September 10, 2009

Response by poster: Thanks so far, everyone. To answer some questions, I have tried Orajel but find that it doesn't adhere well at all, so the relief is very short-lived. Kanka has been a bit better, but now I'm intrigued by the Zilactin suggestion.

As for the cause: we had terrible, mealy tomatoes around here this summer ... right up until the last couple of weeks, when I found some good ones and promptly starting devouring them raw, whole, with salt. The wages of gluttony. I don't think I get them often enough to worry about underlying illness, but I'll definitely look into the hydrogen peroxide/baking soda toothpaste, as that seems an easy adjustment to make.
posted by palliser at 7:31 AM on September 10, 2009

Just to say, a friend of mine had terrible canker sores for years and these have stopped since she started using toothpaste that does not contain sodium lauryl sulfate.

Incidentally, her symptoms of Crohn's disease have dramatically improved over a similar time.

For a quick relief, she would sometimes apply Clove oil, though this isn't for everyone and made her breath smell a bit odd for a while. Some of the ideas above look excellent as well.
posted by Rumple at 7:52 AM on September 10, 2009

With me, canker sores seemed to have been connected to stress. I've never had really bad ones -- just kind of low-level annoying -- but they would crop up at times when I was in the midst of a particularly busy or stressful period. Not saying that's the cause, but it could exacerbate things.
posted by EmpressCallipygos at 8:03 AM on September 10, 2009

I think what FuManchu is talking about is Debacterol (or a similar product): http://debacterol.com/
posted by frescaanddietcoke at 8:25 AM on September 10, 2009 [1 favorite]

I had the same experience as Rumple's friend. Stopped using toothpaste with SLS and haven't had a canker sore since.
posted by otherwordlyglow at 8:48 AM on September 10, 2009

I suffered with canker sores for years (30+). A while back I saw a website that mentioned vitamin C. I don't know why this stood out to me, since it's not a commonly recommended cure, but I decided to give it a shot. Shockingly, it worked - for me, at least. I have been taking vitamin C daily for well over a year and I can't even remember the last time I had a canker sore. I take the kind you swallow, not the kind you chew.

As to your main question, yes - see a dentist or an oral specialist if it's that bad.
posted by O9scar at 8:49 AM on September 10, 2009

frescaanddietcoke, that looks exactly right. From its description page in ad-speak:

The pain relief benefits of DEBACTEROL® over other therapies are so great that the burden of seeking professional treatment for Canker Sores is viewed by patients as well worth the effort and expense. It is a common practice in many dental and medical clinics for Hygienists and Nurses to be trained in the use of DEBACTEROL® for the treatment of common lesions, such as Aphthous Stomatitis, and to provide that treatment on a routine basis. In this way, established patients can be treated quickly and easily on a walk-in basis whenever they detect a new developing lesion.

I don't suppose there's any OTC version of that kind of acid, is there?
posted by FuManchu at 9:28 AM on September 10, 2009

Like O9scar, I suffered from canker sores for ages until I started taking vitamin C supplements, at the recommendation of a pharmacist. As soon as I feel one coming on, 500mg in the morning and evening will usually nip them in the bud. Or if I already have one, they cut the healing time down to a couple of days, vs. a couple of weeks in the past.

You have my sympathies!
posted by CruiseSavvy at 9:59 AM on September 10, 2009

Adding another comment to support using toothpastes without SLS (sodium lauryl sulfate). They tend to cost an extra buck or two per tube... but defintely work.

Here's a web-site that lists toothpastes that fit the bill. (NOTE: I've never bought products from this particular site... but it does appear to be a good list of products to look for when you go to a local store.)

I've tried a few of them and all do the trick, but after experimenting for a couple years find that I'm partial to the Nature's Gate Peppermint if you can find it locally. The Tom's of Maine seems to be most widely-available ... but not all of their products are SLS-free, so be sure to read the boxes carefully.

You should be aware that many SLS-free toothpastes are also flouride-free, so you may want to watch for that too if you want to keep the flouride but remove the SLS.
posted by jimmereeno at 10:13 AM on September 10, 2009 [1 favorite]

nthing a toothpaste without SLS and with baking soda.
posted by adamk at 12:33 PM on September 10, 2009

If it's really bad, ask your doctor about a prescription for colchicine, which is an anti-inflammatory usually prescribed for gout. There have been a number of studies on its effect in treating aphthous ulcers (google colchicine and aphthous stomatitis). Problems seem to include recurrence after discontinuing the medicine, but I think the studies have been on treating chronic canker sores; in my experience, colchicine also works well when treating specific canker sore occurrences, drastically shortening the duration and minimizing the size of the sore. Colchicine isn't the most pleasant drug to take (diarrhea and vomiting are common side effects if you take it for more than a few days), but since I take it for gout flareups, I've learned how to deal and when to stop.

I haven't had a torturous canker sore bout since I started using colchicine (I would have truly awful bouts fairly often before then). For example, biting my lip used to invariably result in a bad, large canker sore or two lasting at least a week and a half to 2 weeks. Now, I take colchicine for a couple days immediately after biting my lip, and the bite either does not develop into a canker sore at all, or turns into a tiny one that's easily ignored, and then the bite/sore disappears after only a couple days.

If your doctor doesn't want to prescribe colchicine, Nthing Zilactin, and also washing your mouth with peroxyl or listerine immediately before applying it.
posted by odin53 at 1:04 PM on September 10, 2009

Maybe this is just me, but my canker sores are related to allergies. A few days of Zyrtec clears them right up.
posted by workerant at 6:57 PM on September 10, 2009

Response by poster: Thanks, everyone, for the suggestions -- since these healed up, I had a small mouth injury and started loading up on the L-Lysine, the vitamin C, and made sure to take a multivitamin with vitamin B. It didn't develop into a canker sore, so that's good.

I'm very happy to know about the debacterol, too, in case I ever get another that was as severe as these.
posted by palliser at 5:38 AM on October 11, 2009