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Ask Dr. Marla – How to handle canker pain


My eight-year-old’s mouth is so inflamed with canker sores that it’s hard for her to eat. Any advice?


Canker sores are typically seen as one or two mouth ulcers after age five and are not contagious. However if there are multiple canker sores it is important to be sure that what your child is experiencing is actually a canker sore. Canker sores should not cause fever or generalized illness. If your child has these symptoms, then see your health care practitioner.


Canker sores can be caused by a number of things: over vigorous tooth brushing or braces; citrus fruits can worsen a canker sore or perhaps trigger one; food sensitivities; allergies; low B12; deficiency in folic acid, iron and zinc; and toothpastes containing lauryl sulfate.

Cankers can also be caused by some viral infections, the most common is something called hand, foot, and mouth disease. This is caused by the Coxsachie virus and is common in young children. It is typically self-limited (runs its course) but can be very painful. Other causes include the herpes or cold sore virus. In its very first infection, you can see many ulcers on the mouth as well as tongue and gums. Cankers can also indicate underlying diseases such as celiac disease, Crohn’s, Behcet disease and Systemic Lupus. See your doctor to rule these out.


For simple canker sores there are topical medications, mouthwashes and some oral meds to relieve pain. Avoiding irritants such as citrus fruits or spicy foods is helpful. However if these are recurrent and multiple, it is important to have your child properly assessed and diagnosed. 


Dr. Marla Shapiro is a medical doctor, author, broadcaster, lecturer and parent.

Originally published in ParentsCanada magazine, April 2014.

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