Canker & Cold Sores

Where it is tells you what it is and what to do about it

In or out? That’s the first question to ask when you’re trying to figure out whether you have a canker sore or a cold sore. If it’s inside your mouth it’s most likely a canker sore; outside, probably a cold sore.

The two may seem similar, but the similarity ends with the fact that both are connected with the mouth and both cause pain and discomfort. So knowing which one you have is the first step to knowing how it’s caused and how to treat it.

Canker sores (or mouth ulcers) generally occur inside the mouth and are bacterial in nature. They often are triggered by trauma such as biting your cheek, jabbing your gum with your toothbrush or even overzealous tooth cleaning. Cold sores are tiny, clear, fluid-filled blisters that form around the mouth and are caused by the herpes simplex virus living inside your nerve tissue. Below is a table to help you identify the two different sores.

What Is Gum Disease?

In the broadest sense, the term gum disease–or periodontal disease–describes bacterial growth and production of factors that gradually destroy the tissue surrounding and supporting the teeth. “Periodontal” means “around the tooth.”

Gum disease begins with plaque, which is always forming on your teeth, without you even knowing it. When it accumulates to excessive levels, it can harden into a substance called tartar (calculus) in as little as 24 hours. Tartar is so tightly bound to teeth that it can be removed only during a professional cleaning.

Gingivitis and periodontitis are the two main stages of gum disease. Each stage is characterized by what a dentist sees and feels in your mouth, and by what’s happening under your gumline. Although gingivitis usually precedes periodontitis, it’s important to know that not all gingivitis progresses to periodontitis.

In the early stage of gingivitis, the gums can become red and swollen and bleed easily, often during toothbrushing. Bleeding, although not always a symptom of gingivitis, is a signal that your mouth is unhealthy and needs attention. The gums may be irritated, but the teeth are still firmly planted in their sockets. No bone or other tissue damage has occurred at this stage. Although dental disease in America remains a serious public health concern, recent developments indicate that the situation is far from hopeless.

When gingivitis is left untreated, it can advance to periodontitis. At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums may collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gumline. Bacterial toxins and the body’s enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.

At this point, because there is no longer an anchor for the teeth, they become progressively looser, and the ultimate outcome is tooth loss.

Signs and Symptoms

Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Then one day, on a visit to your dentist, you might be told that you have chronic gum disease and that you may be at increased risk of losing your teeth.

Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:

• Gums that bleed during and after toothbrushing
• Red, swollen or tender gums
• Persistent bad breath or bad taste in the mouth
• Receding gums
• Formation of deep pockets between teeth and gums
• Loose or shifting teeth
• Changes in the way teeth fit together on biting, or in the fit of partial dentures.

Even if you don’t notice any symptoms, you may still have some degree of gum disease. Some people have gum disease only around certain teeth, such as those in the back of the mouth, which they cannot see.

Diagnosis

During a periodontal exam, your gums are checked for bleeding, swelling, and firmness. The teeth are checked for movement and sensitivity. Your bite is assessed. Full-mouth X-rays can help detect breakdown of bone surrounding your teeth.

Periodontal probing determines how severe your disease is. A probe is like a tiny ruler that is gently inserted into pockets around teeth. The deeper the pocket, the more severe the disease.

In healthy gums, the pockets measure less than 3 millimeters–about one-eighth of an inch–and no bone loss appears on X-rays. Gums are tight against the teeth and have pink tips. Pockets that measure 3 millimeters to 5 millimeters indicate signs of disease. Tartar may be progressing below the gumline and some bone loss could be evident. Pockets that are 5 millimeters or deeper indicate a serious condition that usually includes receding gums and a greater degree of bone loss.

Treatment

The goal of periodontal treatment is to control any infection that exists and to halt progression of the disease. Treatment options involve home care that includes healthy eating and proper brushing and flossing, non-surgical therapy that controls the growth of harmful bacteria and, in more advanced cases of disease, surgery to restore supportive tissues.

Although brushing and flossing are equally important, brushing eliminates only the plaque from the surfaces of the teeth that the brush can reach. Flossing, on the other hand, removes plaque from in between the teeth and under the gumline. Both should be used as part of a regular at-home, self-care treatment plan. Some dentists also recommend specialized toothbrushes, such as those that are motorized and have smaller heads, which may be a more effective method of removing plaque than a standard toothbrush.