What are canker sores?

Canker sore also known scientifically as aphthous ulcer, is a common type of ulcer found in the mouth, gums, sometimes the upper throat region. It usually involves the breaking down of mucosal surface, which is the inner lining of the mouth, and this exposes the underlying tissue, leading to immense pain especially with contact or movement.

What are the oral signs and symptoms of canker sores

Depending on the size of the ulcers, they can be categorized under minor or major aphthous ulcers. Minor ulcers are anything less than 1cm in diameter while major ulcers extend beyond 1cm in diameter and can be extremely painful. They both usually have a yellow or whitish base where the tissue is exposed and a fiery red border is found around the ulcer. Minor ulcers usually only takes a few days up to a week to heal and major ulcers take much longer, sometimes up to two weeks. Minor ulcers can coalesce to form one big ulcer in which healing will again be delayed. Multiple small ulcers found in a cluster are usually herpetic form of ulcerations with a viral origin.

Who does it usually affect?

Canker sores are very common in the society, affecting 10% of the general population. It usually affects women more than men. Individuals at the extremities of age can also be susceptible to development of canker sores. Vegetarian is another group to be at risk.

What causes canker sores?

The true underlying cause of canker sores is not fully established but there are numerous factors which can contribute to development of such ulcers in the mouth. These factors include, but not limited to, trauma (e.g  orthodontic braces), cigarettes smoking, stress, sleep deprived, sudden weight loss, weak immune system, hormonal imbalance, local chemical reaction to certain drugs, food allergy, infection and last but not least, dietary deficiency such as iron, folic acid or Vitamin B12.

Vitamin B12 deficiency is a common problem that plague today’s society, usually involving younger children and older adults. Many of us although do not lack food, very often do not have a balance diet which covers all our daily needs. Having inadequate amount of Vitamin B12 is not usually a major problem but does vary in terms of clinical manifestation, which can range from virtually no symptoms to recurrent canker sores and more severe symptoms in a minority of cases, affecting haematological or neural function. These cases need to be managed urgently because if left unattended, can be fatal.

How does the lack of Vitamin B12 cause you to be more susceptible in developing Canker Sore?

The pathophysiology of Vitamin B12 deficiency leading to development of canker sores is yet to be established. Although the link between Vitamin B12 deficiency and canker sore is not conclusive, there are numerous case studies demonstrating the possible causative relationship. This is especially true with recurrent cases of canker sores where no other obvious factors can be determined, an investigation of Vitamin B12 is then indicated.

Vitamin B12 deficiency can be diagnosed relatively easily with routine blood screens arranged with a medical doctor to check the serum Vitamin B12 levels. Once a deficiency is diagnosed, the doctor is then to determine the severity of the condition and if a dietary supplement is warranted. In most cases, patients will be advised to increase Vitamin B12 intake through various food sources, predominantly fish, meat, poultry and dairy products. When this is not possible such as strict vegetarians who avoid dairy products, Vitamin B12 supplement tablets can be use as an alternative. Prior to starting on any sort of dietary supplement, patients should really discuss the benefits and risk with a qualified doctor or nutritionist.

What is an effective canker sore treatment?

1000 micron-gram Vitamin B12 supplements have been shown to significantly reduce the occurrence of recurrent canker sores when taken for more than 5 to 6 months, regardless of whether there was a Vitamin B12 deficiency in the first place. Although Vitamin B12 is a simple cheap treatment option with relatively low risk of side effects, it is unclear as to how Vitamin B12 works to prevent canker sores. Furthermore, the dosage and duration at this stage is not certain because limited clinical trials are available. It is unsure if a short course of Vitamin B12 supplement to boost serum levels will be adequate in relieving canker sores. An opinion from your doctor is hence required before undertaking any form of Vitamin B12 treatment for canker sores. More evidence is required before the definitive usage of Vitamin B12 to treat canker sores.