Frequency Of Canker Sores

What Causes Mouth Ulcers?

Mouth ulcers can have various causes, ranging in severity from 'worrying' to 'critical'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose mouth ulcers, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "mouth ulcers" as a symptom.  Here are eight of many possibilities (more below):
  • Crohn's Disease
  • Megaloblastic Anemia
  • HIV/AIDS
  • Food Allergies
  • Lupus (SLE)
  • Increased Folic Acid Need
  • Iron Need
  • Gluten Sensitivity

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
past and future vaccination
frequent swollen cervical nodes
meals worsen left iliac pain
slight abdominal distension
sinusitis
past H2-blocker antacid use
major inflamed cuticles
herpes type II
regular painful urge to defecate
significant mouth sores
current birth control pill use
blood transfusions
... and more than 130 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of mouth ulcers:
Cause Probability Status
Gluten Sensitivity 96% Confirm
Megaloblastic Anemia 17% Unlikely
Increased Folic Acid Need 14% Unlikely
Food Allergies 4% Ruled out
Crohn's Disease 2% Ruled out
HIV/AIDS 2% Ruled out
Lupus (SLE) 2% Ruled out
Iron Need 1% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

In the Mouth/Oral Symptoms section of the questionnaire, The Analyst™ will ask the following question about frequency of canker sores:
How often do you get Mouth Ulcers, also known as Canker Sores'? These are small, painful ulcers (not blisters) inside the cheeks, lips or under the tongue, usually lasting from 3 to 10 days.
Possible responses:
→ Don't know
→ I have never had one
→ Less than once a year
→ I usually get one or more each year
→ I keep getting them!
Based on your response to this question, which may indicate no history of mouth ulcers, occasional mouth ulcers, recurring mouth ulcers or frequent mouth ulcers, The Analyst™ will consider possibilities such as:
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.

Crohn's Disease

Crohn's disease causes inflammation of the gut, leading to ulcers developing in both the stomach and mouth.

Folic Acid Deficiency

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]

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.  Gluten enteropathy had been excluded by biopsy in the patients who responded to the gluten-free diet.  [B Med J 1986; 292: pp.1237-8]

HIV/AIDS

Any condition that attacks or suppresses the body's immune system can cause you to develop mouth ulcers.

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]

Megaloblastic Anemia / Pernicious Anemia

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]

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.

Lupus, SLE (Systemic Lupus Erythematosus)

Mouth or nose ulcers have been reported by between 12% and 30% of lupus patients, depending on the study.  They most often occur in the mouth on the hard or soft palate but may also be found on the nasal septum.

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