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    Canker Sores (Holistic)

    Canker Sores (Holistic)

    About This Condition

    Pain caused by canker sores can make it difficult to eat, drink, or speak. How can you soothe the pain and shorten the healing time? According to research or other evidence, the following self-care steps may be helpful.
    • Aim for more balanced nutrition

      Not getting the right amounts of certain vitamins can contribute to canker sores; take a multivitamin containing zinc and generous amounts of vitamin B-complex, and include iron if tests show that your levels are low

    • Try a little licorice

      Try chewable (or powdered) deglycyrrhizinated licorice (DGL) to shorten canker sore healing time

    • Make a date with your dentist

      Get checked for sources of minor trauma, such as rough fillings, braces, or poorly fitting dentures, which can aggravate canker sores

    • Forego certain foods

      Work with a knowledgeable health professional to find out if you?re sensitive to foods that make symptoms worse

    About

    About This Condition

    Canker sores are small ulcerations within the mouth.

    Doctors call this common condition aphthous stomatitis.

    Symptoms

    Canker sores appear alone or in clusters as shallow, painful erosions in the mucous membrane inside the mouth. They typically have slightly raised, yellowish borders surrounded by a red zone, and are sometimes covered with a yellowish opaque material. Fatigue, fever, and swollen lymph nodes may be present in severe attacks.

    Healthy Lifestyle Tips

    Minor trauma from poor-fitting dentures, rough fillings, or braces can aggravate canker sores and should be remedied by a dentist.

    Several reports have found sodium lauryl sulfate (SLS), a component of some toothpastes, to be a potential cause of canker sores.1 In one trial, most recurrent canker sores were eliminated just by avoiding toothpaste containing SLS for three months.2 Positive effects of eliminating SLS have been confirmed in double-blind research.3 SLS is thought to increase the risk of canker sores by removing a protective coating (mucin) in the mouth. People with recurrent canker sores should use an SLS-free toothpaste for several months to see if such a change helps.

    Measurements of stress were associated with recurrent canker sores in one preliminary study,4 but not in another.5 More research is needed to determine whether stress reduction techniques might reduce canker sore recurrences.

    Eating Right

    The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

    Recommendation Why
    Try a gluten-free diet
    Sensitivity to gluten, a protein found in wheat and other grains, has been associated with recurrent canker sores in some people.

    Sensitivity to gluten, a protein found in wheat and other grains, has been associated with recurrent canker sores in some people. In preliminary trials, avoidance of gluten has reduced recurrent canker sores in people whether or not they had celiac disease ,6 , 7 , 8 but a double-blind trial did not find gluten avoidance helpful to people with recurrent canker sores who did not have celiac disease.9 One preliminary trial suggested that people with recurrent canker sores, whose blood contains antibodies to gliadin (a component of gluten), may respond to a gluten-free diet even if they have no evidence of the tissue changes associated with celiac disease.10

    Uncover food allergies
    Food sensitivities or allergies may make canker sores worse, an elimination diet can help you identify foods that trigger canker sores.

    Sensitivity to gluten, a protein found in wheat and other grains, has been associated with recurrent canker sores in some people. In preliminary trials, avoidance of gluten has reduced recurrent canker sores in people whether or not they had celiac disease ,11 , 12 , 13 but a double-blind trial did not find gluten avoidance helpful to people with recurrent canker sores who did not have celiac disease.14 One preliminary trial suggested that people with recurrent canker sores, whose blood contains antibodies to gliadin (a component of gluten), may respond to a gluten-free diet even if they have no evidence of the tissue changes associated with celiac disease.15

    Supplements

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Supplement Why
    2 Stars
    Aloe
    Follow label instructions
    Learn More

    A gel containing the Aloe vera polysaccharide acemannan was found in one double-blind trial to speed the healing of canker sores better than the conventional treatment Orabase Plain.16 The gel was applied four times daily. Because acemannan levels can vary widely in commercial aloe gel products, it is difficult to translate these results to the use of aloe gel for canker sores.

    2 Stars
    DG Licorice
    Mix 200 mg DGL in 200 ml in warm water and swish in mouth several minutes, four times per day
    Learn More

    Licorice that has had the glycyrrhizic acid removed is called deglycyrrhizinated licorice (DGL). Glycyrrhizic acid is the portion of licorice root that can increase blood pressure and cause water retention in some people. The wound-healing and soothing components of the root remain in DGL.

    A mixture of DGL and warm water applied to the inside of the mouth may shorten the healing time for canker sores, according to a double-blind trial.17 This DGL mixture is made by combining 200 mg of powdered DGL and 200 ml of warm water. It can then be swished in the mouth for two to three minutes, then spit out. This procedure may be repeated each morning and evening for one week. Chewable DGL tablets may be an acceptable substitute.

    2 Stars
    Iron (Iron-Deficiency Anemia)
    Consult with your doctor
    Learn More

    Several preliminary studies,18 , 19 , 20 , 21 though not all,22 have found a surprisingly high incidence of iron and B vitamin deficiency among people with recurrent canker sores. Treating these deficiencies has been reported in preliminary23 , 24 and controlled25 studies to reduce or eliminate canker sore recurrences in most cases. Supplementing daily with B vitamins?300 mg vitamin B1 , 20 mg vitamin B2 , and 150 mg vitamin B6 ?has been reported to provide some people with relief.26 Thiamine (B1) deficiency specifically has been linked to an increased risk of canker sores.27 The right supplemental level of iron requires diagnosis of an iron deficiency by a healthcare professional using lab tests.

    2 Stars
    Probiotics
    Apply powdered culture topically several times daily and orally take 1.5 billion colony-forming units two times daily
    Learn More

    According to preliminary reports, some people with recurrent canker sores may respond to topical and/or oral use of Lactobacillus acidophilus 28 and Lactobacillus bulgaricus. 29 However, a double-blind study found no effect of acidophilus bacteria on the healing time of canker sores.30

    2 Stars
    Vitamin B-Complex
    300 mg B1 daily, 20 mg B2 daily, 150 mg B6 daily
    Learn More

    Several preliminary studies,31 , 32 , 33 , 34 though not all,35 have found a surprisingly high incidence of iron and B vitamin deficiency among people with recurrent canker sores. Treating these deficiencies has been reported in preliminary36 , 37 and controlled38 studies to reduce or eliminate recurrences in most cases. Supplementing daily with B vitamins?300 mg vitamin B1 , 20 mg vitamin B2 , and 150 mg vitamin B6 ?has been reported to provide some people with relief.39 Thiamine (B1) deficiency specifically has been linked to an increased risk of canker sores.40 The right supplemental level of iron requires diagnosis of an iron deficiency by a healthcare professional using lab tests.

    2 Stars
    Zinc
    150 mg daily plus 1 to 2 mg of copper per day to prevent copper deficiency
    Learn More

    Zinc deficiency has also been linked with recurrent canker sores in preliminary studies41 and in one case report.42 A preliminary trial found that supplementation with up to 150 mg of zinc per day reduced recurrences of canker sores by 50 to 100%; participants who were zinc deficient experienced the most consistent benefit.43 However, a double-blind trial (that did not test people for zinc deficiency) did not find zinc supplements helpful for recurrent canker sores.44

    1 Star
    Agrimony
    Refer to label instructions
    Learn More

    Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. They are used as a mouth rinse and then are spit out. None of these herbs has been studied in modern times. Examples of astringent herbs include agrimony, cranesbill , tormentil, oak , periwinkle , and witch hazel . Witch hazel is approved by the German Commission E for local inflammations of the mouth, presumably a condition that includes canker sores.

    1 Star
    Chamomile
    Refer to label instructions
    Learn More

    Because of its soothing effect on mucous membranes (including the lining of the mouth) and its healing properties, chamomile may be tried for canker sores and other mouth irritations.45 A strong tea made from chamomile tincture can be swished in the mouth before swallowing, three to four times per day. Goldenseal has also been used historically as a mouthwash to help heal canker sores.

    1 Star
    Cranesbill
    Refer to label instructions
    Learn More

    Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. They are used as a mouth rinse and then are spit out. None of these herbs has been studied in modern times. Examples of astringent herbs include agrimony, cranesbill , tormentil, oak , periwinkle , and witch hazel . Witch hazel is approved by the German Commission E for local inflammations of the mouth, presumably a condition that includes canker sores.

    1 Star
    Echinacea
    Refer to label instructions
    Learn More

    The antiviral, immune-enhancing , and wound-healing properties of echinacea may make this herb a reasonable choice for canker sores. Liquid echinacea in the amount of 4 ml can be swished in the mouth for two to three minutes, then swallowed. This procedure may be repeated three times per day. However, no research has investigated the possible effects of this treatment.

    1 Star
    Goldenseal
    Refer to label instructions
    Learn More

    Because of its soothing effect on mucous membranes (including the lining of the mouth) and its healing properties, chamomile may be tried for canker sores and other mouth irritations.46 A strong tea made from chamomile tincture can be swished in the mouth before swallowing, three to four times per day. Goldenseal has also been used historically as a mouthwash to help heal canker sores.

    1 Star
    Myrrh
    Refer to label instructions
    Learn More

    Myrrh , another traditional remedy with wound-healing properties, has a long history of use for mouth and gum irritations. Some herbalists suggest mixing 200 to 300 mg of herbal extract or 4 ml of myrrh tincture with warm water and swishing it in the mouth before swallowing; this can be done two to three times per day.

    1 Star
    Oak
    Refer to label instructions
    Learn More

    Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. They are used as a mouth rinse and then are spit out. None of these herbs has been studied in modern times. Examples of astringent herbs include agrimony, cranesbill , tormentil, oak , periwinkle , and witch hazel . Witch hazel is approved by the German Commission E for local inflammations of the mouth, presumably a condition that includes canker sores.

    1 Star
    Periwinkle
    Refer to label instructions
    Learn More

    Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. They are used as a mouth rinse and then are spit out. None of these herbs has been studied in modern times. Examples of astringent herbs include agrimony, cranesbill , tormentil, oak , periwinkle , and witch hazel . Witch hazel is approved by the German Commission E for local inflammations of the mouth, presumably a condition that includes canker sores.

    1 Star
    Tormentil
    Refer to label instructions
    Learn More

    Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. They are used as a mouth rinse and then are spit out. None of these herbs has been studied in modern times. Examples of astringent herbs include agrimony, cranesbill , tormentil, oak , periwinkle , and witch hazel . Witch hazel is approved by the German Commission E for local inflammations of the mouth, presumably a condition that includes canker sores.

    1 Star
    Vitamin B12
    3 to 1,000 mcg daily
    Learn More

    Several preliminary studies,47 , 48 , 49 , 50 though not all,51 have found a surprisingly high incidence of iron and B vitamin deficiency among people with recurrent canker sores. Treating these deficiencies has been reported in preliminary and controlled studies to reduce or eliminate recurrences in most cases.52 , 53 , 54 In addition, a double-blind study found that supplementing with vitamin B12 prevented recurrences even in people who were not deficient in the vitamin.55 The amount used in that study was 1,000 mcg twice a day for six months. Supplementing daily with B vitamins?300 mg vitamin B1 , 20 mg vitamin B2 , and 150 mg vitamin B6 ?has been reported to provide some people with relief.56 Thiamine (B1) deficiency specifically has been linked to an increased risk of canker sores.57 The right supplemental level of iron requires diagnosis of an iron deficiency by a healthcare professional using lab tests.

    1 Star
    Witch Hazel
    Refer to label instructions
    Learn More

    Historically, herbs known as astringents have been used to soothe the pain of canker sores. These herbs usually contain tannins that can bind up fluids and possibly relieve inflammation. They are used as a mouth rinse and then are spit out. None of these herbs has been studied in modern times. Examples of astringent herbs include agrimony, cranesbill , tormentil, oak , periwinkle , and witch hazel . Witch hazel is approved by the German Commission E for local inflammations of the mouth, presumably a condition that includes canker sores.

    References

    1. Chanine L, Sempson N, Wagoner C. The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study. Compend Contin Educ Dent 1997;18:1238?40.

    2. Herlosfson BB, Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary trial. Acta Odontol Scand 1994;52:257?9.

    3. Herlosfson BB, Barkvoll P. The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontol Scand 1996;54:150?3.

    4. McCartan BE, Lamey PJ, Wallace AM. Salivary cortisol and anxiety in recurrent aphthous stomatitis. J Oral Pathol Med 1996;25:357?9.

    5. Pedersen A. Psychologic stress and recurrent aphthous ulceration. J Oral Pathol Med 1989;18:119?22.

    6. Wray D. Gluten-sensitive recurrent aphthous stomatitis. Dig Dis Sci 1981;26:737?40.

    7. Ferguson R, Basu MK, Asquith P, Cooke WT. Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration. Br Med J 1976;1(6000):11?13.

    8. Ferguson MM, Wray D, Carmichael HA, et al. Coeliac disease associated with recurrent aphthae. Gut 1980;21:223?6.

    9. Hunter IP, Ferguson MM, Scully C, et al. Effects of dietary gluten elimination in patients with recurrent minor aphthous stomatitis and no detectable gluten enteropathy. Oral Surg Oral Med Oral Pathol 1993;75:595?8.

    10. O?Farrelly C, O?Mahony C, Graeme-Cook F, et al. Gliadin antibodies identify gluten-sensitive oral ulceration in the absence of villous atrophy. J Oral Pathol Med 1991;20:476?8.

    11. Wray D. Gluten-sensitive recurrent aphthous stomatitis. Dig Dis Sci 1981;26:737?40.

    12. Ferguson R, Basu MK, Asquith P, Cooke WT. Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration. Br Med J 1976;1(6000):11?13.

    13. Ferguson MM, Wray D, Carmichael HA, et al. Coeliac disease associated with recurrent aphthae. Gut 1980;21:223?6.

    14. Hunter IP, Ferguson MM, Scully C, et al. Effects of dietary gluten elimination in patients with recurrent minor aphthous stomatitis and no detectable gluten enteropathy. Oral Surg Oral Med Oral Pathol 1993;75:595?8.

    15. O?Farrelly C, O?Mahony C, Graeme-Cook F, et al. Gliadin antibodies identify gluten-sensitive oral ulceration in the absence of villous atrophy. J Oral Pathol Med 1991;20:476?8.

    16. Plemons JM, Reps TD, Binnie WH, et al. Evaluation of acemannan in the treatment of recurrent aphthous stomatitis. Wounds 1994;6:40?5.

    17. Das SK, Gulati AK, Singh VP. Deglycyrrhizinated licorice in aphthous ulcers. J Assoc Physicians India 1989; 37:647.

    18. Porter SR, Scully C, Flint S. Hematologic status in recurrent aphthous stomatitis compared to other oral disease. Oral Surg Oral Med Oral Pathol 1988;66:41?4.

    19. Palopoli J, Waxman J. Recurrent aphthous stomatitis and vitamin B12 deficiency. South Med J 1990;83:475?7.

    20. Wray D, Ferguson MM, Hutcheon WA, Dagg JH. Nutritional deficiencies in recurrent aphthae. J Oral Pathol 1978;7:418?23.

    21. Barnadas MA, Remacha A, Condomines J, de Moragas JM. [Hematologic deficiencies in patients with recurrent oral aphthae]. Med Clin (Barc) 1997;109:85?7 [in Spanish].

    22. Olson JA, Feinberg I, Silverman S, et al. Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1982;54:517?20.

    23. Weusten BL, van de Wiel A. Aphthous ulcers and vitamin B12 deficiency. Neth J Med 1998;53:172?5.

    24. Porter S, Flint S, Scully C, Keith O. Recurrent aphthous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies. Ann Dent 1992;51:14?6.

    25. Wray D, Ferguson MM, Mason DK, et al. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Br Med J 1975;2(5969):490?3.

    26. Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991;20:389?91.

    27. Haisraeli-Shalish M, Livneh A, Katz J, et al. Recurrent aphthous stomatitis and thiamine deficiency. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:634?6.

    28. James APR. Common dermatologic disorders. CIBA Clin Symposia 1967;19:38?64.

    29. Werbach MR. Nutritional Influences on Illness, 2d ed. Tarzana, CA: Third Line Press, 1993, 56 [review].

    30. Gerenrich RL, Hart RW. Treatment of oral ulcerations with Bacid (Lactobacillus acidophilus). Oral Surg 1970;30:196?200.

    31. Porter SR, Scully C, Flint S. Hematologic status in recurrent aphthous stomatitis compared to other oral disease. Oral Surg Oral Med Oral Pathol 1988;66:41?4.

    32. Palopoli J, Waxman J. Recurrent aphthous stomatitis and vitamin B12 deficiency. South Med J 1990;83:475?7.

    33. Wray D, Ferguson MM, Hutcheon WA, Dagg JH. Nutritional deficiencies in recurrent aphthae. J Oral Pathol 1978;7:418?23.

    34. Barnadas MA, Remacha A, Condomines J, de Moragas JM. [Hematologic deficiencies in patients with recurrent oral aphthae]. Med Clin (Barc) 1997;109:85?7 [in Spanish].

    35. Olson JA, Feinberg I, Silverman S, et al. Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1982;54:517?20.

    36. Weusten BL, van de Wiel A. Aphthous ulcers and vitamin B12 deficiency. Neth J Med 1998;53:172?5.

    37. Porter S, Flint S, Scully C, Keith O. Recurrent aphthous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies. Ann Dent 1992;51:14?6.

    38. Wray D, Ferguson MM, Mason DK, et al. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Br Med J 1975;2(5969):490?3.

    39. Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991;20:389?91.

    40. Haisraeli-Shalish M, Livneh A, Katz J, et al. Recurrent aphthous stomatitis and thiamine deficiency. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:634?6.

    41. Pang JF. Relation between treatment with traditional Chinese medicine for recurrent aphthous ulcer and human zinc and copper. Zhongguo Zhong Xi Yi Jie He Za Zhi 1992;12:280?2, 260?1 [in Chinese].

    42. Endre L. Recurrent aphthous ulceration with zinc deficiency and cellular immune deficiency. Oral Surg Oral Med Oral Pathol 1991;72:559?61.

    43. Merchant HW, Gangarosa LP, Glassman AB, Sobel RE. Zinc sulfate supplementation for treatment of recurring oral ulcers. South Med J 1977;70:559?61.

    44. Wray D. A double-blind trial of systemic zinc sulfate in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982;53:469?72.

    45. Nasemann T. Kamillosan therapy in dermatology. Z Allgemeinmed 1975; 25:1105?6.

    46. Nasemann T. Kamillosan therapy in dermatology. Z Allgemeinmed 1975; 25:1105?6.

    47. Porter SR, Scully C, Flint S. Hematologic status in recurrent aphthous stomatitis compared to other oral disease. Oral Surg Oral Med Oral Pathol 1988;66:41?4.

    48. Palopoli J, Waxman J. Recurrent aphthous stomatitis and vitamin B12 deficiency. South Med J 1990;83:475?7.

    49. Wray D, Ferguson MM, Hutcheon WA, Dagg JH. Nutritional deficiencies in recurrent aphthae. J Oral Pathol 1978;7:418?23.

    50. Barnadas MA, Remacha A, Condomines J, de Moragas JM. [Hematologic deficiencies in patients with recurrent oral aphthae]. Med Clin (Barc) 1997;109:85?7 [in Spanish].

    51. Olson JA, Feinberg I, Silverman S, et al. Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol 1982;54:517?20.

    52. Weusten BL, van de Wiel A. Aphthous ulcers and vitamin B12 deficiency. Neth J Med 1998;53:172?5.

    53. Porter S, Flint S, Scully C, Keith O. Recurrent aphthous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies. Ann Dent 1992;51:14?6.

    54. Wray D, Ferguson MM, Mason DK, et al. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Br Med J 1975;2(5969):490?3.

    55. Volkov I, Rudoy I, Freud T, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial.J Am Board Fam Med 2009;22:9?16.

    56. Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991;20:389?91.

    57. Haisraeli-Shalish M, Livneh A, Katz J, et al. Recurrent aphthous stomatitis and thiamine deficiency. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:634?6.

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