– Lesion characteristics, healing stages, ulcer locations. | Pictures and diagrams. | Outbreak frequency (statistics). | Normal healing timeline. Canker sore Canker sore Canker sore (aphthous ulcer) identification.Dentists distinguish canker sores (specifically, “recurrent minor aphthous ulcers,” the common type of canker ulceration that affects 80% of sufferers) from other types of mouth sores based on these three points. The three pillars of canker sore identification –
Additionally, the person’s Patient History (in terms of what they specifically did or did not experience with their sores) can also play a valuable role in identification and helps to differentiate this type of lesion from other kinds of mouth sores. For example: Canker sores vs. Oral herpes. - Telling the two apart. Methods that aren’t routinely used for aphthous ulcer identification. As a side note, we’ll point out that the factors mentioned above, collectively, are usually all that’s needed to make an accurate diagnosis for canker sores.
What do canker sores look like?The appearance of a canker sore will change as it advances through its successive stages of formation and then healing. The stages –
As additional help in understanding this topic, we also have Q & A sections that answer questions people frequently have about canker sore identification and their stages.
(Note: The time frames we’ve assigned to each of the stages below overlap because what any one person experiences varies.) #1 – The Prodromal Stage.(Also referred to as the Premonitory Stage.) Time frame: 2 to 48 hours duration. This stage is the earliest indication of pending canker sore formation but it doesn’t involve any visible signs. Instead, what’s noticed is a tingling, itching, burning, or numb sensation in the area where the lesion will ultimately form. These kinds of signs are referred to as “prodromal” symptoms, meaning that they hint that something is brewing but the signs themselves are not specific just for canker sores. # 2 – The Macule Stage.(Also referred to as the Preulcerative Stage.) Time frame: 18 to 72 hours duration. During this time frame, the first visible signs of the developing lesion will have started to show.
Slideshow – Canker sore pictures. Pictures of fully formed aphthous ulcers. #3 – The Ulcer Stage.(Also referred to as the Ulcerative Stage.) Time frame: 1 to 14 days duration. By this stage in its development, the lesion has transformed into a fully-formed ulceration. It may continue to grow in size for 4 to 6 days. What does a canker sore ulceration look like?
Diagram: The physical characteristics of a canker sore. Sores have a grayish membrane-coated central ulceration with a surrounding red border. The skin around the lesion looks normal.
Other characteristic signs and symptoms.
▲ Section references – Neville, Akintoye, Chavan, Casiglia, Scully, Dunlap Can a person have more than one lesion at a time?Yes, outbreaks of multiple, simultaneous canker sores may occur.
▲ Section references – Neville Are they contagious?
Where do canker sores form?They characteristically only form on the “loose” (movable) tissues of the mouth, meaning those areas where the skin is not tightly bound to the bone underneath. These locations generally involve the “nonkeratinized” (softer, less tough) tissues of the mouth. Location, location, location.An important aspect of canker sore identification is based on the fact that they characteristically only form in certain parts of the mouth. These locations are, listed here in order of locations/tissues most affected: Diagram: Locations where canker sores usually form. Canker ulcerations characteristically form on the “loose” tissues of the mouth.
(Listed in order of locations/tissues most affected.) Less common locations.While rare, it is possible for canker sores to form on keratinized tissues. This includes the top (dorsal) surface of the tongue, the gum tissue that surrounds a person’s teeth, hard palate, or even the border of the lips (vermilion border). When this occurs, the lesion typically involves an extension of a sore already formed on adjacent nonkeratinized tissues. ▲ Section references – Neville, Dunlap Additional Q & A about the formation stages.Beyond the questions we’ve addressed above, here are some additional ones that people often have. Can you pop a canker sore?No, aphthous ulcers form from a macule (reddened area of skin), not a blister. There is never any blister to pop. Why are canker sores so painful?These lesions are ulcerations. The protective layer of skin that originally covered over the area of the sore has fully deteriorated thus leaving the inner layer of tissue and the nerve endings it contains exposed. FYI: Some treatments for canker sores work by forming a protective film over the ulceration. Do canker sores get bigger before they go away?With “recurrent minor aphthous ulcers” (the most common type of canker ulceration), once a lesion has fully formed (usually by day 4 to 6), it’s not expected to grow in size. However, during formation, it is possible for two directly adjacent lesions to coalesce into one larger one. Is it normal for canker sores to be yellow?Yes. Especially during the early stages of ulcer formation, a yellow membrane can usually be seen covering its surface. Later on, this yellow coloration will typically transform to a grey-white tint. #4 – Canker sore healing stages.Time frame: 4 to 14 days duration. The Healing stage time frame.Canker sores (specifically, recurrent minor aphthous ulcers) characteristically heal within just a few to several days. This characteristic can be used to help confirm the kind of lesion a person has. How long should it take for a canker sore to heal?
When should I be concerned about a canker sore?Any ulcer that has not healed within a 2-week time frame should be evaluated by a dentist. This is for two reasons.
Canker sore appearance during its healing stages.
▲ Section references – Woo, Casiglia, Scully How can you tell that your canker sore is healing properly?As long as the changes you notice with your lesion’s healing progress stay within the time frame and appearance parameters just discussed, you can assume that all is going well. Reasons for concern.Any events that vary from what’s described above should trigger some concern and is a reason to consult with your dentist.
Additional Q & A about the healing stages.Beyond the questions we’ve addressed above, here are some additional ones that people often have. Do canker sores hurt more when healing?No, once the full extent of the ulceration has formed, your sore’s healing will begin and the level of pain associated with it should start to improve. The new reparative tissues will first start to form around the edges of the lesion and then continue to close in over its entire surface as days pass. As the size of the raw, uncovered portion of the ulceration continues to diminish, the level of pain associated with the lesion should diminish. How long does the pain of a canker sore last?Hopefully, the level of discomfort you notice will start to subside by days 3 to 4. Although, complete resolution of pain won’t occur until that point when the healing process has advanced enough that the exposed tissues of the lesion are finally covered over and protected. What color do canker sores turn when healing?It’s normal for the original yellow-white color of the ulceration to transform to a grey-white tint. This is a sign of primordial skin tissue formation. How do you know when a canker sore is healing?As the process of forming new skin over the lesion progresses (epithelialization), its surface will start to take on a grey-white tint. Since the edges of the ulceration will mature sooner than its center, this area will be the first to return to a more normal pink coloration. As new skin forms over more and more of the sore’s surface, the amount of pain the lesion causes will diminish. How many days does it take for a canker sore to go away?This will depend on the initial size of the ulceration and ultimately how involved its healing process will be. With small sores, it’s possible that resolution may occur as quickly as just several days (3 to 5). But with relatively larger lesions, expect that it may take as long as two weeks. What happens if a canker sore goes untreated?In the vast majority of cases, no treatment is required for a canker sore and its healing will occur uneventfully and without scarring. FYI: Most over-the-counter treatments for aphthous ulcers are only palliative in nature. (Only aimed at reducing pain levels and maintaining a healthy wound as opposed to speeding up healing.) How often do canker sores form?Outbreak frequency.
Incidence rates / Prevalence.
▲ Section references – Akintoye, Woo, Ship, Ship, Chavan, Neville What are “major aphthous ulcers”?Canker sores like we have described above are formally termed “recurrent minor aphthous ulcers.” They are the type of canker lesion experienced by 80% of sufferers. Beyond these “minor” lesions, there’s another type of aphthous ulcer referred to as “major aphthae” or Sutton’s ulcers. And in comparison to the minor variety, these “major” canker sores are large, deep ulcerations whose healing is characteristically slower and more painful. Characteristics.
▲ Section references – Chavan, Neville
Page references sources: Akintoye SO, et al. Recurrent aphthous stomatitis. Casiglia J. Recurrent aphthous stomatitis: Etiology, diagnosis, and treatment. Chavan M, et al. Recurrent aphthous stomatitis: a review. Dunlap CL, et al. A guide to common oral lesions. Neville BW, et al. Oral and Maxillofacial Pathology. Chapter: Allergies and Immunologic Diseases. Scully C, et al. Oral medicine — Update for the dental practitioner Aphthous and other common ulcers. Ship J, et al. Recurrent Aphthous Stomatitis. Ship II. Epidemiologic aspects of recurrent aphthous ulcerations. Woo S, et al. Recurrent Aphthous Ulcers: A Review of Diagnosis and Treatment. All reference sources for topic Canker Sores. How do you get rid of canker sores on your tongue?Rinse your mouth.
Use salt water or baking soda rinse (dissolve 1 teaspoon of baking soda in 1/2 cup warm water). Dab a small amount of milk of magnesia on your canker sore a few times a day. Avoid abrasive, acidic or spicy foods that can cause further irritation and pain.
How long does it take for a tongue canker sore to heal?If you accidentally bite your tongue or the inside of your cheek, you may end up with a canker sore. Other possible causes are infection, certain foods, and stress. Canker sores are not contagious. The pain from your canker sore should decrease in 7 to 10 days, and it should heal completely in 1 to 3 weeks.
Are canker sores on tongue normal?Many tongue sores are canker sores or cold sores. These are relatively harmless conditions that can cause pain and discomfort but will typically heal on their own. People can take OTC medications or try topical remedies for symptom relief. Recurring sores on the side of the tongue may indicate an underlying condition.
How do you know when a canker sore is healing?How long should it take for a canker sore to heal? A sore will usually heal within 4 to 14 days, although some can heal in as little as 3 to 5. The pain associated with a lesion will usually begin to subside around day 3 or 4. In most cases, the process is uneventful and results in no residual scarring.
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