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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.
Causes & Development; Risk Factors
The exact cause of these tiny but quite painful mouth ulcers is unclear, but most research indicates that a virus is responsible.
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 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.
Signs & Symptoms
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 may range in size from the size of a pinhead to as large as a quarter. They are usually about 1/8 of an inch (3mm) in diameter.
Treatment & Prevention
No successful conventional treatment is available. The natural remedies may help relieve the symptoms of canker sores or may prevent sores from recurring.
Prognosis
They appear suddenly and often leave suddenly, usually lasting from four to twenty days.
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Signs, symptoms & indicators of Canker Sores (Aphthous Ulcers):
Risk factors for Canker Sores (Aphthous Ulcers): | | | | | Allergy |  Allergy 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. |
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Autoimmune |
 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] |
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Circulation |
Megaloblastic Anemia / Pernicious Anemia| | See the link between apthous ulcers and iron deficiency. |
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Environment / Toxicity |
Mercury Toxicity (Amalgam Illness) |
Nutrients |
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. |
Increased Folic Acid Requirement| | See the link between apthous ulcers and iron 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] |
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Canker Sores (Aphthous Ulcers) suggests the following may be present: | | | | | Allergy | Allergy 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. |
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Recommendations and treatments for Canker Sores (Aphthous Ulcers): | | | | | Amino Acid / Protein |  L-Lysine| | Some nutritionally-oriented physicians and dentists recommend taking lysine during an outbreak of canker sores to speed healing. However, there have been almost no clinical trials using lysine as a remedy for canker sores. Take 1,000mg L-lysine three times a day with meals while a canker sore is present. Reduce the dose to 500mg three times a day for one week following healing. Take 1,000mg L-lysine three times a day with meals while a canker sore is present. Reduce the dose to 500mg three times a day for one week following healing. |
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Animal-based |
 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] |
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Botanical |
Licorice Root| | 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] |
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Mineral |
Selenium
Multiple Mineral Supplementation
Iron
Colloidal Silver |
Nutrient |
Essential Fatty Acids |
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Preventive measures against Canker Sores (Aphthous Ulcers): | | | | | Habits | Personal Hygiene Changes| | It may be a good idea to avoid 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, and other varieties can generally be found in health food stores. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help |
GLOSSARY
Acidophilus
A microflora (good bacteria) that acts as a digestive aid and lives in your intestines helping your body fight disease.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Allergen (Allergens)
A substance that is capable of producing an allergic response in the body.
Allergy (Allergies)
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
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Canker Sores (Aphthous Ulcers, Apthous Stomatitis)
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.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
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).
Cold Sore (Cold Sores, Fever Blister, Fever Blisters)
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.
Cup (Cups)
A unit of volume measurement equal to 8 fluid oz, or roughly 250ml. It also equals 1/2 pint, 1/4 quart and 1/16 gallon.
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.
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.
Lactobacillus
A genus of gram-positive, acid-resistant bacteria in the Lactobacillaceae family. We know of lactobacillus because of its use in making yogurt and the conventional wisdom of taking it in one form or another after antibiotic therapy, but it is an integral part of the colon and mouth flora, and is the critical acidifying agent in vaginal flora. There is a growing body of rather ignored data showing the value of regular consumption of a lactobacillus-containing food in immunosuppression, slow virus, and candidiasis conditions.
Lysine
Essential amino acid. Important for growth, tissue repair, and the production of hormones, enzymes and antibodies. Research indicates that lysine may be useful in the treatment of migraine and herpes simplex. Precursor to carnitine in the body.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Milliliter (mL)
0.001 or one thousandth of a liter.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Mineral (Minerals)
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.
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.
Stomatitis
Inflammation of the mucous membrane of the mouth.
Topical
Most commonly 'topical application': Administration to the skin.
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
Virus (Viri, Viruses)
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.
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.
Last updated: Apr 13, 2008
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