Canker sores, also known as aphthous ulcers, are small, painful lesions that develop in the mouth or at the base of the gums. They can make eating, drinking, and talking uncomfortable. Canker sores are common, affecting around 20% of people. While the exact cause of canker sores is unknown, some potential triggers have been identified, including nutritional deficiencies, food sensitivities, hormonal changes, and stress.
What are canker sores?
Canker sores are small, round, white or yellowish ulcers surrounded by a red inflamed area. They usually develop inside the mouth, including on the tongue, cheeks, gums, tonsils, or palate. Canker sores can range in size from less than 1⁄4 inch to over 1inch wide. They typically last 1-2 weeks before healing.
Canker sores are different from cold sores (also called fever blisters). Cold sores are caused by the herpes simplex virus and occur outside the mouth, usually around the lips or under the nose. However, canker sores are not contagious.
Symptoms of canker sores
The most common canker sore symptoms include:
- A tingling, burning, or itching sensation 1-2 days before the sore appears
- Pain or soreness when eating, drinking, or talking
- Small, round, shallow ulcers with red edges, yellow or white centers
- Ulcers lasting anywhere from a few days to a couple weeks
Canker sores can occur on any mucosal tissue surface inside the mouth. This includes the:
- Tongue
- Inner cheeks and lips
- Gums
- Tonsils
- Soft palate
- Under the tongue
What causes canker sores on the tongue?
While the exact cause of canker sores remains unknown, contributing factors may include:
- Injury: Physical damage to the tongue or inside of the mouth from a cut, bite, sharp foods like chips or crackers can trigger canker sores.
- Hormonal shifts: Hormone changes during the menstrual cycle in women can make some people more prone to canker sores.
- Food sensitivities: Certain foods like gluten, spices, nuts, chocolate, eggs, and dairy may trigger canker sores in sensitive individuals.
- Nutritional deficiencies: Low levels of iron, vitamin B-12, zinc, folate (vitamin B9), or vitamin D are associated with a higher risk of canker sores.
- Weakened immune system: Conditions like HIV/AIDS, inflammatory bowel disease, and celiac disease are linked to more frequent canker sores.
- Stress and fatigue: High stress levels, anxiety, fatigue, and sleep deprivation may increase susceptibility to canker sores.
- Citrus or acidic foods: Foods high in acidic citrus juices like oranges, lemons, tomatoes, strawberries can irritate the tongue and provoke canker sores.
- Oral trauma: Habitual lip or cheek biting, chewing tobacco, ill-fitting dentures, braces or rough fillings can irritate the tongue and trigger canker sores.
Can stress cause canker sores on the tongue?
Yes, stress is a potential trigger for developing canker sores on the tongue. During times of high psychological stress or anxiety, some people may experience more frequent or severe outbreaks of canker sores. The exact reason is not fully understood, but possible explanations include:
- Stress affects the immune system, increasing susceptibility to infections that could trigger canker sores.
- Elevated stress hormones like cortisol may make the tissue inside the mouth more sensitive and prone to lesion development.
- Stress can cause some people to inadvertently bite their tongue, cheek, or lip more often, leading to injury that provokes a canker sore.
- Fatigue and sleep disturbances from stress impair healing inside the mouth.
- Stress or anxiety may influence nutritional habits, such as reduced appetite or eating more sugary, acidic foods that irritate canker sores.
- Stress can exacerbate other risk factors like food sensitivities, hormonal changes, or deficiencies.
Major life events, chronic worrying, pressure at work or school, financial problems, strained relationships, grief, trauma, and various other emotional issues that cause stress may increase the likelihood of developing canker sores.
Tongue canker sores vs. other causes
Canker sores are one potential cause of painful ulcers on the tongue, but other causes need to be ruled out including:
- Cold sores – Also called fever blisters, these are contagious, fluid-filled lesions around the lips and mouth caused by the herpes simplex virus.
- Oral thrush – A fungal infection, usually with Candida albicans, that causes white, sore patches on the tongue, inner cheeks, gums, tonsils, or palate.
- Aphthous stomatitis – A condition characterized by recurring bouts of single or multiple canker sores, caused by an overactive immune response.
- Oral cancer – Unexplained sore that doesn’t heal may potentially be oral cancer, which requires immediate medical attention.
- Acid burn – Exposure to stomach acid during vomiting or reflux can irritate the tongue and cause soreness.
- Vitamin deficiencies – Particularly vitamins B-12, folate, and iron deficiency can cause a painful, swollen tongue.
- Oral lichen planus – An inflammatory condition that produces lacey white patches or painful sores on the insides of the cheeks, gums, or tongue.
- Celiac disease – People with celiac disease may get canker sore-like ulcers with gluten exposure.
- Mouth injury or bite – Accidentally biting the tongue can lead to a sore, painful ulcer.
- Chemotherapy – Some chemotherapy drugs can cause ulcerations and sores in the mouth.
If mouth ulcers last longer than 2 weeks or keep recurring, it’s important to see a healthcare provider to determine the underlying cause.
Treatments for canker sores from stress
There is no cure for canker sores. Small sores usually heal within 7-10 days with proper home care. Larger or persistent canker sores may require evaluation by a dentist or doctor. Recommended treatments for canker sores linked to stress include:
- Improve stress management through relaxation techniques, counseling, better work-life balance, etc. Reduce sources of anxiety and psychological upset when possible.
- Avoid trigger foods like nuts, chips, spicy foods, chocolate, coffee, and citrus juices until the sore heals.
- Use over-the-counter topical anesthetics like benzocaine, menthol, or phenol to temporarily numb pain from eating and drinking.
- Rinse with antimicrobial mouthwash to keep the sore clean while healing.
- Take vitamins or supplements if a nutritional deficiency is suspected.
- Apply protective pastes or gels that coat the sore and shield nerves.
- Avoid irritants like very hot, acidic or spicy foods, alcohol-containing mouthwash.
- See a healthcare provider if ulcers are severe, large, or non-healing. Prescription steroid creams, mouth rinses, or other treatments may be options.
Identifying and controlling stress is key to reducing canker sore flare-ups. While canker sores often go away on their own, working to minimize stress levels can help prevent recurrences.
Preventing stress-related canker sores
In addition to stress management, other ways to help prevent stress-triggered canker sores include:
- Avoiding injury inside the mouth from biting or abrasive foods
- Eating a balanced, nutritious diet with sufficient vitamins
- Getting enough sleep and regular exercise
- Using soft-bristled toothbrush, gentle flossing
- Wearing well-fitted dentures or orthodontia
- Avoiding tobacco and excessive alcohol
- Using non-irritating oral care products
- Rinsing mouth after high acid foods
- Taking Vitamin B-12, folate, iron supplements if deficient
Keeping stress under control is one aspect of preventing recurrent bouts of tongue canker sores. But paying close attention to nutritional intake, oral hygiene habits, and sources of mouth irritation is also important.
When to see a doctor
Consult a dentist or doctor for evaluation if you experience:
- Canker sores that last longer than 2 weeks
- Frequent outbreaks of canker sores (more than 3-4 times per year)
- Extreme pain that interferes with eating, drinking, or talking
- Sores along with high fever, diarrhea, headache, or skin rash
- Large sores or clusters of multiple canker sores
- Sores that spread or worsen despite home treatment
- Pain, numbness, or tingling in other parts of the mouth or face
- Unexplained weight loss along with mouth sores
Professional guidance can help determine if the sores are due to stress, other medical conditions, or more serious underlying problems requiring treatment.
Conclusion
Stress is one of several factors that may trigger painful canker sores on the tongue. High levels of psychological stress are thought to increase susceptibility to canker sores by affecting the immune system, hormones, oral habits, and nutrition. While canker sores often resolve on their own, taking steps to control stress and reduce sources of anxiety are important for improving overall health and preventing flare-ups. Other preventive measures like avoiding injury inside the mouth, eating a balanced diet, and practicing gentle oral hygiene can also help ward off stress-related canker sores on the tongue.