In this cold season, what can I do to avoid canker sores and mouth ulcers?

Canker sores, mouth ulcers or aphthous stomatitis commonly occur in 80% of the population, while 20% of this group suffers from reoccurring canker sores. They typically appear between ages 10-20. They are a break in the mucosal lining of the mouth and appear to be small white dots. They can appear as single abrasions or clusters on the tongue and the movable parts inside the mouth. They are painful and typically sensitive to citrus fruits and hot or cold. An eruption of canker sores can last up to a week and less commonly for a few weeks. If they do not resolve after several weeks consult a qualified health care practitioner. 

Conventional medicine provides no clear cause for mouth ulcers, but there are many suspected triggers. Major triggers include nutritional deficiencies, allergies, stress, hormonal changes, lack of adequate intestinal flora (friendly bacteria in the gut) and food sensitivities. It is interesting to note that 25% of people with reoccurring mouth ulcers are gluten sensitive and many people with celiac disease suffer from reoccurring bouts of canker sores. Due to hormonal changes, women are more susceptible than men are. A person’s immune status also may be a cause and there is also a genetic factor as canker sores can run in families.

Citric acid and tomatoes can agitate the mucosal lining of the mouth and can cause canker sores. A diet high in sugar, due to its acidic nature and ability to lower the immune and disrupt the hormonal systems, can also be an important trigger to consider. Toothpaste can act as a trigger due to Sodium Lauryl Sulfate (SLS), used as a foaming agent. Also, mouthwash, dental floss and cigarettes can also act as triggers. Piroxicam, a Non Steroidal Anti-Inflammatory Drug (NSAID) also proves to be a trigger in some individuals.

Disorders that may trigger them

Reoccurring mouth ulcers can indicate poor nutritional status. Inadequate intake of Vitamin C, iron and zinc are linked to mouth ulcers. Certain diseases are also associated with reoccurring mouth ulcers. These disorders are:

Crohn’s Disease

Ulcerative colitis

Celiac disease

Corticosteroids use, which is used for inflammatory conditions

Acrodermatitis

Enteropathica

Anorexia nervosa

Pernicious anemia

Iron-deficiency anemia

Mercury poisoning

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Nicotine withdrawal

I would also add excessive decay of the teeth, gingivitis and peritonitis disease. The teeth many times are our first sign that our bodies are not receiving adequate nutrition. When teeth begin to decay rapidly, according to Traditional Chinese Medicine, it is a signal that the stomach or digestive organs are not functioning well. Gingivitis and periodontal disease also signify the same condition. It may be that when enough of these triggers, in susceptible individuals, come together, it manifests in an eruption of mouth ulcerations, with the main trigger being the weakened state of the digestive track. Lack of healthy intestinal flora also hints at an underlying cause that originates in the gut. Although there is no clinical evidence, the over use of antibiotics, which causes a shift in healthy gut flora, may also play a role. Biting or trauma to the mouth can bring on canker sores.

Canker sores only occur inside the mouth on the tongue, inner lips and inside the cheeks. They do not show up on the hard pallet or gums. Canker sores begin as a small reddish swell that burst within a few days. Once the sore ruptures it is coated by a grey, white or yellow membrane surrounded by a small red halo that implies inflammation. These painful 1-2mm wide lesions are extremely painful and can be dehabilitating to some, especially when they occur monthly. Typically healing time takes 4-14 days.

Types of sores

1. Simple: Appearing 2-3 times a year with duration of one week. This type is quite common.
2. Complex: They appear more often and are not as common.

Canker sores differ from cold sores and fever blisters in three important ways. Cold sores occur on the outside of the mouth or below the nose and are a form of herpes simplex virus. As such, they are contagious while cancer sores are not. In addition cold sores and fever blisters are made up of liquid filled blisters that usually appear in clusters. Canker sores are small ulcers that are gray or white with a red halo skirting them. Contact a qualified health care practitioner if large sores are present or if they are spreading, sores that last for longer than 14 days or when there is intolerable pain, even when food triggers were avoided. If there is a fever that appears with the canker sores, seek medical assistance.

Canker sores appear to be a symptomology of deeper conditions. I suggest that canker sores may originate from the digestive system, although other possibilities such an imbalance of the endocrine system is likely, as well as a compromised immunity. A practitioner should take a careful client intake to assess if the underlying imbalance causing a canker sore originates in the digestive track, immune or in the endocrine system. Assessing the menstrual cycle of a client here would be critical; if the canker sores occur during menstruation or during irregular menstrual cycles, it may be acting as a trigger.

Although stress alone is not an endocrine problem, it can cause considerable imbalance to the system. Since our body’s stress response is to release hormones, particularly cortisol, a hormone imbalance can also occur at extremely stressful times in our life. It is important to note that physical and emotional stress are still stressors and one does not out weight the other. Again, with a weakened digestive track, stress can have a profound action on it. Checking for dysbiosis, gut permeability and bacterial overgrowth should be considered. A licensed practitioner can perform these tests. Blood work should also be done to check for food sensitivities or with an elimination diet.

Food choices and your diet

A diet rich in whole foods, copious amounts of fresh fruit, vegetables and following an 85/15 ratio of nourishing foods to depleting foods would be helpful. Eliminating sources of xenoestrogens, hormones and antibiotics found in commercially raised foods would be another consideration. Supplementation of the anti-oxidants C, zinc, the B-complex vitamins, iron, a multi-vitamin and probiotics, like yogurt, would also be helpful.

Conventional medical approaches include a rinse with antimicrobial mouthwash or warm water with salt and over the counter oral anesthetics.

• Homeopathic preparations for teething can be used as well as ice, honey or aloe vera gel. In addition, licorice roots (deglycyrrhized, DGL) for soothing mucosal lining. Myrrh, goldenseal and castor oil are also useful in relieving pain.
• It is common for Non Steroidal Anti-Inflammatory Drugs to be prescribed, however NSAIDs can also be a trigger. So avoiding them is prudent.
• A mouth wash made from the teas of myrrh, Echinacea and goldenseal can have the same healing action. Essential oils can also be mixed into carrier oil like grapeseed oil.
• An anti-microbial mouth rinse maybe recommended to reduce the irritation. Remember that canker sores are linked to inadequate gut flora, so an anti-microbial may not be the best choice. It would be better to use a mouth wash that used myrrh, golden seal, tea tree oils or liqorish.

Eliminate possible food sensitivities, like potato chips and pretzels; acidic drinks such as lemonade or orange juice; chocolate, nuts, lemons, figs, tomatoes, apples, pineapples, strawberries, shellfish, soy, vinegar, wheat, eggplant, potatoes.

• Avoid toothpastes containing sodium lauryl sulfate (SLS) is an irritant commonly found in toothpaste.
• Avoid hot, spicy or acidic foods when you have an active canker sore and limit intake even when you so not.
• Brush your teeth gently so as not to  irritate the area
• Avoid things you know can trigger this condition.
• Eat a healthy diet.
• Nutrient deficiencies can also lead to a decrease in immunity and hormonal imbalance. The B Vitamins as well as the anti oxidants, like Vitamin C, E, Zinc and selenium are typically deficient in the Standard American Diet.
• Maintain excellent oral hygiene care.
• Reduce stress.
• Eat fermented foods like apple cider vinegar, sauerkraut and yogurt to help re establish healthy gut flora and improve digestion, bowel movements and immunity
• Check if you have Behcet’s Disease, which is prevalent in people form the Middle East. The main symptom is reoccurring canker sores more than 5 times a year. You doctor can perform the test by pricking the forearm with a sharp needle. If the point of entry is raised, then the test is positive.

Preventative

Add in fermented foods like yogurt, sauerkraut and kefir into your diet regularly. A few ounces of each a day will be a tasty addition. An iron deficiency may also be an underlying cause, so consider 30-75 mg/day. Iron can be constipating, time released supplement as well as the herbal iron supplement Floradix can help avoid that. The B-complex vitamins, specifically B1, B2, B6 and B12 should be included in a healing protocol. B-complex vitamins are used by the body during stress. Most Americans are deficient in B vitamins, so a supplement that contains at least 25milligrams of each B vitamin would be useful in general. To insure that zinc needs are meet, additional supplementation maybe needed. Take no more than150 mg/ a day to avoid adverse effects. An easy way to know if your body is receiving too much zinc is if you experience a metallic taste in the mouth. In addition a multivitamin with minerals that include the following; 1,000 mg of calcium, 500 mg of magnesium, 400 IU of D, at least 250 mg of C, 100 IU of E, 100-200 micrograms chromium, 100-200 micrograms of selenium, 5-10 mg of manganese, 15 mg of zinc and at least 25 mg of each B vitamin.

If you do not like to take pills, there are various herbal teas you can take like oat straw, alfalfa, hibiscus, rose hip or nettles. You can drink it freely throughout the day in place of a multi vitamin. Vitamin C 500-1000 mg 1-3 times a day or to bowl tolerance. Take a minimum of 2,000 mg of vitamin C and continue to increase intake until you have lose stool. When this happens, you will know that you reached tissue saturation. You may need to take as much as 5, 000 mg or more. I had one client that needed to take 20,00 mg a day. Once you reach bowel tolerance, reduce the amount by1/2-3/4 daily. If you have stomach ulcers or Acid Reflux, use a buffered vitamin C to avoid the acidity.

Healing options during a flair up

Try Vitamin C at 1,000 -2,000 mg a day. One client I worked with only suffered 3 days with canker sores as opposed to 7-12 days. You can also try 50 mg of chewable zinc. A few herbs to consider are Echinacea, golden seal and myrrh. They can be made into teas and drunk or used as a gargle three times a day. Herbal salves made with these herbs can also be used topically to ease pain. Black cumin, nigella sativa, is another herb that can be used as a tea or the oil can be placed directly on the ulcer. Black cumin has many immune stimulating properties as well as naturally occurring vitamin E.

A homeopathic teething gel applied to the area was enough for one client to get a good night’s rest. Again, a diet rich in whole foods, copious amounts of fresh fruit, vegetables and following an 85/15 ratio of nourishing foods to depleting foods would be helpful. Eliminating sources of xenoestrogens, hormones and antibiotics found in commercially raised foods would be another consideration. Supplementation of the anti-oxidants C, zinc, the B-complex vitamins, iron, a multi-vitamin and probiotics would also be useful, as well as eliminating all provoking foods such as citrus and tomatoes as well as identifying food sensitivities.