Many individuals suffer with canker sores without ever finding a cause. For some, the answer is irritation or damage to the inside of the mouth, citric acid or other food sensitivities and allergies, or the sodium laurel sulfate (SLS) found in toothpastes and mouthwashes. One problem area that is often overlooked is gluten. If plagued by recurring mouth sores that don’t respond well to medical treatment, the cause might be celiac disease; one of the underlying conditions known to produce mouth sores.
Canker Ulcer or Cold Sore Blister: Canker and Cold Sore Differences
Cold sore blisters are contagious oral ulcers that form outside the mouth. They are caused by the herpes simplex virus (already in the body) becoming activated. Also known as fever blisters, these mouth sores occur on the lip or facial skin near the mouth. Since the herpes virus lives in the facial nerves, cold sores tend to return to the same place where the infected nerves sit, each time the individual experiences a cold sore outbreak.
A canker sore is not contagious and forms inside the mouth. Generally, they occur along the inside lining of the lips and cheeks, underneath or at the side of the tongue, on the mouth floor, or at the back of the throat. More painful than a cold sore, canker ulcers are very small, usually less than half an inch, and grouped in clusters of two or three. While both begin with pimple-like blisters, rupture, then ulcer, canker and cold sores have different causes.
Canker Mouth Sores are Related to Celiac Disease
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 or scraping the inside of the mouth on sharp pieces of food, accidentally biting the side of the cheek, or irritating the mouth with friction from braces, a rough tooth, or a loose filling can all create canker sores, many causes of canker ulcers are associated with celiac disease:
- physical stress
- inflammatory diseases
- allergic reaction or sensitivity to foods, drugs, or chemicals
- immune system impairment, malfunction, or deficiencies
- nutritional deficiencies: B vitamins (especially B-12), zinc, folate (folic acid), iron
There is also a genetic component to canker sores that shadow celiac disease as well, since all celiacs inherit their condition. Mouth sores also tend to run in families.
A Gluten-free Diet Can Reduce Canker Mouth Sores
Celiac disease is triggered when a susceptible individual with gluten intolerance eats gluten-containing grains. However, a celiac doesn’t always manifest gastrointestinal symptoms. In some individuals, atypical reactions are more common.
According to a study published in BMC Gastroenterology entitled “Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis,” Ramin Shakeri and colleagues state that for susceptible individuals, recurrent canker sores may be the only manifestation of gluten intolerance. To discover the prevalence of celiac disease among those suffering with canker sores, as well as the effectiveness of a gluten-free diet treatment, Shakeri studied 247 patients having at least three attacks of canker sore outbreaks per year.
Test results found seven patients (2.83%) had unknown, undiagnosed villi atrophy, and that for the four patients who adhered to a strict gluten-free diet, as recommended, noticeable improvement was seen over a period of two to six months. While Shakeri went on to write that a previous study had found 24% of its patients to have celiac disease upon biopsy, there is still much debate among the scientific community regarding the prevalence of celiac disease among those with recurring canker sores. Findings tend to vary.
The same holds true for a gluten-free diet. While the results of Shakeri’s study were favorable for those who complied, Shakeri writes that other studies have shown the withdrawal of gluten to be ineffective. Therefore, the strongest point that Shakeri’s study makes is that for some individuals, typical gastrointestinal symptoms may be absent in the presence of celiac disease.
Gluten Can Cause Canker Sores and a Gluten-Free Diet May Improve them
Many individuals suffer with canker sores. While mouth sores come from many causes, several causes are associated with celiac disease. Gluten intolerance does not always manifest gastrointestinal symptoms. Many times the only symptom a celiac sufferer has is canker sores. While a gluten-free diet may or may not improve canker ulcers, the presence of mouth sores holds the potential for damaged villi. If current medical treatment is ineffective against canker sore outbreaks, consider seeking out a physician who is willing to test for celiac disease.
Canker sores are not the only symptom that is often ignored. Overweight and obesity is also a sign of possible celiac disease. For more information, read In Overweight Adults Celiac Disease Symptoms are Often Ignored. Gluten sensitivity can still be an issue, even if you don't have celiac disease. A Gluten Free Diet Benefits Those With Gluten Sensitivity discusses similar problems. Ignoring atypical symptoms can adversely affect health. Read What if Medical Care Doesn't Catch Celiac Disease Early Enough to find out what how diagnosis delays affect someone with undiagnosed celiac disease.
Sources:
BCM Gastroenterology, Shakeri, Ramin et al, " Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis," 9:44, 2009; doi:10.1186/1471-230X-9-44
Dental 1 Education Center, Rolf, David D. II, DMD, MSc, Director of Education, “Aphthous Ulcer (Canker Sore)” (accessed August 20, 2010)
Mayo Clinic Health Library, “Canker Sore Causes” (accessed August 20, 2010)
The Merck Manuals, online medical library, “Mouth Sores” (accessed August 20, 2010)
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Vickie Ewell - Vickie has worked with autistic individuals for 9 years. She has celiac disease and specializes in gfcf living.
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