How can I prevent canker sores?

Preventing Canker Sores

Good oral hygiene practices, dietary modifications to include sufficient vitamin B12 and folate, and avoiding irritating foods are the most effective strategies for preventing canker sores. 1, 2

Primary Prevention Strategies

Oral Hygiene

• Maintain rigorous oral hygiene routine:
  • Brush teeth four times daily with a soft toothbrush
  • Use mild fluoride-containing toothpaste
  • Replace toothbrush monthly to prevent bacterial accumulation
  • Use alcohol-free mouthwashes (alcohol-based rinses can cause irritation) 1
  • Consider sodium bicarbonate (baking soda) rinses as a preventive measure

Dietary Modifications

• Ensure adequate intake of key nutrients:
  • Vitamin B12 and folate - patients with recurrent canker sores show significantly lower dietary intake of these vitamins 2
  • Consider foods rich in these nutrients (leafy greens, legumes, fortified cereals, meat, fish)
• Avoid potential trigger foods:
  • Acidic foods (citrus fruits, tomatoes)
  • Spicy foods
  • Salty foods
  • Rough/coarse foods that may cause oral trauma 1

Trauma Prevention

• Avoid oral trauma which can trigger canker sores:
  • Be cautious with sharp-edged foods
  • Address ill-fitting dental appliances promptly
  • If you have braces, use orthodontic wax to cover sharp edges 1
  • Regular dental check-ups every 6 months to assess fit of dental appliances 1

Management During Active Episodes

When canker sores do develop, prompt management can reduce severity and duration:

Topical Treatments

• Benzocaine can be applied to affected areas up to 4 times daily for temporary pain relief 3
• Topical corticosteroids may help reduce inflammation:
  • Triamcinolone acetonide 0.1% in Orabase adhesive paste applied to dried mucosa 2-4 times daily
  • For severe cases, clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly 1

Pain Management

• Over-the-counter pain relievers like acetaminophen
• Topical anesthetics such as 2% lidocaine for moderate pain 1

Special Considerations

• Persistent or severe canker sores warrant medical evaluation as they may indicate underlying conditions
• If canker sores are frequent and severe despite preventive measures, consider:
  • Blood tests to check for vitamin deficiencies
  • Evaluation for underlying conditions like celiac disease or inflammatory bowel disease 4

Common Pitfalls to Avoid

• Acyclovir is not effective for preventing canker sores, despite their ulcer-like appearance similar to herpes lesions 5
• Delaying treatment of active sores can lead to prolonged discomfort and healing time
• Using alcohol-based mouth rinses which can exacerbate irritation 1
• Neglecting nutritional factors, particularly vitamin B12 and folate intake 2

By implementing these preventive strategies consistently, most people can significantly reduce the frequency and severity of canker sores, improving oral health and quality of life.