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As with all disorders of the mouth, an accurate diagnosis by a trained healthcare professional is required before treatment is started. Some conditions that can mimic canker sores include traumatic injury, autoimmune conditions, viral infections (such as herpes simplex and herpes zoster [shingles]), and most importantly, oral cancer. The discomfort and severity of canker sores can roughly be categorized as mild, moderate, or severe. In general the goals of treatment are threefold: to decrease pain, speed healing, and prevent recurrence. A large number of therapeutic agents are available, including both prescription and over-the-counter (OTC) preparations.
Below is a brief discussion of the many choices available for the treatment of canker sores.
Other Approaches include the use of mild cautery or caustics to deaden nerve endings and decrease symptoms. Final Cautionary Note: Because canker sores can be caused by systemic abnormalities and also be confused with other pathologic conditions that present as ulcers, it is important to seek professional attention if lesions do not resolve within two weeks. This 60 year old financial planner was referred to me by his general practitioner who was disillusioned with the limited efficacy of topical steroids. The patient had been using topical betamethasone (Betnovate) almost daily on his face and body for approximately 15 years. Three days earlier, he suffered a severe flare secondary to a herpes simplex virus infection of the eye, which affected his face and upper body. This is a severe case of immune-suppressed skin unable to prevent spread of the herpes simplex virus that responded well to topical wheatgrass spray. Although atopic eczema is thought to be genetically determined, I believe there may also be an important auto-immune component to the condition. Because this laser wavelength is absorbed by pigments such as hemoglobin, the laser light will pass through the outer layer of skin and be absorbed in the underlying blood vessels and blood cells. The patient has had this hemangioma diagnosed and treated twice approximately 5 years ago with injections. In addition, oral ulcers can be associated with a number of systemic conditions in which the oral ulcers represent only a small part of the underlying problem. Mild disease is characterized by its infrequent occurrence, short duration, and lack of severe symptoms.
Currently, no available therapy meets all these goals, although most therapies do provide some benefit to those affected. Individuals with advanced training in Oral Medicine have additional expertise in managing more severe cases.
This information is not a substitute for professional medical advice, diagnosis, or treatment. He used such large quantities trying to control his itchy, dry skin, his dermatologist prescribed 10 x 100gm tubes of the topical steroid at each visit - a very large amount!

Most likely the rapid, wide spread of the virus, which is not typical, was a direct result of the patient's topical steroid-induced immune suppression.
I have had numerous other patients, not so severe, but with chronically itchy, dry and discoloured skin that have recovered to the point that only basic preventive practices such as soap and excessive water exposure plus the wheatgrass have given them a greatly enhanced quality of life.
The reason I say this is because of the apparent immunomodulatory effect of the wheatgrass. This makes the lesion look whitish in color and very acceptable to the patient immediately post-op. She went all the way to Boston to have it surgically removed and it was very painful, then it grew back. A general rule of thumb recommended by health care professionals is that any ulcer that lasts for more than 10 to 14 days should be evaluated by a dentist and biopsied if necessary. Fortunately, most patients who experience canker sores experience mild disease (see right). The method selected depends upon the site of the lesion(s), accessibility for treatment, severity, duration, and success with previous treatment regimens.
They generally provide relief as long as they are in place, but it can be difficult to keep them adherent for sustained periods. However, benzocaine is a known allergen and should not be used by patients with hypersensitivity. The foaming of the oxygen exerts a mechanical action that loosens debris and cleanses the wound. In many instances, topical therapy with a potent corticosterioid may be prescribed to reduce the immune response in the area.
If you have or suspect you may have a health concern, consult your professional health care provider.
Nine months later, patient remains topical steroid-free with wheatgrass skin recovery spray daily. Flares still occur, but these are usually mild and short-lived, and topical steroids are hardly ever necessary. Topical steroid damaged skin appears to break out and flare when the skin reaches a point of critical dryness. While there is no formal classification to distinguish between moderate and severe disease, the presence of four or more canker sores per year with annoying but non-debilitating symptoms can be classified as moderate disease.
If needed, an expert in Oral Medicine may be consulted concerning the need and feasibility of more advanced treatment protocols. When protective coatings are combined with a therapeutic agent, a two-fold benefit is obtained. A professionally applied or prescribed product Debacterol® is also available for nerve deadening. Finally, in some cases the use of systemic corticosteroids or other immunosuppressive drugs may be warranted.

Since 1972, the Food and Drug Administration (FDA) requires that all new OTC agents must be safe and effective. The assessment of your particular situation may be extensive and necessitate consultation with other health care professionals.
When I first saw him, he had a severe eczematous facial rash that was inflamed, fissured and weeping in places.
Dryness is governed by the output of sebum from the sebaceous glands, which are hormonally controlled.
This can be borne out by the observation that addition of oral wheatgrass often assists recovery when used in combination with wheatgrass topically.
Severe canker sores are often more widespread, more painful, and interfere with the patient’s ability to eat and speak. The occlusive prevents external stimulation of the wound site and also holds the therapeutic agent in place. Hydrogen peroxide when obtained as a 3% solution should be diluted with equal amounts of water before application either directly to the ulcer or as a mouthrinse. For example, your dentist may order dietary surveys and blood tests to help rule out the presence of food sensitivities or other systemic causes. Strategies for identifying potential allergens include observing any relationship between the intake of a particular food or beverages and development of canker sores. It may be that wheatgrass influences these hormone levels as well as reduce inflammation in blood vessels under the skin. Unfortunately, individuals with severe disease often suffer frequent to constant recurrence. Sodium bicarbonate, either as a solution (½ to 1 teaspoon in 4 ounces of water) or as a paste, can also be used to for wound cleansing. Many individuals are intolerant of wheat products (gluten), nuts, tomatoes, and various fruits. 1.) He was commenced on wheatgrass topical Skin Recovery Spray twice daily combined with his usual colloidal oatmeal based moisturiser. Two frequent food additives that are associated with canker sores are the spice cinnamon and benzoic acid (a common preservative found in foods and soft drinks).
A trial elimination of a suspected food substance or additive is a sound approach to identifying potential allergens. The photographs below show rapid improvement in the first 4 days of wheatgrass treatment and thereafter, complete control of eczema 9 months later. He continued using the wheatgrass spray at least once daily since commencement of treatment.

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