According to The Cleveland Clinic, "Some cases of complex canker sores are caused by an underlying health condition, such as an impaired immune system; nutritional problems, such as a deficiency in vitamin B-12, zinc, folic acid, or iron; and gastrointestinal tract disease, such as the inflammatory bowel diseases celiac disease and Crohn's disease." (1)

Canker sores can also be caused by hormonal changes (women report increased canker sore activity during their menstrual cycle), food allergies, biting the lip or mouth, and or emotional stress.(2)

Symptoms: Canker sores usually begin as burning or tingling sensation before developing into a full ulcer. Ranging in size from 1-2 mm to 1 cm, most canker sores have a bright red, round circular border with a white, or white-gray center. In severe cases, you may also experience fever, physically dull, and swollen lymp nodes.

Treatment: In most cases, canker sores go away by themselves and treatment is not necessary. However, in severe cases where mouth ulcers are larger than 1 centimeter or last longer than 3 weeks, a doctor may administer tetracycline and instruct the patient to hold it in their mouth for 2-5 minutes. [Tetracycline is only available as a treatment option for those who have lost all their baby teeth].

Besides tetracycline, severe cases may be treated by a doctor with corticosteroids, antibiotics and lidocaine.

Other over the counter and home remedy treatment options which act as pain relievers, antiseptics and oral wound cleaning agents include: (3)

• Anbesol - oral anesthetic gel.

• Orabase B - an anesthetic commonly used to treat canker sores

• Amosan - an oral wound cleaning solution sold under the Oral-B brand name.

• Hydrogen Peroxide - either administered directly on the ulcer with a Q-tip or as part of a homemade or store bought mouth wash.

• Listerine - an antiseptic mouthwash for bad breath.

• Salt Water - 1 tablespoon of salt added to 1/2 cup of warm water.