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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