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Aphthous Ulcers and Nutrition
Recurrent aphthous stomatitis is common and consists of small painful ulcers in the mouth. It
seems that some genetic disposition is associated with the development of recurrent aphthous
stomatitis. Recurrent aphthous stomatitis typically resolves in the 3rd decade of life.
However, aphthous-like ulcers rarely resolve spontaneously with age. These ulcers sometimes
are associated with these conditions:
 Inflammatory bowel disease
 Celiac disease
 Malignancy
 Behcet’s syndrome
 Human immunodeficiency virus/acquired immunodeficiency syndrome
The following correlate to the development of recurrent aphthous stomatitis:
 Deficiency in iron, folic acid, or vitamin B12—up to 20% of patients are deficient:
– Iron is found in liver, oysters, meat, poultry, tuna, crab, shrimp, halibut, cereal, oatmeal,
beans, lentils, tofu, and spinach
– Folic acid is found in beans, nuts, peas, asparagus, Brussels sprouts, avocado, broccoli, wheat
germ, citrus fruit, green leafy vegetables, liver, poultry, pork, shellfish, wheat bran, and other
whole grains
– Vitamin B12 is found in meat, liver, clams, fish, poultry, eggs, milk, nutritional yeast, and
some breakfast cereals
 Malabsorption in gastrointestinal disorders, such as celiac disease, Crohn’s disease, pernicious
anemia, and dermatitis herpetiformis
 Quitting smoking, which increases the risk of recurrent aphthous stomatitis in some individuals
 Stress
 Trauma, such as biting of the mucosa or using dental appliances
 A fall of the progestogen level in the luteal phase of the menstrual cycle, which is correlated to
development of the ulcers—the ulcers might temporarily regress during pregnancy (in some
women)
 Food allergies
 Sodium lauryl sulfate, a detergent found in some health care products
 Immune deficiency
 Certain medication, specifically nonsteroidal anti-inflammatory drugs, alendronate, and
nicorandil
In one small study of 21 patients completed in 1991, food allergy testing was positive in 20 of
the patients. After eliminating the foods that they tested positive for, 18 of the patients had
improvement in their aphthous ulcers.
Conventional treatment of aphthous ulcers includes:
 Topical corticosteroids
 Topical tetracyclines, chlorhexidine gluconate mouthwashes, anti-inflammatory agents, and
systemic immunomodulators (in severe cases that do not respond to other therapies)
Alternative treatment of aphthous ulcers includes zinc lozenges (4-6/day), vitamin C (500
milligrams [mg] four times/day), vitamin B complex, and L-lysine (500 mg one to three
times/day). Some individuals have reported that carrot, celery, and cantaloupe juices also are
helpful.
References and recommended readings
McBride DR. Management of aphthous ulcers. American Family Physician® Web site.
http://www.aafp.org/afp/2000/0701/p149.html. Accessed July 31, 2013.
Nolan A, Lamey PJ, Milligan KA, Forsyth A. Recurrent aphthous ulceration and food sensitivity.
J Oral Pathol Med. 1991;20(10):473-475.
Scully C. Aphthous ulcers. Medscape Web site. http://emedicine.medscape.com/article/867080overview. Accessed July 31, 2013.
Contributed by Elaine Koontz RD, LD/N
Review Date 7/13
G-1891