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Canker sores can have several causes or triggers. Canker sores, also called aphthous ulcers, are small, painful sores that appear inside the mouth on the lips, cheeks, on the gums, and tongue. They are appropriately named, too: In Greek, aphthae (root of aphthous) means to set on fire. Most of us get canker sores from time to time; some of us get them over and over. Either way, you want to get rid of them as quickly as possible. We talked to doctors to find out where canker sores come from, how to avoid them, and what to do if you get one. No one knows exactly what causes most canker sores, but we know theyre not contagious and cant be spread through saliva. They can be the result of an injury, like when you accidentally bite your cheek or when braces catch or rub against the inside of the cheeks or back of the lips, but often they appear seemingly out of nowhere. They can be triggered by a number of things, like a weak immune system, dehydration, allergies, stress, and even medication. Hormonal shifts during menstrual cycle A diet lacking in vitamin B-12, zinc, folic acid, or iron Genetics Sensitivity to chocolate, coffee, strawberries, eggs, nuts, cheese, or spicy or acidic foods Toothpaste containing sodium lauryl sulfate Unlike cold sores, canker sores dont occur on the external surface of your lips (outside the mouth). Even though canker sores and cold sores can have the same triggers, canker sores are not contagious, says Dr. Varinthrej Pitis. There is no virus or bacteria associated with them. They tend to go away on their own within 10 days, and theyre not life-threatening. Avoid canker sores with these tips: Brush and floss after meals to keep your mouth clean and free of excess foods. Use a soft toothbrush to prevent irritation to your mouth and gums. Use orthodontic waxes to cover up any sharp edges on braces or other dental devices. Practice stress-reduction techniques, such as meditation. Keep a food diary. You may find connections between when canker sores appear and what you eat. Id also stay away from mouthwash, says Dr. Nitin Kapur, primary care physician. I get we all like that minty taste, but mouthwash is alcohol-based and that can cause a lot of irritation. If the canker sore is unusually large, lasts 2 weeks or more, extends to the lips, makes it very difficult to eat or drink, or if you develop a fever, seek the advice of your primary care doctor, a dentist, or dermatologist. Most people who get reoccurring canker sores will get them 2-3 times a year, on and off, starting by the time theyre 30 years old, says Dr. Kapur. But if youre older and getting them for the first time, that may be an indication something else is going on, so youll want to seek medical advice. Daniels TE, Jordan RC. Diseases of the mouth and salivary glands. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 397.Dhar V. Common lesions of the oral soft tissues. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 341.Klatt EC. Head and neck. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Atlas of Pathology. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 6.Page 2Bodnar LM, Himes KP. Maternal nutrition. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resniks Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 12.Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. National Academies Press. Washington, DC, 1998. PMID: 23193625 JB, Booth SL. Vitamins, trace minerals, and other micronutrients. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 205.Markell M, Siddiqi HA. Vitamins and trace elements. In: McPherson RA, Pincus MR, eds. Henrys Clinical Diagnosis and Management by Laboratory Methods. 24th ed. St Louis, MO: Elsevier; 2022:chap 27.Ramu A, Neild P. Diet and nutrition. In: Naish J, Syndercombe Court D, eds. Medical Sciences. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 16.Page 3Litwack G. Vitamins and nutrition. In: Litwack G, ed. Human Biochemistry. Philadelphia, PA: Elsevier; 2018:chap 20.Mason JB, Booth SL. Vitamins, trace minerals, and other micronutrients. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 205.Markell M, Siddiqi HA. Vitamins and trace elements. In: McPherson RA, Pincus MR, eds. Henrys Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 27.Page 4Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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