What Causes Mouth Sores?
One Overlooked Area is Celiac Disease
Mouth sores are no fun. They are very painful, and when you have several of them at the same time, it can be difficult to talk, eat, or sleep. Although many people confuse the differences between asphthous stomatitis (canker sores) and cold sores, they are actually two different conditions.
Both problems can occur at the same time. However, the cause and treatment for cold sores differs from the cause and treatment for canker sores. One area that is often overlooked in connection with mouth sores is gluten. Unfortunately, information on how celiac disease relates to cold sores is scarce, and mostly anecdotal, but the scientific evidence that shows a relationship between celiac disease and canker sores continues to increase.
In fact, canker sores are so common among celiac patients that Dr. Peter H. R. Green and colleagues believe all patients with tooth defects and recurring canker sores should be screened for celiac disease. Since untreated celiac can lead to multiple autoimmune conditions, neurological disorders, bone density issues, and intestinal cancer, the earlier a diagnosis is made and the condition treated, the sooner health can be restored and further complications avoided.
What is Celiac Disease?
Celiac disease is an autoimmune disorder. Unlike a typical immune system response where forces are mobilized to destroy a perceived invader, when you have celiac disease, the immune system becomes confused and begins attacking the lining of the small intestine. This occurs whenever you eat foods containing wheat, barley, or rye. The attack results in destruction of the villi, the fingerlike projections inside the small intestine that help the body absorb vitamins, minerals, and nutrients.
Celiac Disease and Canker Sores Connection
Celiac disease results in severe malabsorption and malnutrition. That further interferes with the immune system’s ability to fight off viruses such as cold sores, and often triggers canker sores. In a study published in BMC Gastroenterology, Ramin Shakeri and colleagues studied 247 patients having at least three canker-sore outbreaks per year.
Test results found seven patients (2.83%) had unknown, undiagnosed villi atrophy.
While Shakeri wrote that a previous study found 24% of its patients to have celiac disease upon biopsy, findings tend to vary. At first glance, the percentage of individuals with recurring sores appears small. A little less than 3% is three canker patients out of 100. Even so, that figure is three times higher than the general prevalence rate for celiac disease.
Other studies have found absolutely no association. This variance points toward the connection between celiac disease and canker sores being extremely individual. However, nearly 50% of all celiac patients report recurring canker sores when exposed to gluten. Many of these reports share a long history of recurring mouth sores.
That makes the recent research by Alessio Fasano that made gluten sensitivity an entity extremely significant, as there are six times more people with gluten sensitivity than there are with celiac. Although there is no current scientific connection between gluten sensitivity and canker sores, it stands to reason that many people who test negative for celiac may have gluten sensitivity instead.
What are Cold Sores?
Cold sores are very contagious oral ulcers or blisters that form outside the mouth. They are caused when the herpes simplex virus, already in the body, becomes activated. Also known as fever blisters, these particular mouth sores occur on the lip or the facial skin near the mouth, but they can also populate the chin or cheeks.
The herpes virus lives in your facial nerves, so each time you experience a cold-sore outbreak, the mouth sores tend to break out in exactly the same place where the infected nerves are sitting. Cold sores don’t travel around, and the herpes simplex virus never leaves the body, even after the mouth sore has healed. The sores simply appear in the same spot, preceded by a tingling or burning sensation, and then blister and sometimes rupture.
Cold sores are more common than canker sores, and affect over 50% of the population at one time or another. They seem to signal an overabundance of stress in your life or a compromised immune system. They can be easily spread to others through touch, so if you have this problem, you’ll need to be meticulous at washing your hands after you touch one of your cold sores.
What is a Canker Sore?
Canker sores are not herpes, and they are not contagious. They form inside the mouth, rather than outside. Generally, these mouth sores occur:
- along the inside lining of your lips and cheeks
- underneath your tongue
- at the side of your tongue
- on the mouth’s floor
- at the back of your throat
However, the Gluten Free Society has warned those with gluten intolerance that canker sores can also occur inside your gastrointestinal tract. More painful than a cold sore, canker ulcers are very small, usually less than ½-inch, and are grouped in clusters of two or three – but not always. You can certainly have a single sore. In addition, both types of mouth sores begin with pimple-like blisters, rupture, and then ulcer, but sometimes these conditions can also manifest as a split lip.
What Causes Canker Sores?
Many individuals suffer with canker sores. According to the Intermountain Health Care system, about 20% of Americans experience recurring canker sores. These inner mouth sores can come from a variety of causes.
Saliva helps to protect the lining of the mouth. Therefore, any condition that decreases saliva production can create an environment for the outbreak of canker mouth sores. While scratching your mouth on sharp pieces of food, accidentally biting your cheek, or a loose filling can all cause sores, many causes are also associated with celiac disease:
- inflammatory bowel disease
- irritation or damage to the inside of the mouth
- citric acid
- food sensitivities and allergies
- hormone fluctuations
- Behcet’s disease
- NSAIDS and other drugs
- compromised immune system function
- sodium laurel sulfate (SLS) found in toothpastes and mouthwashes
- minor injury such as biting your cheek
- vitamin deficiencies, particularly B12, iron, zinc, folate (folic acid)
- Helicobacter pylori bacteria
- emotional stress
If plagued by recurring mouth sores that don’t respond well to medical treatment, it’s now thought by the Mayo Clinic and other health professionals that the cause of recurring canker ulcers and teeth defects might be celiac disease. In fact, some celiac specialists and research studies have clearly indicated that canker sores can often be the only symptom you have of that diseased state. The same thing goes for dental enamel defects, yellow or gray teeth, and other tooth irregularities.
Gluten-sensitivity specialist, Vikki Petersen, agrees. In the following video, she explains how going gluten free eliminated her problems with canker sores, and addresses a few additional causes of mouth sores unrelated to celiac disease or gluten sensitivity.
Does Gluten Cause Canker Sores?
Dr. Vikki Petersen, DC, CCN Shares Her Personal Experience
You don’t have to have classic celiac symptoms of bloating, inflammation, cramps, and diarrhea to have intestinal damage. Celiac disease manifests in a wide variety of ways, and most people have absolutely no symptoms at all. In addition, there is also a genetic component to canker sores. That genetic component shadows celiac disease as well, since all celiacs inherit their condition. Like celiac disease, mouth sores tend to run in families.
A Gluten-Free Diet Can Eliminate Canker Sores
According to the BMC Gastroenterology study mentioned earlier, four of the seven celiac disease patients they discovered agreed to go on a strict gluten-free diet. Noticeable improvement was seen over a period of two to six months. While the results of this study were favorable for those who complied, other studies have shown that the withdrawal of gluten was ineffective.
That may have been because the patients were still consuming gluten from unknown sources. In celiac disease forums, dozens of celiacs have reported that their canker sores disappeared completely within only a few weeks after starting a gluten-free diet, but they return whenever they’ve been glutened. For that reason, many celiacs use mouth sores as a sure sign that some form of cross contamination with gluten is going on.
For many celiacs, that can often be gluten-free grains. In June of 2010, Tricia Thompson and colleagues published a study done on naturally gluten-free grains in the Journal of the American Dietetic Association. The outcome of that pilot study was that one-third of the tested grain and flour samples contained various amounts of gluten that were over the newly proposed recommendation of 20 parts per million.
In fact, those samples ranged from a minor 25 parts per million (just barely over the proposed legal limit) to a whopping 2,925 parts per million! To put that into perspective, scientific studies have showed that damage begins at about 50 parts per million.
That means that a large percentage of gluten-free grains, flours, and seeds are not actually gluten free, and each time you consume them, you are running the risk of being contaminated by gluten. While many celiacs can handle a small amount of gluten contamination and be fine, others react to even very small amounts. If you’re on a gluten-free diet, but still having recurring canker sores, try eliminating grains for at least 6 months, and then evaluate the results.
Don’t Go Gluten Free Without Testing for Celiac Disease First
If you have a history of recurring canker sores, and are not currently on a gluten-free diet, you might be tempted to give the diet a trial run, but that isn’t a good idea. A biopsy for celiac disease won’t be accurate if you have already eliminated gluten from your diet. You can’t go off of gluten for a month or two, and then be tested for celiac disease because the body will have already begun to heal.
While there are no conclusive tests for gluten sensitivity, other than an elimination diet, celiac disease needs to be ruled out first. The best idea is to approach your family doctor or a medical practitioner about being tested. Although the association between celiac disease and canker sores is now well established, most doctors do not think to test for celiac in patients that don’t manifest classic symptoms.
Early diagnosis and intervention can save you a lifetime of medical problems, but you sometimes have to take the initiative yourself. Although a gluten-free diet won’t help mouth sores that are not associated with celiac disease, you owe it to yourself to find out if you are one of the thousands of celiacs who have not yet been diagnosed.