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Herpetiform Canker Sores: Everything You Need To Know

A man and a woman holding a light therapy device


Canker sores are a pain — literally. 

But herpetiform canker sores are particularly unpleasant. These large ulcers aren’t common, but when they do occur, they interrupt your quality of life and interfere with the simplest of tasks, like chewing and smiling. 

Here’s everything you need to know about identifying, treating and preventing herpetiform canker sores in the future. 

What Are Canker Sores?

Canker sores, or aphthous ulcers, are shallow white lesions with inflamed pink borders that develop inside the lips and mouth. The sores are typically 1-4 mm in size, but aggressive sores can be larger than 5 mm. 

Though often confused with cold sores, canker sores are different and are not contagious. Raw canker sores can make it challenging to eat, sleep and speak. Even with traditional therapies, they can take as long as 2-3 weeks to heal.

How To Identify Herpetiform Canker Sores

Herpetiform canker sores are the least common type of aphthous ulcer, occurring in less than 5% of all people with canker sores. As the name suggests, herpetiform canker sores resemble herpes blisters in appearance, but they’re two distinctly different problems. 

Herpetiform canker sores are tiny blisters that occur in clusters of up to 100. They can develop anywhere in the mouth, including:

  • On the inside of the lips
  • On the roof of the mouth
  • Inside the cheeks
  • Under the tongue
  • At the base of the gums

This type of mouth ulcer causes a tingling or burning sensation before the sore itself forms. After a herpetiform canker sore emerges, you may also notice these symptoms:

  • Tiny clusters merge into one large, painful canker sore
  • Ulcers are white or yellow in color
  • Irregular edges around ulcers

Fortunately, herpetiform canker sores typically heal within one to two weeks, so no additional medical attention is needed. 

Complex Canker Sores vs Herpetiform Canker Sores

The most obvious difference between herpetiform canker sores and complex canker sores is size. Herpetiform canker sores consist of dozens of tiny, regular canker sores, while a complex canker sore spreads 5 mm or more inside the mouth.  

Complex canker sores also linger weeks longer in the mouth. Instead of healing on their own over the span of one to two weeks, complex canker sores continue to create pain and discomfort in your mouth for up to six weeks at a time.

Complex canker sores can also be accompanied by other seemingly unrelated symptoms, such as:

  • Fever
  • Swollen lymph nodes
  • Lethargy

These complications indicate that your complex canker sores aren’t just an oral health issue; they’re signs of a more serious, underlying problem that needs to be addressed. Only your doctor can determine the underlying condition responsible for triggering your complex canker sores. The most likely causes include an existing autoimmune disease, vitamin deficiency, or allergy. 

herpetiform canker sores


Common Causes of Herpetiform Canker Sores

There’s no single cause of herpetiform canker sores. Instead, a combination of factors can play a role in the development of these ulcers.

Injury in the Mouth

Injury and irritation to your cheeks, gums or tongue can cause herpetiform canker sores to develop. This is especially true for people with braces or denture appliances that rub against the inside of the mouth. Other causes of oral injury include:

  • Vigorous brushing
  • Excessive flossing
  • Using toothpicks
  • Dirty dental appliances

Do your best to avoid these triggers by brushing gently and cleaning your dental appliances daily. 

Allergy to Oral Care Products

Toothpaste and mouthwash products containing sodium lauryl sulfate (SLS) are especially notorious for irritating the mouth. SLS functions as a “surfactant” that produces cleansing and foaming action. Though The United States Food and Drug Administration (FDA) claims SLS is safe, thousands of studies have explored the toxicity of SLS and associate the ingredient with skin irritation and organ system toxicity.

Acidic Foods

Acidic fruits and vegetables, such as lemons, pineapples, tomatoes and oranges, are believed to trigger canker sores. Some people are more prone to this reaction than others, so pay attention to the condition of your mouth before and after eating acidic foods. 

Vitamin Deficiency

Vitamins and minerals such as iron, zinc, folic acid, and vitamins B1, B2, B6, B12 and C are fundamental to your core health and wellness. Untreated nutrient deficiencies are known to contribute to canker sore development. 

Zinc, for example, is an essential trace element the body needs in small doses each day to properly function. Though zinc doesn’t receive a great deal of attention as a nutrient, it actually supports hormone production, immunity and digestion.

The full range of B vitamins serves many critical roles in your body as well, including healthy cell growth, metabolism and energy. You need all these functions in full force to protect your mouth from herpetiform canker sores. 

Severe Stress

Anecdotal evidence indicates that canker sores can develop from stress. Existing research also suggests a high correlation between canker sores and anxiety, depression and psychological stress. Experts don’t yet understand exactly why, but people experiencing stress may indulge in behaviors that trigger canker sores, such as biting their lip and cheeks or eating acidic foods.

Who Faces the Highest Risk of Herpetiform Canker Sores?

Anybody with a history of canker sores has the potential to develop herpetiform canker sores, but some adults are at higher risk than others. Young and middle-aged adults tend to develop herpetiform canker sores more frequently, with females affected more than men. 

The following factors may also increase your likelihood of developing this type of mouth ulcer:

  • Family history of canker sores
  • Use of poorly fitting dentures
  • Poor oral hygiene
  • Hormonal changes such as pregnancy, menstruation or menopause
  • Consuming large amounts of spicy foods

Treating Herpetiform Canker Sores

Mouth Rinses

Antimicrobial rinses such as Listerine, Peridex and Periogard are all popular options for people vulnerable to frequent canker sore outbreaks. 

These rinses reduce the number of bacteria and microbes in the mouth, which can protect gum tissue from canker sores in the future. The deep cleaning effect of antimicrobial rinses can also control plaque and prevent canker sores from becoming aggravated by excess bacteria. 

Oral Medication

Though no available pharmaceutical medications treat canker sores, you can try over-the-counter oral medications like ibuprofen, acetaminophen or naproxen to alleviate your discomfort. Zinc throat lozenges may also help reduce canker sore symptoms. 

Topical Analgesics

Over-the-counter topical anesthetics like benzocaine (Kank-A) and Orajel provide safe, temporary numbing for painful sores. You can apply these local anesthetics a few times a day to relieve discomfort until your canker sores heal completely. 

Natural Remedies

Milk of magnesia, best known by the brand name Maalox®, can be blended with Benadryl® or another antihistamine to alleviate the pain caused by your canker sore. Milk of magnesia is an antacid that coats your canker sore to prevent irritation, while antihistamines treat inflammation symptoms and create a sedative effect. 

Helpful Tip for Prevention and Healing

The Luminance RED is an FDA-registered device that harnesses high-powered light treatment for your canker sores. Light treatments can gently alleviate canker sore pain and accelerate the healing process. The skin metabolizes medically optimized light and converts it into cellular energy to accelerate healing and help you become pain-free faster.

Light therapy has been shown to improve regular canker sores and prevent future breakouts. Clinical data conclusively shows that the application of specific wavelengths of high-powered light to canker sores reduces the average healing time from 8.9 days to 3.1 days. This therapy is an easy-to-use treatment for lasting healing and prevention of canker sore outbreaks!

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