Food for canker sores

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Canker Sores

Topic Overview

What is a canker sore?

A canker sore is a shallow sore shaped like a crater (ulcer) on your tongue or on the inside of your lip or cheek. Canker sores have a red border and a white or yellow center. They may be painful and can make it hard to talk and eat. You may have one or more than one canker sore at a time. Unlike cold sores , you cannot spread canker sores to other people. See a picture of canker sores .

Anyone can get a canker sore, but women, teens, and young adults have them more often. Most people have canker sores at some time in their lives, and some people have them regularly.

What causes a canker sore?

The cause of canker sores is unknown, but they tend to run in families. Canker sores are not contagious.

Canker sores may also develop when you:

  • Are stressed or tired.
  • Have your menstrual cycle, if you are a woman.
  • Hurt your mouth, such as biting your lip.
  • Have braces on your teeth.
  • Have food allergies. Eating foods that you are allergic to may cause you to get a canker sore.
  • Eat or drink food or juice that has a lot of acid, such as orange juice.
  • Do not get enough vitamins or minerals in your diet, such as iron, vitamin B12, and folic acid.

What are the symptoms?

The main symptom of a canker sore is getting a shallow ulcer on your tongue or on the inside of your lip or cheek. The sore may be large or small, and it will have a red border and a white or yellow center. You might have more than one canker sore at a time.

Canker sores usually begin with a burning or tingling feeling. They may be swollen and painful. Having a canker sore can make it hard to talk or eat.

Canker sores may hurt for 7 to 10 days. Minor canker sores heal completely in 1 to 3 weeks, but major canker sores can take up to 6 weeks to heal. Some people get another canker sore after the first sore has healed. Most canker sores heal without a scar.

How is a canker sore diagnosed?

If you see your doctor or dentist about the pain caused by your canker sores, he or she will do a physical exam by looking in your mouth to diagnose the canker sores.

How is it treated?

You do not need to see a doctor for most canker sores. They will get better on their own. There are many things you can try at home to relieve the pain caused by your canker sores:

  • Eat soft, bland foods that are easy to swallow, such as yogurt or cream soup. Cut your food into small pieces or mash or puree it. Avoid coffee, chocolate, spicy or salty foods, citrus fruits or juices, nuts, seeds, and tomatoes.
  • Drink cold fluids, such as water or iced tea, or eat Popsicles. Sometimes fluid touching the canker sore can cause a stinging pain. Use a straw so the fluid doesn’t touch the canker sore. Hold ice on the canker sore until it is numb.
  • Carefully brush your teeth so you don’t touch the sore with the toothbrush bristles.
  • Rinse your mouth with salt water. To make a salt water rinse, dissolve 1 tsp (5 g) of salt in 1 cup (250 mL) of warm water.
  • Buy an over-the-counter medicine, such as Anbesol, Milk of Magnesia, or Orabase, to put on your canker sores. Use a cotton swab to apply the medicine. Put it on your sores 3 to 4 times a day. If your child is under 2 years of age, ask your doctor if you can give your child numbing medicines.
  • Take a pain reliever, such as nonsteroidal anti-inflammatory drugs (NSAIDs) , including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen (such as Aleve). Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome . Be safe with medicines. Read and follow all instructions on the label.

If your canker sores do not feel better after trying these steps at home for 2 weeks, you may need to see your doctor or dentist. He or she may recommend medicines that will help relieve pain caused by your canker sores. Usually these medicines are swished or gargled in your mouth, or they are painted on the sore. Your doctor may prescribe steroid cream or paste to rub on your canker sore and/or a prescription mouthwash to use.

Talk to your doctor if you have a fever, have trouble swallowing, or if your canker sores keep coming back. You may have another problem that is causing your symptoms.

How can canker sores be prevented?

Most of the time the cause of canker sores is unknown. Unless you know what causes your canker sores, you cannot prevent them from happening. If you do know what causes your canker sores, you can help prevent them by avoiding what you know causes them. For example, if you have gotten canker sores in the past from hurting the inside of your mouth, you might help prevent them by chewing your food slowly and carefully, trying not to talk and chew at the same time, and using a soft-bristled toothbrush when you brush your teeth.

If you have gotten canker sores in the past by eating foods that have a lot of acid (such as citrus fruits or tomatoes) and sharp or harsh foods (such as bread crusts, corn chips, or potato chips), it might help to avoid these. Other ways that might help to prevent canker sores include limiting your use of alcohol and tobacco and controlling the stress in your life.

In general, it is important to get enough vitamins and minerals in your diet, like folic acid, vitamin B12, zinc, and iron.

What Causes Canker Sores, and How to Prevent Them

Multiple factors can contribute to a canker sore. Here’s what you need to know about possible causes and risk factors, as well as tips for stopping future lesions.

Avoiding acidic foods and taking care with good oral hygiene may help prevent canker sores. ; iStock (2)

Even though most canker sores are harmless and go away on their own in about one to two weeks, these lesions can be painful and annoying. (1)

Whether you’re dealing with your first canker sore or you have a history of repeated sores, preventing future problems starts with understanding why these lesions occur in the first place.

While the exact cause of canker sores is unknown, many factors can increase the risk of these mouth ulcers. Here’s a look at possible known triggers.

Injuring Your Mouth Can Lead to a Canker Sore

The skin inside of your mouth is delicate and sensitive. And unfortunately, it doesn’t take much to damage this soft area.

It can occur from brushing or flossing your teeth too roughly. Or you might sustain an injury during dental work or while playing sports. (2,3)

Accidentally biting the inside of your mouth while chewing on food can also lead to canker sores.

Toothpaste and Mouthwashes Can Irritate Your Mouth

Toothpastes and mouthwashes help maintain oral health by removing plaque from your teeth and freshening your breath. But if your oral hygiene products contain sodium lauryl sulfate (SLS), you may develop a canker sore if you’re sensitive to this ingredient. (1)

A review published in March 2017 in the journal Clinical and Aesthetic Dermatology noted that in a trial conducted among patients using SLS-free products and a control group, the SLS-free products didn’t reduce the occurrence of sores, but did positively affect the healing process. (4)

If you have a history of canker sores, check the ingredient label of your oral products. Choose toothpastes and mouthwashes that don’t contain this ingredient, and then monitor your condition for improvement.

Diet Can Play a Role in Canker Sore Development

Certain foods are known triggers. These include salty foods and spicy foods, as well as acidic drinks and foods, such as oranges, lemons, tomatoes, and pineapples. (2)

A low intake of certain vitamins and nutrients — folic acid, zinc, iron — may also bring about canker sores. (2)

Research suggests that supplemental intake of vitamin B12 can help reduce the incidence of mouth ulcers. In a study published in the Journal of the American Board of Family Medicine, 58 people with recurrent canker sores were given 1,000 micrograms (mcg) of vitamin B12 at bedtime for six months. (5) The study found that after supplementing with the vitamin, 74 percent of participants no longer had sores at the end of treatment.

The Bacteria That Causes Stomach Ulcers Can Affect Your Mouth

Helicobacter pylori is a bacteria that causes infections in the stomach. It’s also the same bacteria responsible for peptic ulcers, which are sores in the lining of the stomach and the upper part of the small intestines. Sometimes the bacteria can be found in the oral cavity, triggering canker sores in some people. (1)

Other Possible Triggers: Hormonal Shifts, Heredity, and Stress

You’re also at risk for canker sores if you have a gluten intolerance or a gluten allergy (Celiac disease), or other food allergies. (1) But it’s important to note that canker sores aren’t always caused by food, notes Jennifer Silver, DDS, who is based in Calgary, British Columbia.

These types of lesions can also run in families. So if your mother or father are prone to canker sores, you may be, too. (1,2,3)

Additionally, emotional stress and hormonal shifts can be culprits, as well as autoimmune diseases or conditions that cause inflammation, such as Crohn’s disease, Behcet’s disease, and HIV or AIDS. (1,2)

What Doesn’t Cause Canker Sores

Canker sores aren’t contagious — you can’t get a sore from kissing someone, sharing food or drinks, or touching another person’s lesions. (3)

Cold sores produce oral lesions, too. But unlike a canker sore, cold sores are contagious, warns Samantha Rawdin, DMD, a prosthodontist based in New York City. Cold sores or fever blisters are caused by the herpes virus, which doesn’t cause canker sores. (1)

In addition, recurrent cold sores occur outside of the mouth and don’t form on the “keratinized” tissues of the oral area (lips and along the gum line) like canker sores, Dr. Rawdin adds.

How to Prevent a Canker Sore

Since the exact cause of canker sores is unknown, prevention isn’t always possible. But you can take steps to reduce the likelihood and frequency of these sores.

“Write down everything you eat and drink, as well as whenever you get a canker sore,” says Dr. Silver. “You may start to notice that eating certain foods or drinks, typically things with high acidity or lots of spice, will correlate with a canker sore.”

Also, if you have known food allergies or a gluten intolerance, avoid eating these foods, too.

Vitamin supplementation may also reduce your risk, if you have a deficiency. So talk to your doctor about blood testing to check your levels.

Make sure you eat a healthy, balanced diet to receive adequate nutrients and minerals each day. This include fruits, vegetables, lean meats, and whole grains.

Some people develop canker sores while under emotional stress. If you believe stress is a trigger, here are tips to reduce your stress level, and possibly reduce the frequency of outbreaks: (1,3)

  • Practice deep breathing exercises or meditation
  • Get plenty of sleep
  • Exercise regularly
  • Find enjoyable activities
  • Eat a healthy diet
  • Build your social connections
  • Get counseling

Reducing canker sores might also be a matter of improving oral hygiene, or changing your oral habits. This includes gently brushing your teeth at least twice a day to remove germs and bacteria, and flossing daily. It’s worth seeing if you notice a difference when you use oral products that don’t contain sodium lauryl sulfate. (1)

Also, don’t ignore repeated canker sores. “If it’s a constant problem, see your dentist or primary care doctor to determine if there’s an underlying cause,” says Rawdin.

If you’ve taken steps to limit incidents, yet your condition hasn’t improved, talk to your doctor. The underlying trigger might be something you haven’t considered, such as a food allergy, chronic inflammation, or an autoimmune disease.

Mouth ulcer

Mouth ulcers are painful sores that appear in the mouth. Although they’re uncomfortable, they’re usually harmless and most clear up by themselves within a week or two.

Mouth ulcers are common and can usually be managed at home, without seeing your dentist or GP. Visit your pharmacist first, unless your ulcer has lasted longer than three weeks.

What does a mouth ulcer look like?

Mouth ulcers are usually round or oval sores that commonly appear inside the mouth on the:

  • cheeks
  • lips
  • tongue

They can be white, red, yellow or grey in colour and swollen.

It’s possible to have more than one mouth ulcer at a time and they may spread or grow.

Mouth ulcers shouldn’t be confused with cold sores, which are small blisters that develop on the lips or around the mouth. Cold sores often begin with a tingling, itching or burning sensation around your mouth.

When to see your pharmacist, dentist or GP

Mouth ulcers can be painful, which can make it uncomfortable to eat, drink or brush your teeth.

It’s usually safe to treat mouth ulcers at home. See your GP or dentist if:

  • your mouth ulcer has lasted three weeks
  • you keep getting mouth ulcers
  • your mouth ulcer becomes more painful or red – this could be a sign of a bacterial infection, which may need treatment with antibiotics

Mouth ulcers are also a possible symptom of a viral infection that mainly affects young children, called hand, foot and mouth disease. Speak to your GP or call the NHS 24 111 service if you’re unsure.

Read about the symptoms of hand, foot and mouth disease.

How to treat mouth ulcers

Mouth ulcers don’t usually need to be treated, because they tend to clear up by themselves within a week or two.

However, treatment can help to reduce swelling and ease any discomfort. This may help if you keep getting mouth ulcers or your mouth ulcer affects eating and drinking.

Self care

Things you can do to speed up healing include:

  • applying a protective paste recommended by your pharmacist
  • using a soft toothbrush to brush your teeth
  • using a toothpaste that doesn’t contain sodium lauryl sulphate, as this may be irritating
  • avoiding hard, spicy, salty, acidic or hot food and drink until the ulcer heals
  • using a straw to drink cool drinks
  • avoiding things that may be triggering your mouth ulcers – see causes, below

Pharmacy medicines

You can buy several types of mouth ulcer treatment from a pharmacy. Speak to your pharmacist about the best treatment for you. Options include the following:

  • Antimicrobial mouthwash may speed up healing and prevent infection of the ulcer. Children under two shouldn’t use this treatment. It also contains chlorexidine gluconate, which may stain teeth – but this may fade once treatment is finished.
  • Painkillers are available as a mouthwash, lozenge, gel or spray. They can sting on first use and your mouth may feel numb – but this is temporary. Mouthwash can be diluted with water if stinging continues. Children under 12 shouldn’t use mouthwash or gel. Mouthwash shouldn’t be used for more than seven days in a row.
  • Corticosteroid lozenges may reduce pain and speed up healing. These are best used as soon as the ulcer appears, but shouldn’t be used by children under 12.

Medicines from your dentist or GP

If necessary, you may be prescribed a course of stronger corticosteroids to help reduce pain and swelling, and speed up healing.

Corticosteroids are available on prescription as tablets, mouthwash, paste or spray, but are not suitable for children under 12.

Is it mouth cancer?

In a few cases, a long-lasting mouth ulcer can be a sign of mouth cancer. Ulcers caused by mouth cancer usually appear on or under the tongue, although you can get them in other areas of the mouth.

Risk factors for mouth cancer include:

  • smoking or using products that contain tobacco
  • drinking alcohol – smokers who are also heavy drinkers have a much higher risk compared to the population at large
  • infection with the human papilloma virus (HPV) – the virus that causes genital warts

It’s important to detect mouth cancer as early as possible. If mouth cancer is detected early, the chances of a complete recovery are good. Regular dental check-ups are the best way to detect the early signs.

What causes mouth ulcers?

In many cases, the reason for mouth ulcers is unclear. Most single mouth ulcers are caused by damage to the lining inside of the mouth. For example:

  • accidentally biting the inside of your cheek or a sharp tooth
  • poorly fitting dentures
  • hard food
  • a defective filling

It’s not always clear what causes mouth ulcers that keep returning, but triggers are thought to include:

  • stress and anxiety
  • hormonal changes – some women develop mouth ulcers during their monthly period
  • eating certain foods – such as chocolate, spicy foods, coffee, peanuts, almonds, strawberries, cheese, tomatoes and wheat flour
  • toothpaste containing sodium lauryl sulphate
  • stopping smoking – when you first stop smoking, you may develop mouth ulcers

Your genes are also thought to have a role – around 40% of people who keep getting mouth ulcers report that it runs in their family.

Medical conditions

Mouth ulcers can sometimes be caused by certain medical conditions, such as:

  • viral infections – including the cold sore virus, chickenpox, and hand, foot and mouth disease
  • vitamin B12 or iron deficiency
  • Crohn’s disease – a long-term condition that causes inflammation of the lining of the digestive system
  • coeliac disease – a common digestive condition where a person has an adverse reaction to gluten
  • reactive arthritis – a condition that causes inflammation in various places in the body, usually as a reaction to an infection
  • weakened immune system – for example, due to HIV or lupus
  • Behçet’s disease – a rare and poorly understood condition that also causes swelling of the blood vessels

Medications and treatments

Mouth ulcers can sometimes be caused by certain medications or treatments, such as:

  • non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen
  • nicorandil – a medication sometimes used to treat angina
  • beta-blockers – used to treat conditions such as angina, high blood pressure and abnormal heart rhythms
  • a side effect of chemotherapy or radiotherapy – this is known as mucositis

Can mouth ulcers be prevented?

It may not be possible to prevent mouth ulcers, because they’re often caused by things you can’t control (such as a family history or a medical condition).

However, the following may help to reduce your risk of developing mouth ulcers:

  • avoiding certain foods – such as chocolate, spicy foods, coffee, peanuts, almonds, strawberries, cheese, tomatoes and wheat flour, if they cause you to have an ulcer
  • not chewing gum
  • brushing your teeth with a soft-bristled brush, which may reduce irritation in your mouth
  • using toothpaste that doesn’t contain sodium lauryl sulphate
  • reducing stress and anxiety – which may be a trigger for some people

Read more advice on dental health.

Mouth Ulcers: Causes, Prevention and Easy Home Remedies

We have all suffered from ulcers in the mouth at some time or another. Mouth ulcers or canker sores are small, painful legions that are usually harmless and clear up on their own. However, they can be painful and extremely troublesome as they interfere with your eating habits. They are round or oval with a white or yellow centre and a red rim. Ulcers of the mouth can be found inside the cheeks, on the tongue or below it, on the gums, or the lips. Sometimes, these ulcers may even make it difficult for you to eat, brush your teeth or talk. There are three types of ulcers: First is minor that are small, oval shaped with red edges and heal quickly, leaving no scar, second is major that are larger than the minor sores, extremely painful and can take up to six weeks to heal, often leaving scars. Finally, the third one is Herpetiform that is a cluster of 10-100 pinpoint ulcers merging into one entity. They take about two weeks to heal and leave no scar.

Causes of mouth ulcers

Why do mouth ulcers occur? The answer to this remains unclear, however some common causes may be:

– A sharp tooth or accidental biting of the inside of your cheek

– Dentures that do not fit well

– Eating hard food items that may cause friction

– Poorly filled tooth

If you have recurring issues of mouth ulcers, the reasons may be any of the following:

– Hormonal changes – some women develop mouth ulcers during or just before their monthly period.

– Stress and anxiety in daily life

Home remedies for mouth ulcers: Stress may also cause mouth ulcers

– Eating certain foods – such as chocolate, spicy foods, coffee, peanuts, almonds, strawberries, cheese, tomatoes or wheat flour

– Toothpaste containing sodium lauryl sulphate

– Stopping smoking – when you first stop smoking, you may develop mouth ulcers

Home remedies for mouth ulcers: Eating foods like chocolates, et al can cause ulcers

– A diet lacking in vitamin B-12, zinc, folate (folic acid) or iron

– An allergic response to certain bacteria in your mouth

– Helicobacter pylori, the same bacteria that cause peptic ulcers

Certain underlying medical conditions may also lead to oral ulcers. These include but are not limited to:

– Impaired immune system

– Bechet’s disease, that causes inflammation all over the body

– Celiac Disease- an intestinal disorder caused by sensitivity to gluten a protein found in grains

– Inflammatory bowel diseases like Crohn’s and ulcerative colitis

Home Remedies for Mouth Ulcers

1. Mouthwash
Medical therapy includes relief of pain and reduction of ulcer duration, says Dr. AK Singh MD, Consultant, Department of Pulmonology, Fortis Escorts Heart Hospital, Delhi.

– Antimicrobial mouthwash can hasten healing and prevent infection of the ulcer. However, children under the age of two shouldn’t use this treatment.

– Painkillers are available in the form of mouthwash, lozenge, gel or spray. You must consult a physician before taking these. Mouthwash shouldn’t be used for more than seven days in a row.

Home remedies for mouth ulcers: Painkillers are available in the form of mouthwash

– Corticosteroid lozenges may reduce pain and speed up healing. These are best when used as soon as the ulcer appears. Again, these shouldn’t be used by children under 12

– Iron or vitamin deficiency should be corrected

– The occasional patient who relates ulcers to her menstrual cycle or to the use of an oral contraceptive may benefit from suppression of ovulation with a progestogen or a change in the oral contraceptive. Consult a gynecologist before making these changes.

– Severe diseases may require antibiotic oral rinses, other medications or even low level laser therapy to relieve pain

2. Prevention of oral ulcers

– Avoiding certain foods can help steer clear of mouth ulcers. These include chocolates, spicy foods, coffee, peanuts, almonds, strawberries, cheese, tomatoes and wheat flour. You may want to get a patch test to reveal allergies to determine which food to avoid.

– Avoid eating particularly hard or sharp foods (eg. toast, potato crisps)

– Do not chew gum

– Use a small-headed, soft tooth brush for brushing your teeth

– Use toothpaste that doesn’t contain sodium lauryl sulphate

– Try to reduce stress and anxiety as these may also be a trigger for some people

3. Food therapy

Eating is painful with an ulcer and our normal spicy food is poorly tolerated. Milk based dishes like kheer, porridge, dahi are easy to ingest and do not irritate the mouth lining. Bland soft food including bakes, moong dal, khichri, idli, upma, bread, paneer, soft boiled eggs and soft vegetables and fruits like ghiya, pumpkin, potato, papaya, and banana are soothing to eat. The temperature of the food should not be very hot or very chilled as both may cause difficulty and pain. See what you are comfortable with and eat accordingly.

Home remedies for mouth ulcers: Eating is painful with an ulcer and our normal spicy food is poorly tolerated

4. Other Remedies

You may try these home remedies to treat painful ulcers:

1) Rinse your mouth with lukewarm saline water 2-3 times during the day. Hold the water in your mouth for a short time before spitting it out.

2) Apply ghee to the ulcers

3) Chew tulsi leaves, their natural anti-inflammatory properties help healing.

4) Castor oil applied locally helps alleviate the pain and discomfort.

5) Placing damp tea bags over the ulcer.

6) Chamomile tea and liquorice (mulethi) is also found to be beneficial.

7) Have lots of fluids like chaas and fresh coconut water to improve digestion and help with healing.

Disclaimer:

The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

Nutrition Tips for Managing Sore Mouth, Throat, and Tongue

Radiation therapy, chemotherapy, and several cancer medications can cause mouth sores, ulcers, and tender gums. All can cause your mouth, throat, and tongue to feel sore, raw, or dry and may lead to dehydration, poor eating, and weight loss. The following tips and recommendations may help you to manage sore mouth, throat, and tongue.

Choose soft, bland foods.

  • Softer foods will be easier to chew and swallow.
  • Soups and stews are good options, as long as meats are soft and tender.
  • Try breakfast foods like instant oatmeal, grits, pancakes, waffles, and cold cereal that has been softened in milk.
  • Pick side dishes like cottage or ricotta cheese, macaroni and cheese, mashed white or sweet potatoes, and rice or risotto.
  • Try desserts like custard, tapioca pudding, ice cream, milkshakes, and sherbet.
  • Choose snacks like applesauce, gelatin, smoothies, and yogurt.

Prepare foods in ways that make them easier to eat.

  • Cut foods into small pieces. You may consider using a blender or food processor to puree foods.
  • Cook foods until they are soft and tender.
  • Serve foods with gravy, broths, or sauces.
  • Choose soft or canned fruits or applesauce instead of raw fruits with tough skins.

Avoid foods and drinks that make mouth sores worse.

  • Avoid citrus fruits and juices, salty or spicy foods, and acidic foods like tomatoes.
  • Do not drink carbonated or caffeinated drinks.
  • Refrain from having beer, wine, liquor, or any other type of alcohol.

Avoid very hot foods.

  • Hot foods can cause mouth and throat discomfort.
  • Choose room temperature or cold foods that are soothing.
  • Allow soups and hot foods to cool to room temperature before serving.
  • Try freezing fruits, and suck on frozen fruit pops, fruit ices, or ice chips.

Choose foods that are good sources of protein to combat weight loss.

  • Aim to have a good source of protein with meals and snacks.
  • Ground meats, eggs, cottage cheese, yogurt, custard, beans, lentils, and smoothies are good soft food choices that also provide protein.
  • Eat small, frequent meals. You may find it easier to eat smaller amounts at a time.

Drink at least 8-10 eight-ounce glasses of water each day.

  • Drink liquids with your meals as this will make it easier to swallow foods.
  • Sip cool drinks in between your meals.
  • Drink with a straw. This can help push the foods past the painful sores in your mouth.
  • Avoid caffeinated or/and carbonated beverages.
  • Avoid alcohol. Alcohol can irritate the mouth.

Use good mouth care.

  • Rinse your mouth several times a day. Mix one quart water and one tablespoon baking soda to make a rinse that removes food and promotes healing.
  • Do not use a mouthwash that has alcohol. Alcohol makes a sore mouth worse.
  • Use a toothbrush with soft bristles.
  • Remove dentures (except during eating) if your gums are sore. Keep dentures clean.
  • Avoid cigarettes, cigars, and tobacco products.
  • Ask your doctor about special mouthwashes and sprays that can numb the mouth and throat.
  • Tell your doctor if your gums are bleeding or if you have white patches in your mouth. Both can be signs of infection.

Oral Hypersensitivity Reactions

Hypersensitivity reactions are abnormal reactions of the immune system that occur in response to exposure to otherwise harmless substances. These reactions encompass true allergic and other non-allergic reactions and their severity can range from mild to life-threatening.

The most severe hypersensitivity reaction is called “anaphylaxis” and this allergic reaction usually begins immediately after exposure to the allergen. Hypersensitivity reactions in and around the mouth may produce a wide range of clinical appearances including redness or whiteness of the mucosa; swelling of the lips, tongue and cheeks; and/or ulcers and blisters.

Types of Oral Hypersensitivity Reactions

Stomatitis: Typical signs of stomatitis are redness and swelling that may involve any part of the mouth (see Right) including the tongue, roof of the mouth, cheeks, and lips (cheilitis). There is occasional formation of blisters and ulcers. Affected individuals may complain of a burning sensation and mouth sensitivity to cold, hot, and spicy foods.

Lichenoid reactions: These lesions resemble lichen planus and consist of slightly raised, thin, whitish lines that blend together to form a lacelike pattern. Sometimes ulcers are located within the lesion and surrounded by the whitish lines (see Right). Lichenoid lesions are found most commonly on the mucosa of the cheeks but may occur throughout the mouth.

Angioedema: Angioedema is a soft, painless, non-itchy swelling that usually involves the lips, tongue or cheeks. It typically develops rapidly and can become a serious event requiring emergency treatment, if the swelling spreads to the larynx and results in severe breathing difficulty.

Erythema multiforme: In erythema multiforme both the skin and the mouth may be affected. Mouth lesions begin as swelling and redness of the oral mucosa, followed by the formation of blisters which break and leave areas of ulceration. The lips may become swollen and develop bloody crusts. The typical skin lesion is the “target” or “iris lesion” which consists of concentric rings of red skin surrounded by areas of normal colored skin (see Right). The extent of involvement can be so severe as to require hospitalization.

Plasma cell gingivitis: Plasma cell gingivitis appears as a bright redness and swelling of the gums without ulceration (loss of skin cells). This characteristic appearance (see Right) is due to the gathering of specific white blood cells, called plasma cells, in the gums. Other areas that may be involved include the tongue or lips. This reversible condition is different than gum disease, and symptoms resolve once the cause is removed.

QUESTIONS AND ANSWERS ABOUT ORAL HYPERSENSITIVITY REACTIONS

Q: What should I do if I think that I am experiencing a hypersensitivity reaction?
A: You should seek out a professional evaluation by a dentist or other health care provider to determine the diagnosis and obtain appropriate treatment. Mild allergic reactions are often treated with antihistamine drugs or topical steroids. If you experience difficulty in breathing, you should go immediately to an emergency treatment facility.

Q: What can cause a hypersensitivity reaction in the mouth?
A: A large number of substances. The most common causes are food, food additives, drugs, oral hygiene products, and dental materials.

Q: Are there any specific foods that are more commonly implicated in intraoral hypersensitivity reactions?
A: Yes. Nuts (walnuts, cashew nuts, almonds, hazelnuts), fruits and vegetables (banana, avocado, kiwi, mango, tomato, potato), milk, eggs, soybeans, fish (cod, tuna, salmon) and shellfish (snails, mussels, oysters, lobster, crabs, shrimps) are the most commonly implicated food allergens worldwide. Gums and candies are often flavored with agents like cinnamon, peppermint or menthol, which can trigger hypersensitivity reactions in susceptible individuals.

Q: What is the “Latex-Fruit Syndrome”?
A: A large number of individuals who are allergic to latex products show hypersensitivity to some foods especially fresh fruits. This association of latex allergy with fruit allergy is called “Latex-Fruit Syndrome”. Fruits such as avocado, banana, passion fruit, kiwi, papaya, mango, peach, fig, melon, and pineapple, are all associated with this syndrome. You should inform your dentist if you are allergic to any of these fruits, because of your increased risk of being allergic to latex.

Q: Which drugs are responsible for intraoral hypersensitivity manifestations?
A: The truth is that almost any drug can cause such a hypersensitivity reaction in the mouth, though some are more common than others. If you suspect you suffer from a hypersensitivity reaction, you should discuss it with your prescribing doctor.

Q: Why oral hygiene products are considered as causes of hypersensitivity reactions?
A: Virtually any. Many toothpastes and mouthwashes are flavored with potential allergens such as cinnamon, peppermint, eugenol and menthol. Even dental floss and denture cleansers may contain ingredients known to cause a hypersensitivity reaction.

Q: How can dental treatment trigger a hypersensitivity reaction?
A: Some dental materials used by the dentist can cause a hypersensitivity reaction in certain individuals. Potential allergens include the metals in amalgam (silver) fillings, crowns and bridges, and orthodontic wires; the plastic or acrylic in dentures; composite restorations; bonding agents; impression materials; varnishes; and rubber products such as gloves and rubber dams.

Q: The roof of my mouth under my denture is red and burns. Is this an allergy?
A: A true allergic reaction to the substances in a denture is uncommon. Your symptoms are much more likely the result of inflammation caused by the denture being to loose or a yeast infection.

Q: Can local anesthetics cause allergic reactions?
A: Yes, they can, although it is rare. Only 1% of the adverse reactions due to local anesthetics are considered truly allergic, and most of these are due to an allergic response to the vast majority of adverse reactions attributed to local anesthetics are in reality caused by either patient anxiety or as a response to the vasoconstrictor present in the anesthetic solution.

Q: How can I determine if I have an allergy?
A: It can be a challenge, particularly when you are experiencing mild allergic reactions. Your healthcare provider will often ask if you can identify a relationship between your exposure to a particular food, drug, or other product and the onset of your symptoms. If necessary, your provider may refer you to an allergist for a more comprehensive evaluation.

Q: Can I prevent a hypersensitivity reaction from occurring?
A: Maybe. The best way to prevent a hypersensitivity reaction is to avoid any agent that provokes it. While this is easy when the causative agent is known, in many cases it is difficult to conclusively identify the causative agent. For example, the foods you eat may contain small amounts of ingredients capable of causing a hypersensitivity reaction.

Prepared by M Arava, A Pinto and the AAOM Web Writing Group
Updated 31 December 2007

Spanish Translation – Traducción Español

The information contained in this monograph is for educational purposes only. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.

Those of us of who have suffered from regular mouth ulcers will probably be familiar with the feeling of frustration from not knowing what causes them. The clinical name for recurring mouth ulcers is aphthous stomatitis, often referred to as canker sores. Not a great deal is understood about the causes and the painful red sores in the mouth are the only detectable symptom. However, they are very common, affecting anywhere between 10% and 25% of the population.

Whilst sometimes it may be possible to trace the origin of an ulcer back to accidentally biting your cheek or lip, just as often there seems to be no apparent trigger. In such cases it is suggested that this is the result of the body’s immune system mistakenly attacking its own cells within the mouth. This has lead many of us to consider and rule out a range of possible causes such as an underlying condition, iron deficiency and even psychological factors such as stress- all of which are common causes.

Can an allergy cause mouth ulcers?

Given the lack of any cast iron cause many people a left scratching their heads as to what might be causing these recurring mouth ulcers. As someone who has been afflicted by various allergic reactions over the years I thought it might be worth investigating whether allergies might be a possible cause.

What I found was it is possible for various sensitivities, intolerances and indeed allergies to cause mouth ulcers, although the latter are the least likely. The main culprits are sensitivities, particularly to acidic foods such as strawberries, tomatoes and pineapple, spicy foods and other triggers like chocolate and coffee. However, it is very unusual for an allergic reaction to cause the level of erosion seen in ulcers, but not completely unknown. Generally speaking the symptoms of a food allergy affecting the mouth are limited to tingling and itching.

A known example of an allergen that is capable of causing mouth ulcers is Balsam of Peru, a plant extract that is commonly used as a fragrance and flavouring in a range of products. Rated one of the top 5 allergens throughout dermatology clinics, oral contact with Balsam of Peru can cause mouth ulcers in allergic individuals.

One of the most widely suspected causes of mouth ulcers is a chemical sensitivity to one of the common ingredients of toothpaste, sodium lauryl sulfate (SLS). SLS is a foaming agent which is not actually an active ingredient to the toothpaste and there are several SLS free products available. However, over the years several studies have been carried out into this with no conclusive findings one way or the other.

So, as you can see, whilst certain allergies can cause mouth ulcers it is technically food intolerances that are the most likely trigger. Whilst most people do not make a distinction between intolerance and allergy there is an important clinical difference with only a true allergy involving the immune system. Unfortunately, if you suspect a food intolerance is causing your mouth ulcers the only reliable way to identify the trigger is via elimination diets, and this should only be carried out with qualified medical supervision.

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Canker Sores From Food Allergies

Canker sores are small, shallow, painful lesions that develop at the gum’s base and on the mouth’s soft tissues. Although their cause is unknown, canker sores may be triggered by problems with the immune system, hormonal changes, medications, trauma and food allergies. Speak with your physician if you believe your canker sores are symptoms of a food allergy.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Canker sore occurs in 20 to 60 percent of people, according to Collins Dentistry for Children 12. The middle of the sore typically is white or yellow, and the perimeter is bright red. A few days before the sores appear, the person feels a burning or tingling sensation. While the cause:

  • of these non-cancerous sores is unknown
  • researchers believe a combination of factors including injury
  • food sensitivities
  • food allergy
  • auto-immune condition
  • hormonal changes contribute to an outbreak

Food Allergy

Food allergy is the result of an immune response against proteins present in the food. The immune system recognizes the protein as foreign and dangerous and mounts an Immunoglobulin E-mediated response against the allergen. IgE — a class of antibody — activates pro-inflammatory immune cells, mast cells and basophils that perpetuate the immune response by releasing histamine and other chemicals.

Food Allergy and Canker Sores

The release of histamine and other immune mediators in the mouth can result in cellular and tissue damage, and the appearance of canker sore as one of the symptoms of an allergic reaction 1. Since not all food allergy symptoms appear at once, try an elimination diet to determine whether your canker sores are related to a food allergy.

Treatment of Canker Sores

If you frequently develop canker sores, keep a food diary to help you identify the condition’s trigger. Elimination of wheat and dairy products can help the sores resolve faster. In addition, avoid crunchy, spicy or irritating foods. Use soft toothbrushes and brush and flush your teeth regularly — particularly after meals — to avoid infection. Cleansing antiseptics like hydrogen peroxide diluted with water can help prevent an infection and promote healing. Over-the-counter medications such as Gly-Oxide and Zilactin can help alleviate the pain and discomfort.

If you are experiencing problems when you chew, it can be because of having lost teeth, gum disease or cavities. If this is the case, you will want to see your dentist at American Fork Family Dentist to determine the cause and recommended treatment. Until you can be seen, however, it is a good idea to stick with soft foods to keep up your energy.

But what if the problem is occurring due to canker sores? Because there’s no “cure” for these types of oral sores you can help limit them in your mouth by avoiding certain things that can irritate the tissue. This can arise thanks to spicy foods, acidic foods (pickles) and citrus fruits (lemons, oranges).

To help you reduce irritation until the canker sore heals, stick to bland foods that are cool or room temperature, like the following:

– Dairy foods like milk and cheese
– Vegetables which are cooked, canned or frozen.
– Mashed potatoes that contain milk so that you get a nutritional boost.
– Fruit, cooked or canned. Applesauce is soothing.
– Soft, cooked cereals such as cream of wheat with milk or oatmeal.
– Shredded, cooked meat like chicken, beef or pork.
– Any style of cooked eggs.
– Plain peanut butter (no chunks)
– Cooked soup

Healing can be expedited by focusing on protein foods. You can boost your protein intake during this time by adding protein powder to smoothies or milkshakes or powdered dry milk to boost your soups or mashed potatoes.

If you have any concerns about sores in your mouth or pain while chewing, we encourage you to schedule a checkup with our dentist by calling 801-756-2809 today. Dr. Clayton M. Hansen and our team are ready to assist you with your oral health in American Fork, Utah.

Chemotherapy can cause sores in your mouth and throat. These sores can become infected by yeast, bacteria, or viruses in your mouth. Chemotherapy medications can also make mouth tissues dry or irritated and cause them to bleed. Sores and dry mouth tissue can make eating painful. Even your favorite foods may irritate your mouth.

If you have mouth sores, ask you doctor for a medication to apply directly on the sores; don’t use over-the-counter applications unless you check first with your doctor. Use lip balm if your lips are dry. And if your mouth is very dry, ask your doctor about using artificial saliva products. Learn more about the causes of a sore mouth and throat and medicines that can help.

What to do if you have a sore mouth or throat:

  • Eat soft, bland, creamy foods high in calories and protein, such as cream-based soups, cheeses, yogurt, milkshakes, pudding, ice cream, or commercial liquid protein supplements. If you’re only able to eat a little without pain, eating higher-calorie foods will help give your body enough energy. Eating a teaspoon of cold sour cream (mix with vanilla extract and a little sugar if you don’t like the sour taste) will soothe and “coat the runway” (your food tube, the esophagus), making it easier for other foods to go down.
  • Soak your food. Soak cold cereal in milk so it’s soggy when you eat it. Soak rice and pasta in sauce so they’re tender. Soak your toast in your egg yolk before you eat it. This will be less irritating to your sore mouth.
  • Chop your food. Chop up your meat, poultry, or fish into small pieces or put it through the blender. You can mix it with a sauce or low-fat gravy.
  • Eat cooked vegetables and canned fruit. Raw ones may hurt your mouth. You can also put fruits and vegetables through a blender.
  • Eat chilled foods such as popsicles, applesauce, flavored gelatin, and sherbet. The coolness is soothing to a sore mouth.
  • Avoid tart, acidic, or salty foods. Stay away from citrus and tomato-based foods. They can sting open sores.
  • Avoid rough foods such as dry toast, pretzels, and granola. They can be irritating to a sore mouth.
  • Avoid spices that can irritate a sore mouth such as chili powder, curry, and hot sauces.

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Last modified on May 8, 2013 at 9:53 AM

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