So – have you ever felt like sometimes you know more than your doctors? I feel that a lot actually, partially because I’m addicted to research, partially because I have a hard time taking “no” for an answer; but also because it seems like doctors go to school, do some on-the-job training, and aside from what the drug reps shove in their faces between patient visits, that’s where their knowledge and authority ends.
Case in point: One time I went into the doctor after being diagnosed with a form of heart disease and asked about krill oil vs fish oil. My doctor had never even heard of krill oil. HELLO? There are MegaRed commercials all over the TV.
The newest event to make my stomach grumble was treatment for, as indicated by the title of this blog, canker sores.. or aphthous ulcers.
I was on vacation and out of the blue got hit with not one, not two, not three, but half a dozen canker sores in various spots of my mouth. And when one finally would go away, another popped up. After dosing up with ibuprofen, Viscous Lidocaine (a topical numbing gel that’s prescription strength) and some Tylenol #3 with Codeine that I had leftover from the dentist.. and after trying countless over the counter canker sore “remedies” like:
I decided to call in the doctors. This was ruining my vacation.
So the first call was to my regular doctor. It was after-hours so I left a message with the answering service. She called me back and basically said yeahhh we don’t know why canker sores happen and there really isn’t much to do for them, aside from OTC pain relievers, popsicles, and Anbesol/Orajel type numbing gels that you’ve already tried. You just have to wait for them to go away.
Seriously? It’s 2010 and there’s absolutely nothing you can do to help me with a canker sore problem that’s so bad I can barely have this conversation with you because talking is excruciating, eating is impossible..
I wanted a second opinion. So I called another one of my doctors. He, too, said all he could think of would be Lidocaine visc 2%, and I already had some of that from the dentist. He confirmed my other doctor’s statement that canker sores are a medical mystery and can be caused by anything from stress to the wrong toothpaste to mouth trauma.
I appreciated his time, but this was frustrating me.
You’ve probably seen the doctor contributors on talk shows say “be an active participant in your health care”.. that defines me to a T. It’s rough, though, because a lot of medical personnel are offended when you seem like a know-it-all, and a lot of providers feel threatened for some reason like you’re trying to do their job. However, every once in awhile you’re lucky to match up with that one great practitioner who is glad to take your findings into consideration and admits they don’t always have time to stay as educated as they’d like to. I had a great doctor, unfortunately his business went under and he closed up shop.
But alas, I started Googling. Hit the Mayoclinic web site. Then the online PDR. Turns out there are quite a few things available that I hadn’t tried – by prescription and OTC – to help with canker sores. So neither doctor spent 5 minutes online researching before ruling out any treatment they could provide? And this was the stuff I could find PUBLICLY available. Doctors have medical journals and special databases full of info… don’t they?
I paced the hotel room, trying to figure out a game plan that didn’t involve going, web site print-outs in hand, into urgent care or an emergency room for some stupid canker sores. That would be super expensive and waste an entire night. I called my dentist.
He sympathized with my condition and apologized that my previous doctors didn’t know that another cause of canker sores can be nutrition-related and some can actually be caused by a virus. He said if I was in town I could come to his office for an emergency appointment in which he would use a series of special lasers to treat the areas where the sores were occuring. This treatment would shorten healing time by TEN DAYS and highly reduce the risk of new sores appearing. I said I would definitely consider this when I got back home, but needed something now to allow me to enjoy this pricey vacation.
He offered some more Tylenol #3 and recommended I get a tube of SLS-free toothpaste right away. Actually he wasn’t sure what the compound was called at first; but because I watch a lot of Dr. Oz I knew what he was referencing when he said special toothpaste.
There are a number of different makers of SLS-free toothpaste, and I’ve requested samples from just about each one of them. Not all of them contain fluoride, so be careful if that’s something you need in your toothpaste. The best I’ve found so far include:
- Tom’s of Maine, which features a cousin of licorice root that actually mimicks the SLS foaming action without the harsh side effects
- Biotene, which is low-foaming but also contains calcium and a number of special enzymes which control dry mouth
- Therabreath, which utilizes a patented system where you brush with the toothpaste and DON’T rinse with water; you rinse with their special mouthwash that, when mixed with the toothpaste residue, ensures a spotless clean and prevention of bacteria which cause bad breath (hence the name Therabreath)
SLS, by the way, is sodium lauryl sulphate – a super foaming agent present in most toothpaste. Even though there are other ways to get your teeth equally clean and fresh-feeling, SLS is in there because the manufacturers have done focus groups and determined people like to feel foam in their mouth while brushing. Unfortunately, some people are unknowingly allergic to SLS; some people’s mouths dry out from the irritant characteristics of SLS; and…AND – canker sores are provenly aggrevated by SLS.
My dentist also recommended that I find a product called Herpetrol, but not the gel. He said the pills will shorten the life of the sores and make your body more resilient to future sores; something about the immune system. BTW that gel “sister” product has most of the same ingredients as the pills, along with pain-relieving and soothing topical offerings but he said what I needed at this point were the pills. Side note: I spent half a day at various drug and food stores in the area, even health food stores, and no one carried Herpetrol tablets. I did find them online, though. Unfortunately I wasn’t able to wait around for shipping so I copied down the ingredients and picked up them individually.
For the record, it’s an antioxidant blend along with high-dose L-Lysine which is an amino acid that your body cannot unfortunately store and keep on hand for canker sore outbreaks. I already take a pretty good assortment of antioxidants via my multivitamin and other food concentrates, but I did buy L-Lysine 500mg tablets and a “B-100 Complex” supplement. To match the Herpetrol, I took 4000mg of Lysine per day and one of the B-100’s.
He advised staying away from acidic and carbonated foods and drinks – basically anything that makes it hurt more means it’s further damaging the tissue area because the pain comes from an inflammatory response. Further, my dentist said it was also important to keep my mouth clean, so brushing my teeth at least twice a day and flossing once was key.
I thanked him very much and before giving him the number for a local pharmacy to call in the Tylenol #3, I asked him if he had ever heard of Aphthasol paste being successfully used to treat canker sores. He said no and asked me more about it. I told him it popped up when I was Googling after two doctors told me there was nothing to do for canker sores. I said that it was new and apparently was a sort of anti-inflammatory and antihistamine blended topical treatment in a base of.. paste. I was pleasantly surprised when he perked up and asked me to read him the entire prescribing information with all of the medical jargon that’s provided for doctors’ consideration when treating patients. He thanked me for letting him know about a treatment that could potentially help his other patients, and said this drug definitely had potential. He would call this in right away for me. Side note: He initially prescribed a 5gm tube of the generic (amlexanox 5%) but it turned out the manufacturers stopped producing 5gm tubes and only offer 3gm. Also there is no generic; it’s still brand-name only. But it was only $25. This stuff works. It’s a little messy and confusing to get applied the right away, but after a few tries you get the hang of it.
- You dry the sore area and put a tiny dab of the paste on your slightly-moistened finger and then press it on the sore. That’s it. Do it a few times a day, doesn’t matter if you swallow it etc.
- I determined that the finger route was not going well for me and because of the odd location of some of the sores, cutting the “head” off a Q-tip and gently using the remaining “stick” as the “finger” worked a ton better.
Now, on to the virus issue. That boggled me a bit because I was always under the impression that cold sores were: a) outside the mouth, b) caused by a virus; and canker sores were: a) inside the mouth only, b) never caused by a virus. Turns out that if canker sores are overly painful or constantly recurrent, while it’s unlikely that they’re CAUSED by a virus, in those cases it’s probable that a virus is inhibiting the body’s natural resources used to kill them off. And it’s actually the same virus that causes cold sores: herpes.
So there’s a gel called Zovirax that you can apply to the canker sores a few times a day, and again no worries if you swallow. HOWEVER, that gel is brand-name only and costs about $175 if you don’t have insurance. That was WITH my prescription discount card. I believe the full retail was like $250 for a tiny tube. Needless to say, I asked about an oral version. The pharmacist said there was a generic Zovirax (Acyclovir) to be taken orally and the only thing to consider is that tablets might take longer to get the mouth problem under control since they go through your entire blood stream, and also taking oral antivirals can cause more side effects than just using a topical gel. But he called my dentist and asked if switching to capsules would be okay. They discussed dosage instructions and he finally agreed. 400mg 3x per day for 7 days. Basically taken like an antibiotic: make sure you finish it even if you feel better. I guess it’s primarily used for genital herpes and shingles, believe it or not.
Now, when I got back home I *DID* go in for the laser procedure. I did NOT, however, think to ask about the price. It was $52 for the office visit plus $98 per “area” he needed to “laser”. I had 3 areas so the grand total was about $350. Oh well, I figured, I spent that much at the mall on vacation so why not. It was interesting, too, because he doesn’t do this procedure often so his entire staff was in the room wearing special goggles and observing his every move. It was like on House when they’re in the observation room. But I digress.
The laser is switched to 3 different frequencies of light and with each different frequency the wand is held at different lengths from the sore areas. It disinfects in numerous ways, killing all bacteria, viruses, and any other foreign microbes.
He sent me home with some Vicodin for the still-there pain, and also a prescription mouthwash that you rinse with twice a day. It’s called Peridex and it wipes your mouth seriously clean, then attaches itself to the tissue in your mouth and sort of “time releases” itself throughout the day so you have continual benefit. It’s used a lot for periodontal disease, he said. The only negative is that it makes your mouth feel kinda tingly, and my tongue actually went numb for the first couple of times, making it impossible to taste anything I was eating. It can also temporarily stain teeth brown if used for a long period of time – the pharmacist said that isn’t likely unless you use it for months and months without a break, and even then your dentist can remove the stains at an annual cleaning. It’s actually on the $4 generic list as chlorhexidine at most pharmacies now so that was great.
Since I was doing so much to get this canker sore problem under control, it’s hard to say what ultimately was responsible for its dormancy.. but I wanted others to know that there ARE treatment options out there. I only wish one of my doctors would have stumbled on a blog like this during our talk.