Possible causes of my outbreak of aphthous ulcers

March 30, 2016 12:39 AM

(standard YANMD) I've had on and off aphthous ulcers my entire life since I was very young, they are not something new to me. But for the past 2-3 months, I've had them continuously. As soon as one starts to fade, a new one shows up. This is new, and it's driving me insane. I cannot think of what's caused this change, and I'd appreciate help brainstorming what I could investigate.

Some additional details: My father, my brother, and my cousin all also suffer from recurrent aphthous ulcers, so presumably there's some genetic component. We've always tried to avoid food with sulfates because of rumors that they cause the ulcers, although avoiding those foods has never prevented me from getting them.

I have never successfully identified what causes them, it's not food or stress as far as I can tell. (the only source of stress right now is the damned ulcers themselves). My lifestyle did not undergo any major changes recently. I still use my special sulfate free toothpaste, have been eating the same menu as always, and except for when my sores have been waking me up from pain have been sleeping fine.

If I'm going to go to a doctor about this, I need to go equipped with as much information about what I want them to check as possible, because in my experience what I don't ask for explicitly I won't get.

Any ideas, mefites?

posted by Cozybee to Health & Fitness (24 answers total)

Best answer: I'm just going off wikipedia so these may have already occurred to you, and I know you said you don't think it's food, but how are your B12, folate, and iron levels? Have you been tested for allergies? Did you recently go on or off the pill?
posted by aniola at 12:51 AM on March 30, 2016

Best answer: Ergh, I know your pain. I used to get these extremely commonly and still do occasionally when I'm not sleeping well. For how much of a pain in the ass they are we seem to know frustratingly little about them, unfortunately. Anyway, IANAD at all, but I was also going to suggest B-12, because there's at least a little evidence that supplementing can still help for aphthous ulcers even for people who didn't appear to be deficient. (B-12 deficiency is also the kind of thing that can creep up on you after being veg*n for a while so it wouldn't have to be a recent diet change.)

When mine got so bad I could barely eat, though, I got a course of prednisone and it was a godsend; if the pain's really waking you up at night (!) that might be something to explore. If they're just single ulcers and look like the same ones you've always had it's probably not a new, e.g., HSV infection, but I guess that could also be something to get a doctor's opinion about just in case (since then you'd want acyclovir and not steroids).

Best of luck!
posted by en forme de poire at 1:22 AM on March 30, 2016

Best answer: Is there any chance your toothpaste has changed formulation recently and added some irritating ingredient? Maybe try switching toothpastes, or even just brush with no toothpaste for a week or two and see if it helps.

Whether or not you figure out the cause, talk to your doctor about topical dexamethasone--I've used it as a mouthwash and it really seems to help, especially if you do it a few times a day.
posted by fermion at 1:26 AM on March 30, 2016

Maybe, it is a symptom of a weakened immune system. Probably you're just exhausted and it affects your immune system.
posted by korpe4r at 2:15 AM on March 30, 2016

Have you investigated Behcet's as a cause?
posted by PorcineWithMe at 2:38 AM on March 30, 2016

No answer about the causes, but two bits of info that may help:

You could try out this toothpaste: Parodontax. I've used it for 25 years [gasp] and have not had one of those ulcers in the entire time. It may be coincidence, but it remains a fact that I just stopped having them...

To alleviate the pain and make them pass more quickly, I recommend tincture of myrrh, applied right on the spot with a q-tip a number of times a day.
posted by Namlit at 3:10 AM on March 30, 2016

Whoa. I now have a name for these fuckers.

All I can suggest is more sleep and Oral-b topical and Biotene mouthwash. I used to get them often and at least for me they were directly pegged to sleep, stress, or right after a cold.
posted by canine epigram at 3:10 AM on March 30, 2016

IIRC they are a common complaint of people who then go on to be diagnosed with celiac. That might related to the b12 deficiency mentioned above since celiac affects the body's ability to absorb nutrients.

Hardly compelling data but I had them all my life til I had to go gluten free. Not a one since.
posted by kitten magic at 3:27 AM on March 30, 2016 [2 favorites]

I had the same problem all my life until I switched to sodium lauryl sulfate free toothpaste, but I see you've already done that. Try switching toothpaste brands?

Now I almost never get the sores and when I do they go away within a day or two. One thing that helps the pain for me is to put an uncoated baby aspirin directly on the sore and let it dissolve.
posted by mareli at 5:29 AM on March 30, 2016

I had these things continuously as a kid, and I still get them sporadically. Oral antihistamines usually clear them right up.
posted by workerant at 8:14 AM on March 30, 2016

You might not like this, and I didn't either at first, but, and least for me and my son-in-law, it worked. Pack the ulcer with salt. Pack it in good and leave it as long as you can. It hurts, but the pain will ease. For me the ulcers healed way quicker and didn't hurt as much. (after the salt that is, lol) I heard a rumor that they could be a virus and the salt creates an environment where the virus can't survive.
posted by PJMoore at 8:26 AM on March 30, 2016

Best answer: Hi, a number of years ago I was involved in an epidemiological research project that ultimately led to this paper. If you have a lot of dairy in your diet, consider a self-experimental period of limiting or reducing your intake for a period.
posted by late afternoon dreaming hotel at 10:17 AM on March 30, 2016 [1 favorite]

Pack the ulcer with salt

Make it baking soda. I have gotten these on and off for 30 years. Usually when I have recently been ill or shortly before, or going through a stressful period, or bit the inside of my mouth recently. Some foods set it off too. Anyways

Yeah so about a month ago, my daughter was getting sick a lot. We were in and out of the doctors office, and I was barely sleeping because of all the little toddler coughs. Started getting cankers again (thats what we call them here). So on one such visit to the doctor, I asked what to do about these. She told me baking soda is great for the pain. Also apparently eating some plain yogurt can help them heal faster. It was actually a lot better than the over-the-counter stuff and the prescription stuff I'd been given before.
posted by Hoopo at 10:33 AM on March 30, 2016

My dad is plagued by these as well. He was prescribed a "magic" mouthwash that clears them right up. I'll ask him what it is.

Also, and I may be totally wrong, but I think he was also prescribed Acyclovir.

I will get back to you on the name of the mouthwash.
posted by futz at 12:06 PM on March 30, 2016

I get them from tomatoes, citrus etc which I think is common but seemingly also from toothbrushes. I'm apparently allergic to the plastic or bristles in some regular toothbrushes. I have barely had any since I got my sonicare (which is how I put it together).

I kill them by holding an ice cube on them with my tongue for a long time. It works pretty well for me.
posted by fshgrl at 12:28 PM on March 30, 2016

Best answer: Oh god ow I get these too. None for ages and then suddenly out of nowhere a crop, or a few in a row for weeks. I'm sorry I can't help with causes but can you go to a pharmacy and get something like kenalog? This is the only thing that has ever worked for me and I was so glad when I found it. Before kenalog my outbreaks would last for weeks - now I can clear them up in 24hrs. Prior to kenalog I'd tried baking soda, ice, peroxide, mouthwash and salt. Not all at the same time. Zero impact. Except salt which REALLY HURT OW. Where I am (Australian) it's an over-the-counter purchase at a pharmacy but if it's really bad there might also be a prescription-strength option the doctor can help with. Good luck - those things are horrible.
posted by t0astie at 1:38 PM on March 30, 2016 [1 favorite]

Oh also I just remembered about causes - the pharmacist I first went sobbing to with a mouth full of sores told me the ulceration is caused by bacteria infecting microscopic cuts or tears in the mouth tissue. Kenalog works, in part, by sealing off the sore and starving the bacteria of oxygen so they die allowing the sore to heal.
posted by t0astie at 1:44 PM on March 30, 2016

Best answer: I get these too, notably more often when I am jetlagged or otherwise sleep-deprived and stressed. Some kinds of sugar-free gums and candies also seem to trigger them. Until/unless you figure out what's causing them and how to avoid it, I strongly second the recommendation of getting some kenalog/kenocort/adcortyl or a similar corticosteroid oral paste to treat them in the meantime--it helps them heal much more quickly. It's over-the-counter in other countries where I've lived (UK, Turkey) but I think you need a prescription here in the US--I always pick up a couple of tubes when I'm overseas for that reason.
posted by karayel at 2:08 PM on March 30, 2016

Do you have any of the other symptoms of behcet's disease (genital ulcers, eye inflammation, skin lesions, arthritis)? If so, it might be worth looking into - oral ulcers are the most common symptom.
posted by zug at 2:09 PM on March 30, 2016

The mouthwash I mentioned above is called Dexamethasone elixer.

good luck!
posted by futz at 4:50 PM on March 30, 2016

Best answer: I used to get these. A friend's mom (nurse) recommended something called a silver nitrate stick. Wet the end, stuck it on the sore, ten seconds of hurts like hell, ulcer gone. Good luck!
posted by cyndigo at 2:07 AM on March 31, 2016

Best answer: Ask your doctor about Debacterol. I have tried most of the solutions above (and more) and Debacterol is the only medicine that heals the ulcer, as opposed to just numbing or alleviating the pain. It's weird to say this, but it changed my life because I am no longer a slave to these stupid sores. As soon as one crops up, I treat it and it's done.

Oh, and my doctor wasn't the one that tipped me off to this stuff, it was my dentist. It's only available by prescription. No doctor I've discussed the issue with knew about this medicine, and I've had to literally print information off their website for them and say THIS. Good luck.
posted by ohohcyte at 8:56 AM on April 10, 2016

Response by poster: Okay, I got a corticosteroid + prescription topical painkiller.

It worked... The first time I applied it.

But they're back now (several at once) and the prescription meds have become much less effective - not speeding the healing, and not so effective on numbing pain.

This is a pattern I've had with every other solution I've tried in the past as well (initial effectiveness that then declines)

There's still several suggestions (like the nitrate stick) left to try before I totally give up...

I'm going to get tested for vitamin deficiencies and am considering trying an elimination diet (eat only a few types of things for a month, and if the sores go away gradually add other foods to see what might be causing it) although I really don't want to.

Thanks for all the answers. I'm leaving the question as unresolved for a little longer, in case someone stumbles across anything else...
posted by Cozybee at 12:23 PM on April 30, 2016

Get tested for celiac before you eliminate gluten from your diet (if that's something you were planning eliminating). You have to be consuming it regularly for tests to be valid.
posted by kitten magic at 6:14 PM on April 30, 2016