MOUTH ULCERS

Canker sores are a type of mouth ulcer.
Some of the medical terms used to refer to canker sores are "recurrent minor aphthous ulcers" and "recurrent minor aphthous stomatitis" (thus differentiating canker sores from other forms of aphthous ulcers or aphthous stomatitis).
Canker sores are the most commonly occurring type of mouth ulcer.

CAUSES

The precise mechanism by which canker sores form has not been definitively determined but it is likely that their development is related to a reaction of an individual's own immune system.

Canker sores are thought to form when, for unexplained reasons, a person's immune system identifies the presence of chemical molecules that it does not recognize.
The presence of these molecules activates an attack by the immune system's lymphocytes (a type of white blood cell), somewhat similar as when a person's immune system attacks a transplanted organ. The carnage created by the lymphocytes' attack on these unrecognized molecules results in the formation of mouth ulcers. We term these ulcers canker sores.

Risk factors are associated with aphthous ulcer breakouts

Several factors that seem to be triggers for outbreaks of canker sores have been identified. Any one or a combination of the following risk factors may play a role in the formation of canker sores for any one individual:

Toothpastes and mouthwashes that contain sodium lauryl sulfate (SLS).

Research has suggested that the use of products that contain sodium lauryl sulfate ("SLS"), a foaming agent found in most toothpaste and mouthwash formulations, can be associated with an increased risk for canker sore outbreaks. This may be due to a drying effect SLS has on the protective surface of oral tissues. Once this protective layer has been compromised the tissue underneath is more vulnerable to irritants such as acidic foods.
Several studies have reported that participants who brushed using SLS free toothpaste found that they experienced a reduction in the total number of canker sores that they had form. This reduction in mouth sores was found to be as high as 81% in one study. In this same study also reported that some of its participants stated that the canker sores that did form were less painful than those that developed during those time periods when they had been using a toothpaste that did contain SLS.

Mechanical trauma to oral tissues.

People state that they often recall some sort of physical trauma preceding the formation of their canker sores. This trauma might take the form of a self-inflicted bite, irritation from a sharp tooth edge, or possibly trauma from some type of food such as a crisp chip. 38% of the participants of one study felt that their canker sores were precipitated by trauma.

Emotional stress / Psychic stress.

Psychological stress has been shown to adversely affect the health of people in a number of ways. Many people who suffer from canker sores report that the appearances of their ulcers coincide with periods of stress.

Diet: Nutritional deficiencies.

Researchers have found that some people who suffer from canker sore outbreaks have poor diets and therefore an accompanying nutritional deficiency. Some of the nutritional deficiencies that have been correlated with the presence of canker sores are:

* Vitamin deficiencies: B1, B2, B6, B12, C
* Other nutrients: zinc, folic acid, iron, selenium, calcium

Diet: Allergies and sensitivities.

Allergies to foods and other substances have been postulated as being triggers for canker sore breakouts.
Any substance that comes into contact with the person's oral tissues must be considered to be a potential causative agent.
If an allergy is suspected the individual might choose to maintain a diary so to help them (and their dentist) identify the most likely candidates associated with the causation of their sores.
In some cases allergy testing might be considered.

Some of the dietary substances identified by researchers as being potential triggers for canker sore outbreaks are:

* Cereal grains: buckwheat, wheat, oats, rye, barley, the gluten protein found in grains
* Fruits and vegetables: lemons, oranges, pineapples, apples, figs, tomatoes, strawberries
* Dairy: milk, cheeses
* Other foods: nuts, chocolate, shellfish, soy, vinegar, French mustard
* Additives: cinnamonaldehyde (a flavoring agent), benzoic acid (a preservative)
* Other substances: toothpastes, mints, gums, dental materials, metals, medications

Hormonal changes.

Some women have reported that they find a relationship between the presence of canker sores and certain phases of their menstrual period.
It has also been reported that a woman may notice a remission of canker sores during pregnancy.
Neither of these observations has been adequately documented nor explained by research.

Genetics.

Some researchers have felt that they have identified a genetic predisposition for canker sores.
One study found that 35% of those persons who experience canker sores have at least one parent who suffers from these ulcers also. Another study found that 91% of identical twins both suffered from canker sores whereas only 57% of fraternal twins did.

Infectious agents (both bacterial and viral).

The fact that chemical compounds typically associated with bacterial and viral infections have been isolated from canker sores suggests that bacteria or viruses could be causative agents in the formation of these mouth ulcers.

Medical conditions.

Several different medical conditions can be associated with the presence of canker sores (and other forms of aphthous ulcers as well). For those patients who experience persistent difficulties with canker sores consideration must be given to the presence of an underlying undiagnosed systemic disease and the need for an evaluation and testing by a physician.
A few of the medical conditions that have been associated with the presence of mouth ulcers are: Behcet's disease, neutrophil dysfunction diseases, inflammatory bowel diseases (celiac and Crohn's), and HIV-AIDS.

Medications.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs), beta blockers, chemotherapeutic agents, and nicorandil have each been suggested as possibly placing a person at greater risk for outbreaks of canker sores.


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