Canker Sores
Definition
Western
Canker sore is a type of oral ulcers which is also known as aphthous stomatitis. It is a common, non-communicable disorder [9] that afflicts about 20 percent of the world’s population [1]. The disorder can occur in all age groups, with a higher incidence among women. It manifests as ulcerative lesions in the oral mucosa, ranging in sizes depending on the severity of the condition. These ulcers can be very painful, and can make eating and talking difficult. Severe canker sores may leave scars.
Traditional Chinese Medicine (TCM)
Heat in the body can be caused by exogenous pathogenic factors, as well as disharmony of yin and yang within the body. TCM believes that internal heat can affect the physiology of the body tissues or make tissues more prone to stress. Accumulation of heat due to stress, anxiety and irregular sleep patterns, or the ingestion of oily and spicy food often affects membranous tissues in the oral cavity as well as the harmony of the stomach system, thus is directly linked to the formation of canker sores. Herbs can be used to remove accumulated heat, either through diuresis or replenishing bodily fluids, to prevent the outbreak of canker sores.
Symptoms Displayed / Classifications / Types
Severe Heat Syndrome
Sores are very painful and usually of bright red colour. Other manifestations include aversion to heat, fever, flushed complexion, restlessness, bad breath, desire for cold drinks, constipation and a red tongue with yellow coating.
Mild Heat Syndrome
Sores tend to be less painful and duller in colour. Other manifestations include low or erratic fever, night sweating, feverish sensation felt in the chest, palms and soles, dry sensation felt in the mouth and throat, fatigue, insomnia and a red tongue with little or no coating.
Causes
Physical Trauma
Toothbrush abrasions, lacerations due to consumption of hard foods, accidental biting and other activities that damage the mucosa lining are the most common causes of ulcerations [2]. Chemical irritants or thermal injuries may also contribute to the ulcer’s formation.
Dietary Deficiencies
Research has shown that deficiencies in vitamin B-12, zinc, folic acid or iron have strong correlations to recurrent canker sore development [3,11].
Inheritance
Canker sore is one of the main manifestations for genetically-linked diseases such as Behçet's disease and Crohn’s disease [4].
Emotional Stress
Stress lowers the body’s immunity, which directly increases the chances of an outbreak or delays recovery [12].
Allergic Reactions
Many allergic reactions, especially food allergies, can lead to sore formation. One recent study showed a strong linkage with allergies to cow’s milk [5].
Risk Factors
Gender
Female sex hormones apparently play a role in causing canker sores. Many women experience bouts of ulcers during certain phases of their menstrual cycles [6-7], the cause, however, is still unclear.
Family History
Many people with recurrent canker sores have a family history of the ailment [10]. This may suggest the possibility of inheritance or shared factors in their environment, such as food or allergens. About 30 to 40% of patients with recurring canker sores report a family history [8].
Treatments
Herbs commonly used in prescriptions:
1. Chuan Xin Lian – 穿心莲
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English/ Common name
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Common Andrographis Herb
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Latin species
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Andrographis paniculata (Burm.f.) Nees
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Park of plant used
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Whole organism, except roots
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Action/s
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Helps to ease trapped heat from the body, counteract toxicityand induce subsidence of swellings [14].
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Precaution/s
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Not recommended for prolonged or excessive dosage. Individuals with gastrointestinal disorders should avoid.
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2. Dan Zhu Ye – 淡竹叶
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English/ Common name
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Lophatherum Herb
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Latin species
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Lophatherum gracile Brongn.
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Park of plant used
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Dried stem and leaves
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Action/s
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Helps to ease body heat through diuresis, and also helps to ease the mind [14].
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Precaution/s
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No significant side-effects.
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3. Shi Hu – 石斛
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English/ Common name
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Dendrobium
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Latin species
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Dendrobium loddigesii Rolfe.
Dendrobium fimbriatum hook.var.oculatum Hook.
Dendrobium Chrysanthum Wall.
Dendrobium candidum.wall.ex Lindl.
Dendrobium nobile Lindl.
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Park of plant used
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Fresh or dried stems
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Action/s
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Helps to replenish bodily fluids lost through physiological or pathological processes [15].
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Precaution/s
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No significant side-effects.
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4. Xuan Shen – 玄参
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English/ Common name
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Figwort Root
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Latin species
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Scrophularia ningpoensis Hemsl.
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Park of plant used
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Dried Roots
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Action/s
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Helps to replenish bodily fluids and counteract toxicity [14].
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Precaution/s
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Not to be taken together with Black False Hellebore.
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5. Sheng Di Huang生地黄
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English/ Common name
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Rehmannia Root
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Latin species
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Rehmannia glutinosa Gaertn.
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Park of plant used
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Dried Roots
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Action/s
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Helps to ease accumulated heat and replenish bodily fluids lost through physiological or pathological processes [15].
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Precaution/s
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Not recommended for prolonged or excessive dosage. Individuals with gastrointestinal disorders should avoid. May result in loose stools.
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Performed by a qualified physician, acupuncture can help to release accumulated body heat and to supress anxiety and stress, thus reducing the susceptibility to canker sores.
Most sores tend to subside within a week or two, sometimes even without treatment. Some studies have shown that using toothpaste without sodium lauryl sulfate may reduce the frequency of aphthousulcers [13]. Maintaining good oral hygiene and watching what you eat is the key to prevention.
Tests & Diagnosis
Visual inspection by physician is usually performed during consultation. However, it is recommended that patients who have frequent bouts of sores undergo further blood and allergy tests to determine the root causes.
Home Remedies
Fresh Aloe Vera (cut into bits) + Lophatherum Herb (淡竹叶danzhuye) + Honey
a) Put Lophatherum Herb in a cooking pot and pour enough water to cover.
b) Bring to boil for 10 minutes.
c) Simmer for a further 30 minutes.
d) Remove from heat.
e) Add in fresh aloe vera bits and honey. Serve cool.
American Ginseng (sliced)+ Cranberries (cut into bits)
a) Put American Ginseng slices in a cooking pot and pour enough water to cover.
b) Bring to boil for 10 minutes.
c) Simmer for a further 30 minutes.
d) Remove from heat. Add in cranberry bits. Serve warm.
Salt + Hydrogen Peroxide + Luke warm water
a) Combine all ingredients and mix well.
b) Rinse your mouth with it 3 to 4 times daily.
References
1. Amy L. Sutton. Dental Care and Oral Health Sourcebook. Omnigraphics, Inc. 2003
3. Wray D, Ferguson M, Hutcheon W, Dagg J. Nutritional deficiencies in recurrent aphthae. J Oral Pathol 1978 7(6): pp418–23.
4. International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease. Lancet 1990 335 (8697): pp1078–80.
5. Besu I, Jankovic L, Magdu IU, Konic-Ristic A, Raskovic S, Juranic Z. Humoral immunity to cow's milk proteins and gliadin within the etiology of recurrent aphthous ulcers. Oral Diseases 2009 15(8): pp560–564.
8. Jurge S, Kuffer R, Scully C, Porter SR. Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Disease 200612(1): pp1–21.
10. Scully C, Porter S. Oral Mucosal Disease: Recurrent Aphthous Stomatitis. Br J Oral Maxillofac Surg. 2008 46(3): pp198-206.
11. Weusten BL, van de Wiel A. Aphthous ulcers and vitamin B12 deficiency. Neth J Med 1998 53(4): pp172-5.
12. Gallo Cde B, Mimura MA, Sugaya NN. Psychological stress and recurrent aphthous stomatitis. Clinics (Sao Paulo). 2009 64(7): pp645-8.
13. Herlofson B, Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. Acta Odontol Scand 1994 52(5): pp257–9.
14. The State Pharmacopoeia Commission of P.R.China. Pharmacopoeia of The People’s Republic of China, English edition. People’s Republic of China: Chemical Industry Press (2000).
15. Wu Jing-Nuan. An Illustrated Chinese Materia Medica. Oxford University Press (2005).