Canker Sores And Anxiety
Canker sores, also known as aphthous ulcers, are small, painful lesions that develop inside the mouth. While the exact cause of canker sores is unclear, there appears to be a link between anxiety and the occurrence of these painful sores. Frequent canker sores can be anxiety symptoms, including anxiety and panic attack symptoms.
Canker sores usually appear as small, oval-shaped ulcers with a white or yellow center. They are often surrounded by a painful red area that causes a tingling or burning sensation just before the sore appears. In more severe cases, additional symptoms may include swollen lymph nodes, fever, and fatigue.
This article explains the relationship between anxiety and canker sores, especially their frequency.
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Common Symptom Descriptions
- You get canker sores more often than usual.
- The frequency of canker sores has increased but there is no medical or obvious reason why.
- You get one canker sore after another, and it seems no matter what you do, you can’t to stop them from occurring.
Canker sores, also called aphthous ulcers, are small, shallow lesions that occur on the soft tissues in the mouth and base of the gums.
Canker sores can:
- Occur occasionally, frequently, or persistently.
- Precede, accompany, or follow an escalation of other anxiety symptoms or occur by itself.
- Precede, accompany, or follow a period of nervousness, anxiety, fear, and stress, or occur "out of the blue" for no reason.
- Range in intensity from mild, to moderate, to severe.
- Occur for a while, subside, and then return for no reason.
Canker sores can be any size, from tiny (almost imperceptible) to large. They generally go away on their own in about a week or two.
Large canker sores that persist should be discussed with your doctor or dentist.
To see if anxiety might be playing a role in your symptoms, rate your level of anxiety using our free one-minute instant results Anxiety Test, Anxiety Disorder Test, or Hyperstimulation Test.
The higher the rating, the more likely anxiety could be contributing to or causing your anxiety symptoms, including feeling like impending doom symptoms.
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Causes
Medical Advisory
Talk to your doctor about all new, changing, persistent, and returning symptoms as some medical conditions and medications can cause anxiety-like symptoms.
It’s unknown why some people develop canker sores, and others don’t. However, it’s believed there can be many contributing factors, such as:
1. Anxiety-Caused Stress
Anxious behavior, such as worry, activates the stress response, which secretes stress hormones into the bloodstream, where they travel to specific locations to immediately prepare the body for emergency action – to fight or flee. This instinctual survival reaction is often referred to as the Fight Or Flight Response:[1][2]
Visit the “Stress Response” article for the many ways the stress response can affect the body and how we feel.
The degree of stress response is proportional to the degree of anxious behavior. For instance, the more anxious you are, the more dramatic the stress response changes.
Since stress responses push the body beyond its internal balance (equilibrium), stress responses stress the body. Consequently, anxiety stresses the body.
Stress is thought to be a common cause of canker sores,[3] including emotional stress, such as from anxious behavior.[4]
Moreover, canker sores are also thought to be caused by hormone fluctuations. Since stress hormones affect other hormones, an anxiety-caused stress response can be an indirect cause of canker sores.
Furthermore, stress is known to deplete B vitamins. Low vitamin B-12 is also thought to be a cause of canker sores.
A weakened immune system is also thought to cause canker sores. Stress responses suppress the immune system.
Overall, anxiety can play a role in the development of canker sores because of how anxiety stresses the body and how stress can lead to the development of canker sores.
2. Hyperstimulation
Frequently activating the stress response, such as from overly anxious behavior, can leave the body in a state of semi-stress-response-readiness, which we call “stress-response hyperstimulation” since stress hormones are powerful stimulants.
Hyperstimulation is also often referred to as “hyperarousal,” “HPA axis dysfunction,” or “nervous system dysregulation.”[5][6]
Visit our “Hyperstimulation” article for more information about the many ways hyperstimulation can affect the body and how we feel.
Hyperstimulation can cause the changes of an active stress response even though a stress response hasn’t been activated. Consequently, hyperstimulation is a source of chronic stress.
While infrequent stress responses can cause infrequent episodes of canker sores, hyperstimulation can cause chronic episodes of canker sores.
Hyperstimulation is a common cause of chronic and persistent canker sores.
3. Behavior
Anxious behavior can play a role in other ways, too. For instance, some people chew the inside of their cheeks and lips when anxious and stressed. This chewing can cause lesions inside the cheeks and lips that turn into canker sores.
Furthermore, many anxious people clench their teeth and jaws. Clenching can inadvertently cause canker sores if you accidently bite the inside of your cheek, which turns into a canker sore.
4. Other Factors
Other factors that cause stress can contribute to and aggravate canker sores, including:
- Medication
- Recreational drugs
- Stimulants
- Sleep deprivation
- Fatigue
- Hyper and hypoventilation
- Low blood sugar
- Nutritional deficiencies
- Dehydration
- Hormone changes
- Pain
Select the relevant link for more information.
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Treatment
When this symptom is aggravated by other factors, addressing those factors can help reduce the incidences of canker sores.
Since a virus does not cause canker sores, they aren’t contagious and typically heal on their own.[7]
To reduce anxiety-caused canker sores, contain anxious behavior, and reduce stress.
Recovery Support members can learn more about anxiety containment in Chapter 6 in the Recovery Support area.
As anxiety is contained and the body recovers from stress, including hyperstimulation-caused chronic stress, the prevalence of canker sores should diminish.
You can reduce and eliminate hyperstimulation by:
- Containing anxious behavior.
- Reducing stress.
- Regular deep relaxation.
- Relaxed diaphragmatic breathing.
- Regular light to moderate exercise.
- Getting regular good sleep.
- Eating a healthy diet of whole and natural foods.
- Avoiding stimulants.
- Passively-accepting your symptoms until they subside.
- Being patient as your body recovers.
Visit our “60 Natural Ways To Reduce Stress” article for more ways to reduce stress.
Keep in mind that it can take a long time for the body to recover from hyperstimulation. The higher the degree of hyperstimulation, the longer it can take to recover.
Recovery Support
The Recovery Support area of our website contains thousands of pages of important self-help information to help individuals overcome anxiety disorder, hyperstimulation, and symptoms.
Due to the vast amount of information, including a private Discussion Forum, many of our Recovery Support members consider it their online recovery support group.
Short-term remedies:
Even though eliminating hyperstimulation will eliminate chronic anxiety symptoms, including frequent canker sores, some people have found the following strategies helpful in reducing episodes of this symptom in the short-term.
However, keep in mind that each person can have a unique symptom experience since each person is somewhat physically, chemically, psychologically, and emotionally unique. What might work for one person might not for another.
Reduce stress – Since stress, including anxiety-caused stress, is a common cause of canker sores, reducing stress can reduce episodes of this symptom.
Any stress reduction strategy can help improve this symptom. Visit our article “60 Ways To Reduce Stress And Anxiety” for natural stress reduction strategies.
Recovery Support members can read chapters 4 and 14 for many natural ways to reduce stress and anxiety.
Regular good sleep – Regular good sleep can reduce stress, cortisol, and the body’s overall level of stimulation. Their reduction can reduce and eliminate anxiety symptoms, including this one.
Regular deep relaxation – Deep relaxation reduces the body’s overall level of stimulation and stress, leading to a reduction in anxiety symptoms, including frequent canker sores.
Regular light to moderate exercise – Regular light to moderate exercise can reduce stress and use up excess cortisol, which can help reduce anxiety symptoms, including this one.
Avoid stimulants – Stimulants, such as caffeine, bring about their stimulating effect by increasing circulating cortisol, the body’s most powerful stress hormone. To help the body recover from hyperstimulation, we need to reduce the production of stress hormones and stimulation, not increase it. A reduction in stress and stimulation can help reduce symptoms of hyperstimulation, including frequent episodes of canker sores.
Maintain good oral health – Brushing your teeth regularly with a soft-bristle toothbrush can reduce incidences of canker sores.
Avoid spicy, acidic, and salty foods – Reducing or avoiding these foods can reduce episodes of canker sores.
Therapy
Unidentified and unaddressed underlying factors cause issues with anxiety. As such, they are the primary reason why anxiety symptoms persist.
Addressing your underlying factors (Level Two recovery) is most important if you want lasting success.
Addressing Level Two recovery can help you:
- Contain anxious behavior.
- Become unafraid of anxiety symptoms and the strong feelings of anxiety.
- End anxiety symptoms.
- Successfully address the underlying factors that so often cause issues with anxiety.
- End what can feel like out-of-control worry.
All our recommended anxiety therapists have had anxiety disorder and overcame it. Their personal experience with anxiety disorder and their Master's Degree and above professional training give them insight other therapists don't have.
If you want to achieve lasting success over anxiety disorder, any one of our recommended therapists would be a good choice.
Working with an experienced anxiety disorder therapist is the most effective way to treat anxiety disorder.[8][9][10]
In many cases, working with an experienced therapist is the only way to overcome stubborn anxiety.
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Common Anxiety Symptoms
Additional Resources
- For a comprehensive list of Anxiety Disorders Symptoms Signs, Types, Causes, Diagnosis, and Treatment.
- Anxiety and panic attacks symptoms can be powerful experiences. Find out what they are and how to stop them.
- How to stop an anxiety attack and panic.
- Free online anxiety tests to screen for anxiety. Two minute tests with instant results. Such as:
- Anxiety 101 is a summarized description of anxiety, anxiety disorder, and how to overcome it.
Return to our anxiety disorders signs and symptoms page.
anxietycentre.com: Information, support, and therapy for anxiety disorder and its symptoms, including increased frequency and prevalence of canker sores.
References
1. Chu, Brianna, et al. “Physiology, Stress Reaction.” StatPearls, 7 May 2024.
2. Godoy, Livea, et al. "A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications." Frontiers In Behavioral Neuroscience, 3, July 2018.
3. "Canker sores (mouth ulcers): Overview." Institute for Quality and Efficiency in Health Care. 2006.
4. “Canker Sore.” Mayo Clinic, retrieved 30 Sep 2021.
5. Yaribeygi, Habib, et al. “The Impact of Stress on Body Function: A Review.” EXCLI Journal, Leibniz Research Centre for Working Environment and Human Factors, 2017.
6. Teixeira, Renata Roland, et al. “Chronic Stress Induces a Hyporeactivity of the Autonomic Nervous System in Response to Acute Mental Stressor and Impairs Cognitive Performance in Business Executives.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2015.
7. “Canker Sores.” Cleveland Clinic, retrieved 30 Sept 2021.
8. Hofmann, Stefan G., et al. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses.” Cognitive Therapy and Research, U.S. National Library of Medicine, 1 Oct. 2012.
9. Leichsenring, Falk. “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA, American Medical Association, 10 Oct. 2017.
10. DISCLAIMER: Because each body is somewhat chemically unique, and because each person will have a unique mix of symptoms and underlying factors, recovery results may vary. Variances can occur for many reasons, including due to the severity of the condition, the ability of the person to apply the recovery concepts, and the commitment to making behavioral change.