Canker Sores

Prevention and Natural Treatment of Canker Sores

Cathy Wong, ND

Canker sores, also known as mouth ulcers, apthous stomatitis and ulcerative stomatitis, are small painful ulcerations that have yellow-gray centers and a red border.

Usually 1-2mm wide, they occur on non-keratinized mucosa inside the mouth: the inner side of the lips, the tongue, the back and floor of the mouth and the wall of the cheeks. They do not occur on the lips, the gums or the hard roof of the mouth. Ulcers can be single or can occur in clusters.

The cause of canker sores is uncertain, however, associations with human herpesvirus 6, food sensitivities, stress, and nutrient deficiencies have been suggested. They generally take 1-2 weeks to heal and may recur monthly or several times per year.

Canker sores must be differentiated from drug allergies, herpes simplex infection, Behcet's syndrome, inflammatory bowel disease, and squamous cell carcinoma. In some cases, biopsy of the ulcer may be necessary.

Conventional treatments include topical steroids, mouthwash, or an oral paste for symptomatic relief. In severe cases, systemic glucocorticoids may be prescribed.

Therapeutic Considerations

1) Avoid toothpastes containing sodium lauryl sulfate

Sodium lauryl sulfate (SLS) is an irritant detergent commonly found in toothpaste. People with recurrent canker sores may benefit by switching to a brand of toothpaste that does not contain SLS, which is believed to abrade the protective mucus layer in the mouth and increase the likelihood of developing canker sores.

Research studies have found a decreased incidence of recurrent canker sores after two months of avoiding SLS, however, one double-blind study did not support this finding.

2) Deglycyrrhizinated licorice (DGL)

DGL is the herb licorice that has had the glycyrrhizic acid removed, the portion that can increase blood pressure. In one research study, DGL was found to promote the healing of canker sores, with a 50-75% improvement in one day. This study used a mouthwash made of powdered DGL mixed with water.

Alternately, DGL tablets can be chewed with water, swished in the mouth and swallowed.

3) Identify and eliminate food sensitivities with an elimination and challenge diet

Food sensitivities, especially to gluten-containing foods (wheat, rye, barley, oats), have been found clinically to be associated with recurrent canker sores.

The microscopic appearance of the sores and the increased antibodies to certain food antigens in some people with recurrent canker sores support this theory. Double-blind studies, however, have yet to confirm this.

4) Decrease dietary intake of nitrites

Cured and processed meats, such as bacon, sausage and ham, are high in nitrites. One study found that the risk of esophageal cancer was seven times greater in individuals with a history of canker sores. The authors report that canker sores may be an indicator of a high conversion of nitrites to carcinogenic nitrosamines.

5) Vitamin C

Vitamin C works directly against viruses and has been found to inhibit the herpes virus in vitro. In addition, it inhibits the formation of nitrosamines from dietary nitrites, found in bacon, ham, sausages and other processed meats, and from dietary nitrates, found in vegetables and other foods.

6) Nutrient Deficiency

Thiamin (vitamin B1) deficiency has been linked to an increased risk of canker sores. Other nutrients that have been found to be low in people with recurrent canker sores include riboflavin (vitamin B2), pyridoxine (vitamin B6) and iron. A health practitioner can assess nutrient status.

References

1. Lininger S, Gaby A, Austin S, Brown DJ, Wright JV, Duncan A. The Natural Pharmacy, 2nd Edition. Prima Health and Healthnotes, Inc., 1999.

2. Murray M. Dr. Murray's Total Body Tune-Up. New York, New York. Random House, Inc.; 2000

3. Murray MT, Pizzorno JE. Textbook of Natural Medicine, Vol 1 and 2. Churchill Livingstone. Edinburgh, 1999

4. Rogers MA, Vaughan TL, Davis S, Thomas DB. Consumption of nitrate, nitrite, and nitrosodimethylamine and the risk of upper aerodigestive tract cancer. Cancer Epidemiology Biomarkers Prev 1995 Jan-Feb; 4(1):29-36.

5. Tannenbaum SR, Wishnok JS, Leaf CD. Inhibition of nitrosamine formation by ascorbic acid. Am J Clin Nutrition 1991 Jan;53(1 Suppl): 247S-250S.