Preventing Canker Sores

Recurrrent Apthous Stomatis (canker sores) plague millions. Just how does one prevent these terrible outbreaks? We have spent countless hours researching this question.

<>Below we discuss factors related to RAS and how they may influence the course of RAS in your life, as well as methods you can take to address the Recurrent Apthous Stomatitis question. Our discussion is based on research literature, experience with our patients, and feedback we have received from our Web site visitors. We hope this helps to bring you some relief.

The Foods We Eat

It appears that some of the foods we eat may be related to RAS. Appearantly some people have allegerdies to foods or certain ingredients in foods which leads to canker sore formation. Several studies have shown that elimination of certain foods resulted in significant improvements in RAS sufferers.

Specifically, Wray, Vlagopoulos, and Siraganian (1) illustrated a relationship between the following foods and RAS: buckwheat, whole wheat, rye, barley, chocolate, nuts, shellfish, soy, tomatoes, apples, and cheese.

In these studies a histamine release assay illustrated that 38% of 60 RAS patients experienced sensitivities to these foods.

In a separate study (2) , Hay and Reade illustrated that diets which eliminated certain foods resulted in complete resolution in 42 percent of 15 patients involved in the study. Foods eliminated in these diets included: figs, cheese, tomatoes, lemon, vinegar, French mustard, pineapples, apples, milk, wheat, and flour.

Many of our visitors have e-mailed sharing their experiences with certain foods and RAS as well. Chocolate seems to be a particular problem for some people. For these people eating chocolate often leads to RAS. Another common culprit appears to be oranges and other citrus fruits. Many expereince an increase in the occurence of RAS and severity of RAS after eating these fruits or after drinking orange juice.

Keeping a Canker Sore Diary in which you keep track of the food you eat and of the RAS incidences can sometimes help you identify those foods which may be contributing to your RAS.

Ingredients In Your Toothpaste

Outside of reducing stress and avoiding trauma to your oral tissue, the latest information on a new causitive factor for RAS provides us with hope that the incidence and severity of RAS can be reduced, perhaps dramatically. It appears that an ingredient in toothpaste called SLS may lead to RAS in certain people. SLS-free toothpaste has provided so much relief to our patients that we devoted an entire article to this subject.

Stress

We all feel stress at one time or another. Stress is simply the body's reaction to preveive threatening or harmful stimuli. In response the body stimulates heart rate, increases blood pressure, and releases a host of cytokines and other chemical. While meant to be a protective mechanism, in today's society we often face so many pressures that stress runs rampant in our lives.

Uncontrolled stress has severe medical complications and contributes to migraines, high blood pressure, heart disease, and gastric/intestinal disorders. Not surprisingly stress has been suggested as a factor contributing to Recurrent Apthous Stomatitis (RAS).

Several satudies have looked at highly stress populations and have shown an increased incidence of canker sores in these populations. Medical students and dental students, for example, lead an extremely demanding and stressful life and have been shown to sufffer from RAS to a greatan the rest of the population.

We have seen stress as a factor in causing RAS in our patient population with people experiencing an increase in RAS during extremely stressful times. Many of our visitors have e-mailed us also pointing out the role that stress plays in causing their RAS outbreaks as well.

We advise those patients susceptible to RAS (canker sores) to try to reduce the stress in their lives. In today's society this is often easier said than done. It's well worth the effort, however, since reducing stress has other health benefits as well. We have provided the following links which may help:

• Wellmedia Stress Page
• Mind Tools - How to Master Stress
• UT Austin Learning Skills Center - Stress Relief Information
• Rose Medical Center Stress Page

Vitamins and Minerals

The relationship between vitamin and mineral deficiencies and RAS is less clear. Several studies have shown deficiencies in B1, B2, B6, B12, iron, or folic acid in a large percentage of RAS. Other studies, however, show little to no correlation between vitamin and mineral deficiencies and RAS.

According to a recent review(3), Research by Nolan, McIntosh, Allam, and Lamey (4) was able to show a deficiency in B1, B2 or B6 in 28.2 percent of the patients with RAS. Providing these patients with the vitamins they were deficient in resulted in fewer days with ulcers for those who suffured from RAS.

Haisreli-Shalish, Livneh, Katz, Doolman, Sela, and Tel-Hashomer (5)( also found a deficiency in B1 levels in RAS patients. Nearly 70% of the RAS patients had B1 deficiencies compared to 4% of the healthy control group. In the follow-up study, however, replacement of B1 those deficient for the vitamin had little effect on RAS occurence.

The relationship between vitamin and mineral deficiencies and RAS amongst visitors to the websites is also unclear. While many e-mail to say that they believe vitamin and mineral supplements have decreased the incidence or severity of their RAS, others see no effect.

A good place to start is by seeing your doctor and having him/her take blood tests to measure the levels of B vitamins in your blood as well as levels of folate and vitamins. If you are deficient in any of these your doctor can suggest an appropriate supplement.

it is not a good idea to take an excess of vitamins or minerals as toxicities can occur with too large an intake.

Oral Trauma

There is evidence that trauma to the inside of the mouth may initiate Reccurent Apthous Ulcers (RAS). In many cases this trauma can be very minor caused by such simple things as biting the inside if the mouth or eating hard candy which may scrape or nick the insdie of the mouth. In our office we advise patients to look for things that may cause trauma to their mouth. These include:

1. Ill-fitting dentures or braces
   
   Often dentures which do not fit properly can irritate and injury adjcent oral tissue causing leading to a case of Recurrent Apthous Stomatitis. If you have dentures and suspect that this may be a culprit, have your dentist take a look to see if you have ill-fitting dentures.
   
   A similiar problem is often experienced by people wearing braces. The metal can rub into and damage the inside of the mouth. As with ill-fitting dentures, if you suspect this is a problem, contact your dentist.
   
   
2. Toothbrushing Trauma
   
   Your very own toothbrush could be damaging your teeth and oral tissue. This is because nearly 2 out of 3 people brush too hard applying excessive and damaging force to teeth, gums, and other oral tissues.
   
   Although we advise our patients to brush with less pressure most often they cannot do this. This is because toohbrushing is a habit which had been ingrained in since childhood. We encourage them to use the Alert Toothbrush which lights when you brush too hard, protecting your teeth, gums, and oral tissue.
   
   
3. Food Trauma
   
   Unfortunately, many of the foods we eat can nick, scrape, or otherwise injure oral tissue and lead to Recurrent Apthous Stomatitis. We encourage our patients to avoid or cut down on foods like potato chips, hard pretzels or cut pre-cut apples. Especially damaging can be hard candies which after being partially eaten or crunched can form sharp edges. These sharp edges can nick and injure the soft tissue of the mouth.
   
   
4. Dental Procedures
   
   Sometimes dental procedures can irritate the soft tissue of the mouth leading to RAS. We had a visitor e-mail us telling us that just the novacaine injection by needle would often result in RAS the next day. If you suspect that you may form canker sores after dental visits warn your dentists so that they can be extra gentle during procedures.
   
   
5. Biting the Inside of Your Mouth
   
   Many people cause oral damage by biting their lips and inside of their mouth. Often this can be an unconscious habit or occur during sleep. For these people we often suggest a mouthguard. Worn over the bottom set of teeth, mouthguards prevent biting damage to lips and the inside of the mouth. Mouthguards can be customed by your dentists or you can find standard, non-custom mouthguards at the local drugstore or sports store.