Canker Sore Primer Part 3: Causes and Treatments
As was talked about in the last post, one of the frustrating things about RAS is that it shows up so much differently from person to person, with different triggers and different solutions. There have been so many different documented causes of canker sores reported over the years, it’s enough to make your head spin.
But in the end, whether it’s a small trauma, or a food allergy, or an illness, it all points to the same place – the immune system. So what’s going on in the immune system to cause these ulcerations to take place?
I have an answer. And it’s something you won’t see anywhere else outside of medical journals.
It’s called Tumor Necrosis Factor Alpha.
Tumor Necrosis Factor Alpha
Also known as TNF-α, tumor necrosis factor alpha is a protein your body produces, one of dozens of proteins and cells that make up our immune system. To explain their function, let’s break the four elements of the immune system down and talk about how it all works together – and just to make it easier to understand, we’ll use war terms.
White blood cells – the soldiers
Lymphocytes and macrophages – the corp of engineers
Glial cells – the scouts
Cytokines – the communications team
When a trauma occurs in the body, the first team on the spot are the glial cells – the scouts of the immune system. They release cytokines, proteins that travel through the bloodstream telling the white blood cells and lymphocytes where to go. The white blood cells arrive on the scene and kick the tiny bacterial butt of any foreign invader that enters through the wound while the lymphocytes and macrophages get to work cleaning the area of debris and promoting the growth of new skin.
All good, right?
Here’s where things go horribly wrong for RAS sufferers. There are several different types of cytokines, the messenger proteins. A handful of them are known as acute phase proteins, who are responsible for inflammation. Typically, inflammation is a healing process as it speeds blood to the site of the trauma – known as an acute phase reaction.
One particular acute phase protein serves the purpose of inciting apoptosis – programmed cell death – around the area of the trauma to clear out damaged and potentially compromised cells and make way for new, healthy cells. What’s the name of this cell-killing protein?
You guessed it. Tumor necrosis factor alpha.
In people with RAS, the body’s immune system sends the production of TNF-α spiraling out of control. An overabundance of TNF-α at the site prompts it to kill off healthy cells at a far too high rate, eventually eating away an ulcer, and a canker sore is born.
And unfortunately, these reactions can be caused by any kind of minor trauma in the mouth, which could range from acidic fruits to chemicals in toothpaste (sodium laurel sulfate) to sharp chips or nuts. While rinses may decrease the amount of bacteria in the mouth and therefore reducing the severity of the reaction, in the end it all goes back to the immune system response.
Didn’t expect a science lesson, did you?
The amount of treatments and home remedies for canker sores is so fast, varied, and sometimes ridiculous that I literally created this entire website with the sole purpose of testing them all out and reporting the results. Since my research is ongoing on all of these treatments, I will simply list them here and you can feel free to try them yourself.
Salt water solution (1/2 teaspoon in 8oz water)
Maalox with ½ tablespoon of Benadryl.
Mix of Listerine and hydrogen peroxide.
Benzocaine-based pain-reducing ointments such as Anbesol, Oragel, Orabase, Zilactin-B, and Tanac.
Canker-X, which contains polyvinylpyrrolidone, sodium hyaluronate, and Aloe Vera.
CankerMelts, which use Clycyrrhiza extract from the licorice plant
Avamin Melts, containing B-12
Rhodiola Rosea — 200 mg capsule once a day
Glycyrrhiza glabra — given as a tea or as a tablet
Coptis supp, Hydrastis canadensis root — diluted in water and applied to ulcers as needed
Mahonia aquifolium root — tincture or tea applied topically to ulcers as needed
Spilanthes acmella flower — tincture or tea applied topically to ulcers as needed
Alchemilla vulgaris leaf — tincture or tea applied topically to ulcers as needed
Myrtus communis leaf — Mix power in water and apply to ulcer as needed
Silver nitrate cauterization.
Debacterol, which is a compound of 30% sulfuric acid.
Triamcinolone Acetonide Dental Paste USP (Kenalog in Orabase): This can be applied up to three times a day, preferably after meals or at bedtime.
Amlexanox (Aphthasol): This can be applied up to four times a day, after each meal and at bedtime. There is little evidence that the medication actually decreases pain or speeds healing.
Tetracycline suspensions (Achromycin, Nor-tet, Panmycin, Sumycin, Tetracap) used as a mouthwash can relieve pain and accelerate healing; however, their use does not prevent recurrence. Also, use for more than five days may cause problems with reactions and yeast infections in the mouth.
Viscous lidocaine: This is a 2% gel that is applied to the affected area up to four times a day. In order to avoid toxicity, patients should avoid swallowing the medication and should not use the medication more than four times a day.
Sucralfate slurry (Carafate, a prescription medication used to treat peptic ulcers): This treatment is not recommended by many experts and there are limited studies supporting its use. You mix one tablet in 5-10 milliliters (1-2 teaspoons) of water. The slurry is swished around the mouth and spit out four times a day.
Suggested supplements include folic acid, iron, lysine, and vitamin B12, but these may not be necessary if you are not deficient in them.
Corticosteroids: In extremely severe cases, doctors may consider giving oral doses of corticosteroids, if they believe the benefits of treatment exceed the risks of oral steroids. Risks of steroid therapy include weight gain, weakening of the immune system, brittle bones, increase in gastric acidity leading to ulcers, and others.
Thalidomide (Thalomid): In extremely severe cases, doctors may consider using thalidomide. Unfortunately, its severe adverse effects limit its use, and it is only FDA approved for treatment of major aphthous ulcers in HIV-positive patients.
Other potential medications. A long list of medications has been tried and may be used to treat aphthous ulcers in carefully selected patients. Each of these has significant potential adverse effects, and many are quite expensive. These include colchicine, pentoxifylline (Trental), Interferon, Cimetidine (Tagamet), clofazimine (Lamprene), anti-TNF-α agents, infliximab (Remicade), etanercept (Enbrel), levamisole (Ergamisol), and dapsone.
Treatment list courtesy of eMedicineHealth.
Check out the other parts below!