When mouth sores keep coming back: checking for nutrient deficiency and systemic disease, and prevention
If mouth sores come back several times a year, most are recurrent aphthous stomatitis. In Korea, Seoul National University Hospital's medical information explains that this condition appears in about 20% of the population and that many patients relapse 3 to 4 times a year. However, the National Health Information Portal advises that when stomatitis recurs, you should check whether there is a hidden systemic disease, so frequent recurrence is a reason to look into the cause with tests at least once.
Key facts
| Frequency of recurrent aphthous stomatitis | About 20% of the population, 5 to 50% depending on the study group (source: Seoul National University Hospital) |
|---|---|
| Pattern of recurrence | Usually 2 to 6 at a time, and many patients relapse 3 to 4 times every year (source: Seoul National University Hospital) |
| Age at first onset | Mainly 10 to 20 (source: Seoul National University Hospital) |
| Blood test items | Iron, folate, vitamin B12, ferritin, tests related to connective tissue disease (source: Seoul National University Hospital) |
| What to check when it recurs | A hidden systemic disease (underlying disease) (source: KDCA National Health Information Portal) |
| When nutrient supplements help | When a vitamin B12 or iron deficiency is the cause (source: KDCA National Health Information Portal) |
Why do mouth sores keep coming back?
Recurrent aphthous stomatitis is a condition in which ulcers repeatedly form only on the oral lining. Seoul National University Hospital's medical information explains that it is the most common cause of recurrent oral ulcers and that heredity is the best-known factor. This means some people are constitutionally prone to mouth sores.
When factors that encourage recurrence overlap, ulcers form more often. The related factors named in the same material are a shortage of serum iron, folate and vitamin B12, wounds from brushing or eating, smoking, anxiety and mental stress, menstruation, upper respiratory inflammation, and food allergy. The factors that affect each person differ, so finding the ones that apply to you is important.
According to Seoul National University Hospital's medical information, recurrent aphthae mainly first appear around the teens. If oral ulcers did not occur in childhood but began to recur for the first time in middle age or later, it is good to check other causes more carefully.
What tests are done for frequent mouth sores?
Seoul National University Hospital's medical information explains that tests are done when the ulcers differ from the usual pattern, worsen over several months, or come with other symptoms. The blood test items then are iron, folate, vitamin B12 and ferritin levels and tests related to connective tissue disease, and if there is an abnormality, internal medicine checks whether there is a problem with nutrients not being absorbed properly.
According to the National Health Information Portal, the blood tests done in stomatitis care are also used to screen for hidden systemic diseases such as anemia, leukemia, hemophilia and acquired immunodeficiency syndrome (AIDS). A biopsy is not done in every case but when other diseases must be excluded, such as Crohn's disease or blistering diseases.
What signs should be looked at along with recurring mouth sores?
If there are symptoms outside the mouth too, they may be part of a systemic disease. Seoul National University Hospital's medical information explains that at the exam, lesions of the skin, eyes, genitals and anus and the presence of inflammatory bowel disease are checked. The disease the National Health Information Portal separately mentions in connection with recurring large ulcers is Behcet's disease, which rarely can leave permanent defects in the lining.
If the symptoms below come with recurring mouth sores, be sure to mention them at the visit. Symptoms that were being treated separately in different departments may turn out to be tied together as one disease.
- Repeated inflammation or redness of the eyes
- Skin lesions that form again and again
- Ulcers around the genitals or anus
- Bowel symptoms such as diarrhea, abdominal pain and weight loss
- Easily tired and a pale face
How are frequent mouth sores treated?
Once the cause is confirmed, the cause is treated first. If a blood test shows a shortage of vitamin B12 or iron, making it up, as the National Health Information Portal advises, can help in managing stomatitis. If there is no deficiency, the basic approach is to reduce pain and duration with topical treatment each time an ulcer forms.
Seoul National University Hospital's medical information explains that if large ulcers or several small ulcers do not improve with topical medicine, systemic treatment is considered, and immunosuppressants or a short course of steroids are used to reduce the number of ulcers. Such drugs may have side effects, so take them as directed by the prescribing dentist.
Topical medicine used each time an ulcer forms works best when started early, around when the tingling begins. People with frequent recurrences should decide at the visit in advance when and how to use the prescribed medicine and how to store the remainder.
How can I reduce the recurrence of mouth sores?
Seoul National University Hospital's medical information explains that there is no special preventive method for recurrent aphthous stomatitis, while recommending reducing stress of body and mind, maintaining overall health, avoiding mucosal wounds from brushing or eating, and quitting alcohol and smoking.
Writing down the dates the stomatitis appears and your life around then helps find the aggravating factors that suit you. If a repeating pattern shows up, such as a week of poor sleep, days you ate a certain food, or the menstrual cycle, discuss it at the visit. Use a soft-bristled toothbrush and cut hard food small before eating, to reduce the mucosal wounds that trigger a recurrence.
Common myths and facts
Myth: Frequent mouth sores are just from being tired, so no tests are needed.
The National Health Information Portal advises that if stomatitis recurs, you should check whether there is a hidden underlying disease. Nutrient deficiency or a systemic disease is sometimes found.
Myth: Taking vitamins steadily will prevent mouth sores from recurring.
The National Health Information Portal explains that supplements can help when a vitamin B12 or iron deficiency is the cause. Seoul National University Hospital's medical information advises that there is no special preventive method for recurrent aphthae.
Frequently asked questions
How many times a year counts as frequent mouth sores?
There is no officially set count criterion. Seoul National University Hospital's medical information explains that many patients with recurrent aphthae relapse 3 to 4 times a year, so if it is much more frequent than this or ulcers continue without a break, it is good to get examined.
Which department tests for frequent mouth sores?
Oral ulcers can first be examined in oral medicine at the dentist or at an ENT clinic. If the blood test shows an abnormality or eye, skin or bowel symptoms come with it, you will be seen together with internal medicine, ophthalmology, dermatology and so on. Keeping the test result sheets makes it easy to compare with earlier values when it recurs next time.
Family members also get frequent mouth sores. Is it hereditary?
A family history is a feature commonly found in aphthous stomatitis. Seoul National University Hospital's medical information explains that the child's risk is higher even if only one parent has the condition. Even with a hereditary tendency, care that reduces aggravating factors such as wounds and stress still has meaning.
I get mouth sores every time I have my period. Is it related?
Seoul National University Hospital's medical information names menstruation as a related factor of recurrent aphthous stomatitis. If it repeats in line with the cycle, record the pattern, tell the clinician at the visit, and discuss whether there is a medicine that can be used around when the ulcer begins.
Why do I get mouth sores when I'm stressed?
Seoul National University Hospital's medical information names anxiety and mental stress as related factors of recurrent aphthous stomatitis, and fatigue and stress as aggravating factors. The exact mechanism has not been identified, but if it recurs in every busy period, it is good to take care of sleep and rest first.
Related topics
- Mouth sores and oral pain
- Mouth sores and oral pain
- Aphthous stomatitis
- Mouth sore care
- Ulcer that won't heal
- Nutrition and Gums