Recurrent aphthous stomatitis (RAS) is accepted as one of the most common diseases involving human oral tissues. They are painful, small ulcers in the mouth or on the inner lips caused by an assortment of viruses. Doctors call this condition aphthous stomatitis, aphthous ulcers or canker sores. They can appear on the tongue, the lips, the gums or the insides of the cheeks. The first sign of a canker sore may be a tingling, burning sensation inside the mouth, followed shortly by the appearance of a white or yellowish spot edged by a red halo.
Canker sores do not form blisters as cold sores (fever blisters) do. The cold sore, commonly confused with the canker sore, is caused by the herpes simplex virus. The canker sore, on the other hand, is an inflammation rather than an infection. Canker sores may range in size from the size of a pinhead to as large as a quarter. They are usually about an eighth of an inch in diameter-the size of a pencil eraser. They appear suddenly and often leave suddenly, usually lasting from four to twenty days. Canker sores often pop up when you’re under stress or after you’ve eaten an irritating food (pineapple, nuts and chocolate are common culprits). A susceptibility to canker sores tends to run in families. No successful conventional treatment is available. The natural remedies may help relieve the symptoms of canker sores or may prevent sores from recurring.One strategy to try is avoiding toothpaste that contains sodium lauryl sulfate because it breaks up a protective barrier on the teeth and gums, which results in a greater frequency of ulcers. The frequency was reduced in one study by 67%. It is hard to find a toothpaste without it, but people with canker sores should make the effort if the problem does not resolve by other means. Weleda pharmacy in New York manufactures such a toothpaste. For a much more scientific and detailed description of this condition, please see maxillo facial center.com.
Risk factors for Canker Sores (Aphthous Ulcers)
Allergy / Intolerance to Foods (Hidden)
Foods including wheat, oranges, tomatoes, chocolate, nuts, eggplant, tea and cola were dietary allergens that have been found to trigger ulcer initiation. A study by Dr. Pelin Gürdal conducted in a dental university in Turkey concluded from previous studies [Oral Surg. 1984:57, pp.504-507] and his own that as many as 50% of RAS patients will improve when offending foods are identified and eliminated. Without laboratory testing or patient insights, identifying these foods for individual sufferers can be challenging. Food allergies continue to be a controversial cause of canker sores, and further research is necessary to resolve the issue.
Gluten Sensitivity / Celiac Disease
In a study of 15 patients, 7 patients responded completely and two partially to diets excluding gluten (3 patients), azo compounds (3), milk (2), azo and milk (1). Two failed to respond and three failed to complete the diet. Responses were confirmed by re-challenge. The patients in this study had relatively severe aphthous ulcers. The patients who responded to the gluten free diet had had gluten enteropathy excluded by biopsy. [B Med J 1986; 292: pp.1237-8]
Autoimmune Tendency
In the first study investigating the origins of a little-known condition called chronic ulcerative stomatitis (CUS), researchers at Tufts University School of Dental Medicine provide evidence that an autoimmune response contributes to the painful oral sores that characterize the disease. The study findings support the classification of CUS as a new autoimmune disease. [Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. “Chronic ulcerative stomatitis: Evidence of autoimmune pathogenesis” Published online April 4, 2011]
Zinc Requirement
Tissue damaged by canker sores has demonstrated an enhanced recovery rate with adequate zinc intake. Total prevention or reduced frequency also occurs when zinc is supplemented in those with zinc deficiency.
Iron Requirement
Vitamin B12, folate, zinc and iron have been shown to be effective in up to 60% of patients with canker sores when such a vitamin or mineral deficiency has been documented. [Dermatologic Clinics 1996:14, pp.243-256, British Dental Journal 1985:159, pp.361-367]
History of aphthous ulcers
Canker Sores (Aphthous Ulcers) suggests the following may be present
Allergy / Intolerance to Foods (Hidden)
Foods including wheat, oranges, tomatoes, chocolate, nuts, eggplant, tea and cola were dietary allergens that have been found to trigger ulcer initiation. A study by Dr. Pelin Gürdal conducted in a dental university in Turkey concluded from previous studies [Oral Surg. 1984:57, pp.504-507] and his own that as many as 50% of RAS patients will improve when offending foods are identified and eliminated. Without laboratory testing or patient insights, identifying these foods for individual sufferers can be challenging. Food allergies continue to be a controversial cause of canker sores, and further research is necessary to resolve the issue.
Autoimmune Tendency
In the first study investigating the origins of a little-known condition called chronic ulcerative stomatitis (CUS), researchers at Tufts University School of Dental Medicine provide evidence that an autoimmune response contributes to the painful oral sores that characterize the disease. The study findings support the classification of CUS as a new autoimmune disease. [Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. “Chronic ulcerative stomatitis: Evidence of autoimmune pathogenesis” Published online April 4, 2011]
Vitamin B1 Requirement
There is some evidence to suggest that recurring mouth ulcers are due to thiamin deficiency. [Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996 Dec, 82:6, pp.634-6]
Recommendations for Canker Sores (Aphthous Ulcers)
Lactobacillus Acidophilus
Acidophilus/bifidus consumption has been found to be useful for the prevention of canker sores in some individuals. Topical use, by chewing lactobacillus tablets several times each day, may also reduce the soreness in some cases. [CIBA Clin Symposia 1967;19: pp.38-64, Oral Surg 1970;30: pp.196-200]
Licorice Root (Glycyrrhiza glabra)
For acute treatment, DGL (de-glycerrizinated licorice root) topically may prove to be of benefit. A mixture of DGL and warm water applied to the inside of the mouth may shorten the healing time for mouth ulcers. This DGL mixture is made by combining 200mg of powdered DGL and 1 cup or less (250ml) of warm water. Swish in the mouth for 2 to 3 minutes twice per day for one week. The use of ordinary licorice root powder may provide benefit also. [J Assoc Physicians India 1989; 37: p.647]
Jeff Haley of Orahealth USA has invented a licorice product called Cankermelts-GX. It is entirely natural and held in place with an oral patch. It is now available for sale from Amazon.com and some chain drug stores, where it has received high rankings from reviewers.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| May do some good |
| Likely to help |
Glossary
Stomatitis
Inflammation of the mucous membrane of the mouth.
Ulcer
Lesion on the skin or mucous membrane.
Virus
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Canker Sores
Also known as Aphthous Ulcers, these are small, painful ulcers that occur on the inside of the cheek, lip or underside of the tongue. Caused by an assortment of viruses, doctors call this condition aphthous stomatitis. Canker sores usually clear up by themselves within a week or so, but they often recur, sometimes in the form of multiple sores.
Cold Sore
Also known as fever blisters, cold sores are localized collections of clear fluid causing elevation of the skin, separating it into an upper and lower layer, often recurring about once per year. Generally due to Herpes Type 1 (HSV1) and appearing as blisters on the outside surface of the lips but also on the face and inside the mouth, eventually breaking down to form small ulcers and finally scabs.
Herpes Simplex
An infection, often recurrent, caused by herpes virus type 1 and 2. It causes cold sores around the lips and mouth, and also causes painful blisters on the genitals and in the pubic area, thighs, and buttocks.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Allergen
A substance that is capable of producing an allergic response in the body.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Biopsy
Excision of tissue from a living being for diagnosis.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Mineral
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Thiamine
(Vitamin B-1): A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.