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Sores in the Mouth

by Linh Cao-Chan, DDS on 01/22/19

Sores in the Mouth

I get a fair number of patients complaining of sores in their mouth, so here's a list of some common lesions found intra-orally.

Canker Sores

Also known as apthous ulcers, these are probably the most common ones seen. They appear as small, flat sores inside the mouth such as the palate, the inside cheek area and by the gums. Unlike cold sores, they don't appear by the lips' outside region and are not contagious. They tend to be round or oval, white or light yellow center, with a red border. They can be quite painful, and usually go away after a few days to a couple of weeks.

Causes can include food irritation (hot pizza, sharp tortilla chips), trauma (cheek biting or dental work), toothpastes and mouthrinses containing sodium lauryl sulfate (SLS), reactions to foods (spicy food, coffee, chocolate (that's a bummer!)), and stress. 

Anyone can get canker sores, but they occur more commonly in teens and young adults, and more in females. For those who get them repeatedly, it could be hereditary- check your family history.

There's no definitive treatment for canker sores. You can rinse with warm salt water to promote healing of the tissue. Some people like using Orajel, which is a numbing gel that numbs the pain for 15 minutes. I've read an article that claims eating yogurt daily decreases the recurrence thanks to the help of the good bacteria (probiotics). Watch what you eat (avoid spicy, salty and acidic foods), and try to reduce your stress.

Cold Sores

Also known as fever blisters, they are common viral infections. They occur around the outer lips in small clusters that blister and crust, then heal without a scar after a couple of weeks. Cold sores are contagious, and are caused by a herpes virus (HSV-1). You may feel a tingling or itching around your lips before the sores appear,

Cold sores are most contagious when when oozing blisters are present, so don't share utensils, food or drinks. Once you've had an episode, it can be re-triggered in the same area by sun exposure, fever, stress, and hormonal changes.

You can use Abreva cream (buy over the counter) to help speed up healing of the sores, or use anti-viral medicine like Zovira and Valtrex (both prescription) to help shorten the course of the sores, most effective when taken within the first 48 hours of the outbreak.


Leukoplakia are thickened white patches that cannot be rubbed off that appears on the gums, the inside of the cheek, the floor of the mouth and sometimes the tongue. It is caused by irritation from tobacco- smoked or chewed. It can also be caused by irritation from rough edges like broken teeth, ill-fitting dentures or partials. These lesions go away once the offending factors are fixed or tobacco use is stopped.

Most leukoplakia are harmless (non-cancerous), though lesions at the floor of the mouth may be associated with the beginning of cancer (those usually needs biopsy to confirm). White lesions with red patch inside may also indicate pre-cancer. Let me know if you have lesions in the mouth that haven't resolved after 2 weeks, or are getting bigger.

Gum Disease and Overall Health

by Linh Cao-Chan, DDS on 12/18/17

I'm sure you are well aware of the correlation between gum disease and systematic health problems such as heart disease. One theory is that the bacteria from gum inflammation enter the blood vessels and attach to fatty deposits, causing blood clots and stroke or heart attacks. Now there is more correlation linking gum disease to diabetes and kidney disease and obesity. Those with diabetes and kidney disease tend to be immuno-compromised and have dry mouths. Dry mouth can lead to more plaque & tartar buildup on teeth, and therefore more gingival inflammation. Those with obesity have more inflammatory factors released by the fat cells, which means the body is in constant low grade inflammation, which can lead to progression of gum disease, diabetes and heart disease. More research are showing at the cellular level the inflammation factors can add up and wreak havoc on your body. It's a circular pattern that link all these conditions and factors. This is why we emphasize regular cleanings, good hygiene- not just to preserve your teeth for the rest of your life, but also to maintain a healthy body. For more info about obesity and perio disease, click here.

Needle -Free Anesthesia

by Linh Cao-Chan, DDS on 12/18/17

There's a great new development in dental numbing, a least favorite part of dental procedures. Most patients do not enjoy the needle injection. Now there is a new kind of anesthesia administered via intra-nasal spray, similar to flu vaccine done by nose spray. This method only works for the 10 upper front teeth, and doesn't apply for lower teeth needing work. A syringe of the anesthetic is sprayed into the nostril two times, with waiting time of 10-15 minutes for the anesthetic to become fully effective. It is indicated for adults and children weighing 90 lbs or more. I am sure they'll come out with lower dosage for younger children soon. It is not recommended for patients with uncontrolled hypertension or thyroid disease, or those taking tricyclic antidepressants. As usual, there are pros and cons with any medicine, but this looks to be a promising new modality of treatment that many will welcome. For more info click here.

Oral Cancer & Risk Factors

by Linh Cao-Chan, DDS on 12/18/17

Each time you come in for your dental cleaning, you'll notice I start with a lower jaw massage. Then I'll look around at your lips and cheeks and gums and make you do some tongue gymnastics. So all those actions are for oral cancer screening. I am looking for lumps (lymph nodes ) by your jaw line, red or white bumps or markings on your gums, tongue and cheeks. Cancer in the mouth 5-year survival rate is about 57%, which is rather low. Early detection helps increase survival rate tremendously, and that's why I'm doing the oral screening each time you come in for your checkup. It's like having your dermatologist re-evaluate all your sun spots and skin discolorations for any changes. Definitely let me know if you've noticed changes in your mouth.

Oral cancer used to be a seen more in higher risk patients with a history of alcohol and tobacco abuse, but now it's seen in population that never smoked or drink much. Studies have shown an increase in oral cancers linked to human papilloma virus (HPV), which is a sexually transmitted disease. Up to 80% of Americans will have had HPV infection in their lifetime, but didn't know they had it because it cleared up and didn't need treatment. The good news is that there is a HPV vaccine, but it works best for children 11-12yo (before they become sexually active). They also recommend the vaccine for those 13-26 yo, so if you fall in that age range ask your doctor about it. If you can decrease your chances of getting oral cancer and HPV, why not take advantage of that! More info here.

Sodium lauryl sulfate in toothpaste- good or bad?

by Linh Cao-Chan, DDS on 09/21/16

A patient asked me about sodium lauryl sulfate in toothpaste- if it's safe to use. I couldn't find any articles in my dental journals, so these findings are from what I can find on the internet. Sodium lauryl sulfate in toothpaste (also known as SLS) is a common ingredient found in shampoo and toothpaste. Its main use is a surfactant, to produce foam and thicken the paste. There are reports of SLS being linked to cancer, but these claims are unsupported. There are reports that SLS can hinder the release of fluoride in the toothpaste, which is not great because you want the fluoride the strengthen your enamel. There are also studies which show SLS can increase incidence of aphthous ulcers (canker sores) in the mouth. So what to do? I wouldn't consider SLS harmful, but if your mouth does get irritated or you get canker sores easily, consider getting SLS-free toothpaste such as the natural toothpaste like Tom's of Maine, or ProNamel.

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