Aphthous stomatitis research and natural treatment by Ray Sahelian, M.D.
The cause of recurrent aphthous stomatitis is unknown and over the years a variety of treatments, including adhesive pastes, antiseptics, vitamins, herbs, and steroids have been tested. Although these treatments may reduce pain or the number of lesions in the short term, very few have had any lasting beneficial effect. This condition is the most common oral mucosal ailment in the general population.
Cause
The exact causes are difficult to determine but consider the following: citrus
fruits such as lemons and oranges and lemons), stress, poor sleep patterns, food
allergies, immune system reactions, and deficiencies in vitamin B12, iron, and
folic acid. Some people may be allergic to cow's milk. Trauma to the mouth is a
trigger such as that caused by toothbrush abrasions, laceration with sharp or
abrasive foods (such as toast or potato chips), accidental biting (particularly
common with sharp canine teeth).
Celiac disease as one cause
Celiac disease is regarded as an autoimmune disorder that is common in the
general population (affecting 1 in 100 individuals), with possible onset at any
age and with many possible presentations. The identification of CD is
challenging because it can begin not only with diarrhea and weight loss but also
with atypical gastrointestinal (constipation and recurrent abdominal pain) and
extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent
miscarriages, aphthous stomatitis and associated autoimmune disorders), or it
could be completely symptomless.
Natural treatments
Bee propolis
Recurrent aphthous stomatitis (RAS) is a common, painful, and ulcerative
disorder of the oral cavity of unknown etiology. No cure exists and medications
aim to reduce pain associated with ulcers through topical applications or reduce
outbreak frequency with systemic medications, many having serious side effects.
The purpose of this pilot study was to evaluate the potential of a product to
reduce the number of outbreaks of RAS ulcers.
Propolis is a bee product
used in some cultures as treatment for mouth ulcers. In this randomized,
double-blind, placebo-controlled study, patients were assigned to take 500 mg of
propolis or a placebo capsule daily. Subjects reported a baseline ulcer
frequency and were contacted biweekly to record recurrences. Data were analyzed
to determine if subjects had a decrease of 50% in outbreak frequency. The data
indicated a statistically significant reduction of outbreaks in the propolis
group. Patients in the propolis group also self-reported a significant
improvement in their quality of life. This study has shown propolis to be
effective in decreasing the number of recurrences and improve the quality of
life in patients who suffer from RAS. Clin Oral Investig. 2007 June. The effect
of bee propolis on recurrent aphthous stomatitis: a pilot study. Harvard School of Dental Medicine,
188 Longwood Avenue, Boston, MA, USA.
Quercetin topically used
Management of aphthous ulceration with topical quercetin: a randomized clinical
trial. Department of Oral Medicine and Periodontology of Minia University in
Minia, Egypt.
Forty male patients with no known pathology of the oral mucosa other than minor
aphthous ulcers were enrolled in this study. Patients were randomly divided into
two groups, each consisting of 20 patients. Group 1 (control group) patients
used a benzydamine hydrochloride mouthwash three times daily. Group 2 patients
placed two to three dabs of quercetin three times daily directly on their
ulcers. Clinical evaluation of patients included assessment of ulcer size, pain
measure, and interviews regarding the topical application of quercetin in terms
of consistency, taste, local tolerability, and ease of application. The
topical application of quercetin cream to minor mouth ulcers relieved pain and
produced complete healing in seven of the Group 2 patients (35 percent) in 2-4
days, 18 patients (90 percent) in 4-7 days, and 20 patients (100 percent) in
7-10 days. When comparing the mean ulcer size after 10 days, lesions in the
Group 2 patients were smaller than those in Group 1, and the size difference
between the two groups was significantly different. Also, 90 percent of patients
responded that they appreciated the ease of application when using the topical
quercetin, and they did not object to its consistency or taste. Quercetin is a
safe, well-tolerated, and highly effective promising new, adjunctive treatment
for healing common aphthous ulcers. Although aphthous ulcers typically resolve
on their own in one to two weeks, the daily topical application of quercetin may
be useful in accelerating the healing process of minor cases. J Contemp Dent
Pract. 2010.
Vitamin B12 for aphthous stomatitis
Vitamin B12 is a safe, effective, and inexpensive treatment for recurrent aphthous stomatitis. Dr. Ilia Volkov, from Ben-Gurion University of the Negev,
Beer-Sheva, Israel, had 58 patients randomized to receive sublingual vitamin B12
(1000 mcg) or placebo daily for 6 months.
Relative to placebo, treatment with vitamin B12 significantly reduced pain, the
number of ulcers, and the duration of outbreaks at 5 and 6 months. Moreover, the
improvements were not affected by the patients' initial serum vitamin B levels.
In the last month of treatment, 74% of vitamin B12-treated patients were
aphthous ulcer-free compared with 32% of those given placebo. Exactly how
vitamin B12 achieves these beneficial effects is not well understood. The fact
that the treatment worked equally well regardless of the initial vitamin B12
level suggests that the vitamin may possess some unrecognized functions.
Journal of the American Board of Family Medicine 2009.
Prescription medications as cause
Severe aphthous stomatitis is associated with the use of oral calcineurin and
mTOR inhibitors.