● Sore that persists after 1 week. ● Increased number of sores/ulcers. ● Sores that inhibit eating or drink- ing. ● Fever. ● Frequent episodes of canker sores. Follow-up Actions ● Reinforce good oral hygiene, ade- quate fluid intake, and careful chewing. ● Reinforce the importance of smok- ing cessation, if appropriate. Refer to guideline for Smoking Cessation on page 295. ● Brush teeth after meals and floss every day. Determine extent and severity of prob- lem. Provide comfort and instructions on self- care. ● Assess number and location of sores. Obtain brief history, including injury to the mouth, use of medications (allergy), and stress. ● Canker sores usually resolve without treat- ment. ● Administer analgesic (e.g., ibuprofen or acetaminophen) or topical medication (e.g., Ambesol) per standing order. ● Encourage employee to maintain good oral hygiene, increase fluid intake, and chew slowly. ● If employee smokes, encourage smoking cessation. 61 Canker Sore 25 Definition Shallow, painful ulcer-like sores in the mouth that can follow an injury, such as accidentally biting the inside of cheek, lip, or the tongue. It also may appear without an obvious cause. The sore eventually heals by itself. Predisposing factors can be trauma, stress, and allergy. Characteristics Small, round, or oval sores that are usually red or may have a white coating. The sores/ulcers are painful and can be single or occur in clusters. They are usually self-limiting. Policy Ensure that the employee is evaluated in the occupational health unit. Objectives Clinical Assessments and Interventions Referral for Medical Action Guideline continues on next page 61