Canker Sore: Causes, Treatment & How to Get Rid of One Fast

A canker sore is small, but it can make every bite and every sip hurt. It's a shallow, round sore inside your mouth, usually on the inside of a lip or cheek, with a white or yellowish center and a red ring around it, and it isn't contagious.12 Most heal on their own in 4 to 14 days, without a scar.1

Most people want two things: to make this one heal faster, and to keep the next one from coming. Clinical trials help with both. Honey, aloe vera gel and licorice shrank sores or eased pain in randomized trials, and honey and aloe did better than prescription pastes in head-to-head tests.348 When sores keep coming back, the trigger is often something you can test or change: a toothpaste ingredient, a low vitamin B12, folate, iron or zinc level, stress, or a gut condition such as celiac disease.691011 That's why a sore that keeps returning is worth reading as a signal about what's happening underneath.

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What is a canker sore?

A canker sore often announces itself with a burning or tingling spot 2 to 48 hours before anything shows.1 Then a round or oval sore opens, with a gray-white or yellowish floor and a red ring around it.1213 Most are the small kind: more than 85% are under 1 centimeter (about 0.4 inch) across and heal without a scar.1

They run in families. A child with two parents who get canker sores has about a 90% chance of getting them too, against about 20% for a child whose parents don't.1 Researchers describe the sore as an immune reaction in the mouth's lining, driven by immune cells called T cells, with nutrient levels, hormones, injury and stress all changing how strongly that reaction fires.14

The three types of canker sores

Despite the name, herpetiform sores have no link to the herpes virus.1

Canker sore vs. cold sore: what's the difference?

The two often get mixed up, but where the sore sits tells you most of what you need to know.1

How a canker sore and a cold sore differ

The cold sore virus is common: the World Health Organization estimates that 64% of people under 50 carry HSV-1.7 Because a cold sore spreads by contact, skip kissing and sharing cups or lip balm while one is active. A canker sore carries no such risk.2

What causes canker sores?

Injury alone isn't enough: denture wearers get more mouth injuries than most people, yet they don't get more canker sores, which is why researchers think trauma starts a sore mainly in people already prone to them.1 Here's how one forms:

What can set off a canker sore, and where to start

Most of these are covered with their numbers in the section on stopping repeat sores below. One you can cross off: a review of 15 studies found no evidence that H. pylori, the stomach bacterium, drives canker sores.22

How do you get rid of a canker sore fast?

The first six options below were tested on the sore itself in human trials, in order of the evidence behind them, and each card names the product the trials used. The seventh is a gentle traditional rinse.

A few more have early research behind them. Bee propolis, the resin bees use to seal their hive, may shorten healing and ease pain compared with placebo, according to a 2024 review of 10 trials with 825 people that rated the certainty of that evidence very low.34 In a 2020 review of 7 trials, probiotic supplements eased pain compared with placebo in the 3 trials that could be pooled, and added to medicated gels, they eased pain and sore severity more than the gels alone.35 A vitamin B12 ointment also eased pain within 2 days in a placebo-controlled trial of 42 patients (pain scores of 0.36 against 1.80).36

While a sore heals, cool drinks through a straw and softer foods make eating easier, and rough, crunchy foods are worth skipping along with the spicy, salty and acidic ones.2

How do you stop canker sores from coming back?

If you get a canker sore once or twice a year, a good remedy is all you need. If they come every month, something is likely keeping them going, and these are the places to look.

Switch to an SLS-free toothpaste

Sodium lauryl sulfate (SLS) is the detergent that makes most toothpastes foam. An early study, from Norway, followed 10 people with frequent canker sores who brushed with an SLS toothpaste for 3 months and then an SLS-free one for 3 months: their sores fell from 14.3 to 5.1, in a small study that wasn't randomized.17

Better-controlled trials followed, with each person trying both toothpastes and neither the people nor the researchers knowing which was which. In 30 people with frequent sores, brushing with SLS brought more sores than either of two SLS-free pastes.19 In 90 people, SLS-free toothpaste didn't change how many sores appeared, but the sores healed faster and hurt less.37 In a UK trial of 47 people whose B12, ferritin and folate levels were all normal, the switch made no difference to any measure.38 Taken together, a 2019 review of 4 such trials (124 people), where each person tried both kinds, found that SLS-free toothpaste cut the number of sores, how long they lasted, how often they came and how much they hurt.6

Check the label for "sodium lauryl sulfate." I'm not a fan of fluoride in toothpaste either; on my show, I've pointed to hydroxyapatite as the ingredient to look for instead.46 A hydroxyapatite toothpaste matched a fluoride toothpaste for preventing cavities in an 18-month trial of 189 adults, where neither the people nor the researchers knew who got what.58 Our ranking of the best fluoride-free toothpastes lists pastes made without SLS.

Test, then correct: B12, folate, iron, zinc and vitamin D

Low nutrient levels turn up often in people with recurring canker sores. Across 9 studies comparing 710 people with canker sores and 602 without, the odds of low vitamin B12 (odds ratio 3.75), low folate (7.55) and low stored iron, measured as ferritin (2.62), were each higher in the canker sore group.9 In a clinic series of 273 people with recurring sores in Taiwan, 20.9% were anemic and 20.1% had low iron, and the authors advise checking a blood count, iron, B12, folate and homocysteine before treating.14 Correcting a shortfall can pay off: in one study of 32 adults with recurring sores, 56.2% had low B12, folate or iron, against 7% of people without sores, and the sores responded dramatically to supplements, a 2017 review reports.15 Blood zinc ran lower in people with canker sores across 19 studies (1,079 people with sores, 965 without), and so did vitamin D across 14 studies (721 with, 747 without).1820

The rule in my bloodwork protocol is simple: test, don't guess.39 These are the markers to ask for:

The tests to ask for when canker sores keep coming back

Vitamin B12. B12 has a direct prevention trial behind it. In a placebo-controlled trial in Israel, 58 adults who'd had recurring canker sores for at least a year took 1,000 mcg of vitamin B12 under the tongue every night at bedtime, or an identical placebo, for 6 months; neither they nor the researchers knew who got what. Both groups improved for the first 4 months, and then only the B12 group kept improving. Of the 52 who finished, 20 of the 27 on B12 (74.1%) were sore-free in month 6, against 8 of 25 on placebo (32%), and the benefit didn't depend on their starting B12 level. The tablets' maker supplied them and paid for part of the study.5

A standard multivitamin at everyday amounts didn't do the same: in a placebo-controlled trial of 160 adults, a once-daily multivitamin at 100% of the daily value for up to a year didn't lower the number of new episodes (4.19 against 4.60 on placebo) or shorten them.40 When MMA shows B12 running low, my bloodwork protocol uses methylcobalamin, 1,000 to 5,000 mcg a day, taken under the tongue or by injection to bypass the gut, paired with 400 to 800 mcg of methylfolate.39

Iron. If your ferritin is low, I recommend iron plus vitamin C every other day.41 Take iron only after testing, since too much iron damages cells too.39

Food first. Beef liver is one of the richest foods in B vitamins and iron,42 and I recommend about 3 ounces once a week unless your bloodwork shows vitamin A running high. Add sardines or wild salmon, fresh grass-fed beef, and leafy greens for folate. Keep red meat fresh, unprocessed and grass-fed. The WHO's cancer agency classifies processed meat of every kind, processed beef included, as a Group 1 carcinogen, largely on colorectal cancer data, and rates red meat itself Group 2A, probably carcinogenic.43 As I've said on my show, the studies that link red meat to poor health mostly reflect grain-fed and processed meat, not the fresh, grass-fed red meat I recommend.44 More choices are in our lists of B12 foods and iron-rich foods.

Zinc. In a 2021 review of 7 trials with 482 people, zinc taken by mouth for 3 months to a year cut repeat sores in 5 of the trials, while 2 found no difference.45 When RBC zinc is low, my bloodwork protocol uses 15 to 30 mg of zinc a day with food, taken apart from calcium and iron, and adds 1 to 2 mg of copper for long-term use.39 Our list of foods high in zinc, such as pumpkin seeds and beef, covers the rest.

Vitamin C. In a study of 16 children and teens with recurring canker sores, a daily dose of vitamin C set by body size cut outbreaks in half and eased pain, compared with their pattern before treatment.59

Vitamin D. Vitamin D belongs on the same panel, since it ran lower in people with canker sores across the 14 studies above; that link comes from comparing blood levels, so test before you supplement.20 See the signs of vitamin D deficiency.

Check your gut: celiac disease and inflammatory bowel disease

Your mouth is where your digestive tract begins. In a conversation with a holistic dentist on my show, I made the point that most people think of the mouth as separate from the stomach and intestines, when it's all one tube.46 Canker sores are commonly linked to celiac disease, inflammatory bowel disease and other conditions that make it hard to absorb nutrients.15

In a 2026 analysis that pooled 14 observational studies (1,749 people with celiac disease, 1,775 without), canker sores were 2.45 times as common in people with celiac disease, the autoimmune reaction to gluten, as in people without it.11 An earlier review of 21 controlled studies found the same link (odds ratio 3.79), clearest in the 13 studies of children, though the reviewers rated the studies' risk of bias as high.47 In a large Canadian study of people with biopsy-proven celiac disease, 16% of children and 26% of adults reported recurring canker sores.15 Mouth lesions also turn up in up to 20% of people with Crohn's disease.15

Mouth sores tied to celiac disease can show up years before any digestive trouble, which is why one review recommends celiac blood tests even when digestion seems normal.15 Ask for one if your canker sores keep coming back, and sooner if they come with bloating, diarrhea, belly pain, weight loss or constant tiredness. Get tested before you change your diet. If you have it, a strict celiac disease diet is the treatment. If the tests are negative but the sores keep coming and certain foods seem to set them off, try removing those foods one at a time; that helped a small group of people with stubborn sores and known allergies to milk, cheese or wheat.1 Our Crohn's disease diet and ulcerative colitis diet guides cover inflammatory bowel disease, and our guide to leaky gut covers the gut-lining basics.

Ease stress and protect your sleep

Stress can set off a new sore. In a U.S. study that followed 160 adults with a history of canker sores for up to a year, with weekly check-ins and daily diaries, a stressful life event almost tripled the odds of a new sore (odds ratio 2.72); mental stress mattered more than physical stress (3.46 against 1.44), and stress didn't change how long a sore lasted.10 A Brazilian study of 25 people with canker sores and 25 without found higher stress during active sores.48 Sleep matters too: in a survey of 122 people in China with canker sores and 207 without, poorer sleep went with a higher risk of sores, while perceived stress scores didn't differ between the groups.21

Build stress relief into every day: a walk outside, prayer, time with people you love and a steady bedtime. Our guides to chronic stress, cortisol levels and sleep hygiene go further.

Be gentle with your mouth

Small injuries start many sores in people who are prone to them, so protect the lining.1 Use a soft-bristled toothbrush and avoid over-brushing, ask your dentist to smooth a sharp tooth, filling or brace wire, and slow down when you chew.2

Daily mouth care helps the whole oral microbiome. In a Q&A on my show, I put the basics this way: "Brushing your teeth is foundational. In addition, flossing and oil pulling can make a really big difference."49 Oil pulling hasn't been tested on canker sores, so treat it as everyday care for your whole mouth: swish coconut oil around your mouth for about five minutes, in the shower if that's easier, then spit it into the garbage.49 When I oil pull, I take a tablespoon of coconut oil and sometimes add a little myrrh or clove oil.50

What about medicated gels and steroid pastes?

Steroid pastes work best when started early.1 A 2025 analysis of 25 randomized trials with 1,474 people found that the triamcinolone paste shrank sores more than a group of alternative treatments, by 0.72 mm on average across 6 trials, and healed them about a day sooner (1.12 days) across 4 trials.51 Single head-to-head trials have gone both ways. Honey, thyme honey and aloe gel did better than a steroid or prescription paste in the trials in the relief section.3234 The steroid did better than chamomile, and better than acemannan, a compound extracted from aloe, in a randomized trial of 180 people, though acemannan still beat a plain gel.3252

The steroid's pain relief is modest. The same 2025 analysis found it didn't ease pain more than the other treatments, and in the trials that compared it directly with placebo (two for pain and two for healing time), it didn't ease pain or speed healing more than placebo.51 A 2023 network analysis of 43 trials (3,067 people) and 20 treatments applied to the sore found that none of the medicated pastes and gels clearly beat placebo for pain; topical doxycycline, an antibiotic, was the one that clearly sped healing.33

Numbing gels with benzocaine bring short-term relief but carry a rare, serious risk, covered with the red flags below.53 For severe sores that keep coming back, a doctor may prescribe medicine by mouth, though a Cochrane review of 25 trials found too little evidence to support or rule out any of those drugs.54 Any of these can sit alongside the natural steps on this page.

When to get care for a canker sore

Medications. If you think a prescription is causing your mouth sores, don't stop it on your own; ask the doctor who prescribed it.2

Remedy cautions:

• Honey and propolis. With asthma, or any past severe reaction to pollen, bee stings or bee products, don't assume honey or propolis is safe for you, even dabbed on a sore.

• Licorice. Whole licorice taken by mouth can raise blood pressure and lower potassium, so skip it if you have high blood pressure or kidney disease, and choose DGL, which has the compound glycyrrhizin removed.2856

• Myrrh. Skip it during pregnancy. It may lower blood sugar, so check with your prescriber first if you take diabetes medication, and ask first if you take a blood thinner. Swish and spit it out; don't swallow the oil.28

• Chamomile. Use caution if you react to ragweed or daisies.28

• Benzocaine gels. Rarely, benzocaine causes methemoglobinemia, a serious condition that lowers the amount of oxygen your blood carries. Don't use these gels for more than 7 days unless a doctor tells you to.53

Canker sores in children

Children get canker sores too, often starting in the grade-school or teen years, and the same gentle care applies.1 Honey is fine from age 1, but never give it to a baby under 12 months, because it can carry the bacteria that cause infant botulism.57 Never use benzocaine numbing gels for teething or in children under 2, and supervise their use in children under 12.53 If your child gets mouth sores with a fever every few weeks, see the doctor: PFAPA syndrome brings 3- to 6-day fevers every 4 to 8 weeks along with mouth sores, a sore throat and swollen neck glands, and cyclic neutropenia, an inherited drop in infection-fighting white blood cells, brings sores about every 3 weeks.15

The bottom line

Canker sore: frequently asked questions

References

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28. Axe J. Top 50 Healing Herbs & Essential Oils. DrAxe.com protocol. 2026. Licorice (DGL), p. 10; myrrh, p. 47; Roman chamomile and the allergy cautions; essential oil safety.
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44. Axe J. 10 Biblical Superfoods That Can Add Years to Your Life. The Dr. Josh Axe Show, Episode 393. September 28, 2026. Red-meat studies and grain-fed meat at 21:03.
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49. Axe J. How to Boost Your Immune System Naturally | Q&A with Dr. Josh Axe. The Dr. Josh Axe Show. December 12, 2023. Dental health and oil pulling at 21:24. YouTube: https://www.youtube.com/watch?v=n9HNcZRXZbs
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