One of the most common complaints of the mouth, canker sores are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. Also called aphthous ulcer or aphthous stomatitis, it may occur on the tongue and on the inside linings of the cheeks, lips and throat. In most cases, these sores appear white, gray or yellow in color, surrounded by red, inflamed soft tissue. Usually, very small in appearance (less than 1 mm), the sores may enlarge to ½ to 1-inch diameter, can be painful and often make eating and talking uncomfortable. Recurrent in nature, in most cases these sores will heal on their own, but will reappear in the same or new locations after a specific period of time. In severe cases, old ulcers may be healing while new ones may appear. It is estimated that around 20-30 percent of people have recurrent episodes. In most cases, canker sores are self-limiting, meaning they will go away (in a week or two) even without any specific treatment. Billing and coding for this dental condition can be challenging. Dentists or other specialists offering treatment for this mouth condition need to ensure that the medical billing and coding for the same is done appropriately on the medical claims. Relying on the services of an established dental billing company would be a practical solution for timely claim filing and correct reimbursement.

Canker sores affect about 20 percent of people in the United States. It is estimated that about 1 in 5 people gets canker sores regularly. Even though they can occur at any age, they are most likely to occur in younger adults and women (possibly because of hormonal differences in women).
Children as young as 2 years may develop canker sores, but they do not normally appear until adolescence.

Causes and Types of Canker Sores

The exact causes of canker sores are not known. Researchers suspect a combination of factors like viral infections, allergies, a family history of aphthous ulcers and nutritional deficiency may contribute to outbreaks. Other related factors include – a minor injury to your mouth (from dental work, overzealous brushing, sports mishaps or an accidental cheek bite), food sensitivities, hormonal problems and other vitamin and mineral deficiencies. Mouth sores can also occur due to certain conditions and diseases such as inflammatory bowel disease, celiac disease, faulty immune system and Behcet’s disease (a rare disorder that causes inflammation throughout the body, including the mouth).

There are several types of canker sores – simple, complex and herpetiform sores.

  • Simple canker sores – Also called minor sores, these are the most common types of mouth sores that occur in people aged 10-20 years. Small and oval in shape (with a red edge), these appear 3-4 times a year and heal without scarring in one or two weeks.
  • Complex canker sores – Less common in nature, these sores are larger, deeper and more painful than minor canker sores. Usually round in nature, with defined borders, these sores may have extremely irregular edges when very large. Complex sores can occur due to an underlying condition like a compromised immune system, Crohn’s disease, or vitamin deficiency and may take up to six weeks to heal, leaving extensive scarring.
  • Herpetiform canker sores – Caused by herpes virus infection, these sores are pinpoint in size with irregular edges and usually develop later in life. These sores in most cases, occur in clusters of 10-100 sores, but may merge into one large ulcer. It may heal without scarring within 1-2 weeks.

Signs and Symptoms

In most cases, canker sores are round or oval in shape with a white or yellow center and a red border. The sores as mentioned above may form inside the mouth – on or under the tongue, inside the cheeks or lips, at the base of the gums or on the soft palate. Patients may experience local pain or notice a tingling or burning sensation a day or two before the sores actually appear. Common symptoms seen in the mouth include –

  • A small white or yellow oval-shaped ulcer
  • A painful red area
  • A tingling sensation

In severe cases, other symptoms like swollen lymph nodes, fever and a feeling of sluggishness may occur. Canker sores are not contagious in nature. They, normally heal within one to three weeks without any specific treatment, although the pain normally goes away in 7 to 10 days. On the other hand, severe canker sores may take up to six weeks to heal.

How Is a Canker Sore Diagnosed and Treated?

No specific tests are required to diagnose canker sores. These sores can be easily identified through a detailed visual examination. However, if the canker sores are severe and ongoing, tests may be required to check for other health problems. On a general basis, canker sores should be brought to the attention of a dentist or other specialist when these sores –

  • Persist for more than 2 weeks without any improvement
  • If the sores get worse (including while being treated with home remedies)
  • If the sores are accompanied by other additional symptoms like fever, diarrhea, headache and skin rashes.
  • If the sores continuously recur (2-3 times a year or more) or are particularly numerous or severe

There is no specific treatment required for minor canker sores as these tend to heal on their own (within a week or two) without intervention. For large, persistent or unusually painful sores, treatment is necessary. Treatment modalities for this condition focus on treating symptoms, reducing inflammation and improving the healing process by countering secondary effects such as bacterial infections that could possibly slow down the process. Treatment options include – steroid mouth rinses, topical anesthetics, antiseptic ointments/rinses, nutritional supplements and oral steroid medications. Treatment procedures administered by dentists or other specialists must be documented using the right medical codes. Medical billing and coding services offered by reputable billing and coding companies ensure this so that accurate claim submissions are done. ICD-10 diagnosis codes canker sores include –

  • K13.7 Other and unspecified lesions of oral mucosa
  • K13.70 Unspecified lesions of oral mucosa
  • K13.79 Other lesions of oral mucosa

Incorporating lifestyle changes like brushing and flossing teeth on a regular basis, gargling with mouthwash or salt water and avoiding spicy foods can help reduce the intensity of bacterial infections and speed up the healing process. Applying ice or tiny amounts of milk of magnesia to the sores can help relieve pain and promote healing. Rinsing the mouth with a mixture of warm water can also help with pain and healing.

Healthcare providers need to be well-informed about the applicable ICD-10 codes to report canker sores. Dental billing services offered by AAPC-certified coders can help physicians optimize reimbursement for the services they offer.