Canker Sores
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Canker Sores or Aphthous Stomatitis

Using the Third National Health and Nutrition Examination Survey, 1988-1994, exams of 17,235 individuals over age 16 found that 1% had at least one aphthous lesion. Annual (reported) prevalences were European-Americans (21%) and Mexican-Americans (13%), and Afro-Americans (5%). Adults younger than 40 years of age had almost twice the prevalence (22.5%) of those older than 40 years (13.4%). Non-smokers and individuals with recurrent herpes were more likely to have canker sores. (The association of tobacco and other factors with recurrent aphthous stomatitis in a U.S. adult population. Rivera-Hidalgo F, Shulman JD, et al. Baylor, Dallas, TX. Oral Dis. 2004 Nov;10(6):335-45).

Based upon the research, I would first try using zinc lozenges like generic Coldeeze and acidophilus tablets used like lozenges.  Both types of lozenges should be allowed to dissolve as slowly as possible in the mouth.  Some recommend avoiding toothpaste with sodium lauryl sulfate if sores develop.  Severe cases can be associated with HIV infections or Behcet's disease.  One study found value from dissolving a tetracycline, or minocycline capsule in 1/3 cup of water and doing a swish and swallow treatment 2-4 times a day.  Sage and or chamomile tea used as a mouthwash has been mentioned.

Aphthous Stomatitis (Canker Sores): Helped by Zinc: DB PC study of 40 patients were treated with 220 mg zinc sulfate per day for one month. Stomatitis improved in the first month and did not recur in treatment group. Effects of zinc treatment in patients with recurrent aphthous stomatitis. Orbak R, Cicek Y, et al. 2003 Mar;22(1):21-9.  Ed: Although it wasn't researched, I wonder if the zinc lozenges used for sore throats might help canker sores even better.  The dose of zinc sulfate above equals 88 mg of zinc, a hefty dose. I would first try the lozenges.

Aphthous Stomatitis Helped by Penicillin Lozenges: A 100-patient DB PC study found that penicillin G lozenges significantly increased the speed of healing and decreased the pain in a Phase 2 study. The efficacy and safety of 50 mg penicillin G potassium troches for recurrent aphthous ulcers. Kerr AR, Drexel CA, Spielman AI. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Dec;96(6):685-94

Aphthous Stomatitis Helped by Adhesive Magnesium-Citrus Oil Tablet Somewhat: In a DB PC study of a new mucoadhesive tablet, which releases citrus oil and magnesium, half of 248 volunteers who had canker sores and were given the active tablet did better. Adhesive tablet effective for treating canker sores in humans. Mizrahi B, Golenser J, et al, the Hebrew University of Jerusalem. J Pharm Sci. 2004 Sep 29;93(12):2927-2935 

Aphthous Stomatitis: The often difficult problem of graft immobilisation in the oral cavity was helped by honey impregnated foam as a stent in oral grafting. Oral cavity onlay grafting using foam impregnated with honey:--a case report. Fasika OM, Arotiba JT, Fasola AO. University College Hospital, Ibadan, Nigeria. Afr J Med Med Sci. 1996 Sep;25(3):297. Ed: This might work for canker sores in the mouth. Brushing teeth twice daily with Colgate Total should block any brief cariogenic effect. Honey worked better than acyclovir for herpes.

Silver Nitrate Quickly Reduces Pain Without Slowing Healing: Silver nitrate sticks have been used for a long time to provide pain relief for the duration of an aphthous ulceration, with only one application. Silver nitrate causes chemical cauterization and increases the depth of injury. In a 1-week DB PC study of 97 patients with painful minor oral aphthous ulceration, the ulcer was gently painted with a silver nitrate stick until it turned white. In the placebo group, the ulcer was gently painted with a placebo stick. In 70% treated with silver nitrate vs. 11% with placebo, there was a reduction in severity of pain 1 day after the procedure (P < 0.001). On the seventh day, the ulcers were completely re-epithelialized in 83% of the treatment group vs. 89% for the placebo group. The difference was not statistically significant (P = 0.39). Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial. Alidaee MR, et al. Tehran University, Iran. Br J Dermatol. 2005 Sep;153(3):521-5

Treatment of H. Pylori May Relieve RAS: In a study of 48 recurrent aphthous stomatitis (RAS) adults, 34 were positive for H. pylori bacteria in the stomach. These were given eradication therapy. At entry patients with HP infection suffered from more severe symptoms compared with HP negative patients (P < 0.05). After the administration of HP eradication therapy, patients who had become negative showed a remarkable improvement (62.5%) of RAS. In 29.2%, symptoms disappeared and in 33.3%, there was a decrease in both the frequency of recurrence and the intensity of symptoms. After the eradication treatment, the periods between recurrence of RAS in patients who had become negative were statistically significantly longer compared with those before treatment (P < 0.001). Outcome following treatment for Helicobacter pylori in patients with recurrent aphthous stomatitis. Albanidou-Farmaki E, Giannoulis L, et al. Aristotle University of Thessaloniki, Thessaloniki, Greece. Oral Dis. 2005 Jan;11(1):22-6; However, no association was found between the two in children. J Oral Pathol Med. 2004 Mar;33(3):129-32.

LongoVital Herbal Vitamins Minimal Benefit: In a 6-month DB PC study of 50 patients with recurrent AS, the number of aphthous ulcers/month decreased significantly in the LV-group (p = 0.02). The number of days in pain/month were also reduced (p < 0.001). However, if a 50% reduction of number of aphthous ulcers and days in pain were considered as clinically relevant, no statistical significant differences were found between the groups. The effect of LongoVital on recurrent aphthous stomatitis in a controlled clinical trial. Bratel J, Hakeberg M, Jontell M. Goteborg, Sweden. Oral Health Prev Dent. 2005;3(1):3-8.

Lactobacillus (Yogurt or Capsules) Old Treatment: The treatment of aphthous stomatitis with Lactobacillus tablets. N Y State J Med. 1958 Aug 15;58(16):2672-3; Viable mixture of lactobacillus acidophilus and bulgaricus in treatment of herpetic and aphthous stomatitis. J Oral Surg Anesth Hosp Dent Serv. 1961 Jul;19:310-2; Treatment of oral ulceration with lactobacillus tablets. Report of forty cases. Oral Surg Oral Med Oral Pathol. 1965 Nov;20(5):591-3; Clinical trial of Sporlac in the treatment of recurrent aphthous ulceration. Uttar Pradesh State Dent J. 1980 Jan;11(1):7-12; A recent Ukrainian study found that lactobacillus is less common in the mouths of those with canker sores, but a variety of pathogenic bacteria, golden staphylococci, escherichia, klebsiella, clostridia, hemophilic rods and campylobacteria, were only found in those with canker sores. Mikrobiol Z. 2003 Nov-Dec;65(6):49-58. Ed: One patient of mine said her chronic problem disappeared when she started using lactobacillus capsules each day.  It would be nice to have modern research, but other lactobacillus and yogurt research would make one think that this is a worthwhile strategy to study.