You usually get your first one as a kid and you can’t believe it. How can anything so small hurt so much? As an occasional sufferer myself, I’m convinced there’s a canker sore demon haunting our lives, maybe sitting at a computer somewhere, waiting to catch us off guard. Press the “Enter” button and, Oh!…Ouch! Then, depending where it’s landed, and unable to kiss (or eat or smile), I mutter pearls of wisdom like, “Doctors can transplant a liver, but they can’t cure a canker sore.” This is all the more exasperating when you’re a doctor yourself. Well, actually, the integrative approach we use at WholeHealth Chicago has helped me quite a bit. And although I can neither transplant your liver nor fully cure your canker sore, let me share with you what has worked for us.
What are Canker Sores?
White or yellowish with red rims, canker sores are small, painful ulcers that can occur anywhere inside the mouth. The craterlike sores appear fairly suddenly, either singly or in small groups of two or three, and occasionally in much larger clusters. Burning, itchiness, or a tingling feeling may signal the start of an outbreak. Canker sores usually heal within about two weeks, with or without treatment, but they can recur. Canker sores are very common, especially between the ages of 10 and 40 and more so among women than men. While they are not a serious health threat, canker sores can make eating, drinking, talking, and kissing extremely painful, especially during the first few days of an outbreak. Fortunately, simple self-care measures and supplements can ease the pain of canker sores, speed their healing, and prevent recurrences.
Small, red-rimmed white or yellowish sores inside the mouth–on the tongue, gums, soft palate, or inside the lips or cheeks
A tingling, burning, or itching sensation that precedes the appearance of canker sores
Sharp pain when talking, eating, and drinking. The pain is most intense during the first few days after sores erupt.
What Causes Canker Sores?
The exact cause is not known, but an important factor seems to be stress, which may trigger an overreaction of the immune system to bacteria normally found in the mouth. Other factors that may precipitate an outbreak of canker sores include:
An injury to the tongue or mouth cavity caused by a chipped or jagged tooth, a rough-surfaced tooth filling, braces, ill-fitting dentures, or a hard-bristled toothbrush; burns from hot foods or liquids; biting the tongue or inside of the cheek; or your dentist “slipping” with one of his instruments against your cheek or gums, and saying, “Oops! Sorry about that.”
Irritation from certain foods, especially acidic, spicy, or salty items. Citrus fruits, tomatoes, pineapples, hot peppers, cinnamon, chocolate, nuts, and potato chips have all been cited as canker sore triggers.
Food allergies. According to some experts, recurring canker sores may be caused by allergic reactions to food preservatives, such as benzoic acid or sorbic acid, or to gluten, a protein found in wheat and other grains.
Deficiencies in vitamin D and in the amino acid lysine.
Treatment and Prevention
Once canker sores occur, the aim of treatment is to relieve pain, speed the healing process, and prevent recurrences. Ice and over-the-counter medications can provide pain relief, while a number of supplements are available that may help promote healing and boost resistance to canker sores.
Other preventive measures include keeping the mouth clean and healthy, eliminating sources of mouth irritation or injury, and identifying and avoiding foods that seem to trigger outbreaks.
If self-care and supplements fail to relieve the pain or frequency of canker sores, you can ask your doctor about amlexanox, a prescription oral paste developed specifically to ease canker sore pain and accelerate healing.
Two additional treatments are currently being used by some physicians, depending on the specific circumstances. They may prescribe acyclovir, an antiviral compound used to treat herpes viral infections, because it’s been reported that canker sores may be triggered by a herpetic viral infection. The medication is taken four to five times daily for five to seven days. If you and your doctor believe this is a possibility, and your problem is a severe one, then you may want to consider a course of this medication during your next flare-up.
A second treatment uses antifungal medications, such as nystatin or Diflucan, which have been reported effective for chronic canker sores. Presumably yeast (Candida albicans) infects the canker sores and prevents prompt healing. Again, you should discuss this therapy with your physician.
Just a reminder: If you have a serious medical problem or are taking medication, be sure to check with your doctor before starting a supplement program.
How Supplements Can Help
Begin supplement treatment with the amino acid lysine. A lysine deficiency has been linked to the development of canker sores.
Along with lysine, add echinacea, an immune system booster. You want to be generous with the echinacea, say 200 mg four or five times a day. Also, if taken in a low dose (200 mg) every morning for three weeks a month, echinacea may also keep canker sores from forming. Calendula tincture may also help. Try swishing the inside of your mouth with the calendula (1 tbsp. tincture in 4 oz warm water) three times a day.
In addition to strengthening the immune system, vitamin C seems to help heal ulcerated mucous membranes in the mouth. Take vitamin C with flavonoids, natural compounds that enhance the vitamin’s effectiveness.
Chewing licorice (DGL) wafers coats canker sores, protecting them from irritants and promoting healing. Another way to speed healing is to apply liquid goldenseal to the sore.
Instead of licorice wafers or goldenseal, consider taking zinc lozenges to help heal sores and increase your resistance to them.
People prone to canker sores may lack B vitamins. A vitamin B complex taken daily is an excellent preventive measure.
Apply crushed ice to canker sores to help numb the pain.
Ask your pharmacist for an over-the-counter pain reliever for canker sores or a waterproof gel that keeps irritants away from sores as they heal.
Avoid spicy or acidic foods that can further irritate sores.
Try to identify those trigger foods that seem to initial canker sores and eliminate them from your diet.
Try to stop gnawing at the inside of your cheek, if this is becoming a habit.
Brush and floss your teeth regularly. To avoid irritating the inside of your mouth, brush gently with a soft-bristled toothbrush.
Make sure you don’t share a toothbrush with anybody else. And get a new toothbrush once you get rid of the ulcer–you don’t want to infect another person or re-infect yourself.
When to Call a Doctor
If you experience pain so severe that you are unable to drink enough fluids
If more than four canker sores erupt in your mouth
If the sores last longer than two weeks
If an outbreak of canker sores is accompanied by fever of 101°F or higher
If you develop canker sores more than two or three times a year
If canker sores are caused by braces, dentures, or a chipped or jagged tooth. (See your dentist for advice.)
From David Edelberg, M.D.at WholeHealth Chicago: Some of the supplements included here are meant to soothe canker sores. And since your immune system very likely plays a role in the eruption of canker sores, we’ve included several nutrients that help strengthen it.
How to Take the Supplements
Start the lysine, echinacea, vitamin C and flavonoids. You can take all of them together in the doses recommended. The lysine supplies an amino acid that may be deficient when canker sores erupt, and the other supplements are immune-system boosters.
Chewing the licorice wafers (the DGL form, not the candy) will coat the sores and help your body’s natural healing processes. If you can’t find licorice wafers, then try zinc lozenges (the kind recommended for colds), or the liquid extracts of either goldenseal (as a topical application) or calendula (as a gargle).
If you get canker sores frequently, you may be deficient in B vitamins, so add a daily vitamin B complex as a preventive.
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
David Edelberg, MD