A pain in the mouth – Natural approaches to preventing and treating mouth ulcers

After completing my MSc I shared a house with a friend who seemed to be constantly suffering with mouth ulcers.  Looking into the literature I discovered that there were a number of natural ways that could help to prevent and treat this painful occurrence.  Since then he has been ulcer free! 

Mouth ulcers, medically known as Aphthous Stomatitis, are small, white or yellow-white, painful ulcers that usually affect the tongue or the lining of the inner cheeks or lips.  The ulcers involve the inflammation or destruction of the mucous membranes that line the mouth.  Usually they will be painful for three to four days with symptoms generally diminishing in seven to ten days.  An ulcer begins as a small red dot on the lip or the inside of the mouth, which then develops into a small blister with a white head, eventually the head will rupture, leaving an open ulcer that, without care, can become secondarily infected by yeast or bacteria.

I was reminded of my friend as I read two recent studies that have linked the herb liquorice to effectively treating mouth ulcers(1,2).  One of the studies(1) was a review that looked at over-the-counter (OTC) treatment available for mouth ulcers, the scientists found that there was no reliable evidence to suggest that OTC preparations could do more than simply manage symptoms – the exception were two treatments which contained the herbal extract liquorice.  The liquorice containing treatments reduced the pain associated with mouth ulcers and also increased the healing time.  In addition, the liquorice containing OTC treatments were as effective as a prescription only medication (amlexanox).  The second study(2) found that liquorice treatments were effective at reducing the size of ulcers, the pain and the duration which they remained.

Liquorice has been traditionally used to treat mouth ulcers for a long time due to its apparent soothing properties.  A small study(3) found that liquid liquorice extract (which is widely available) diluted in warm water and used as a mouth rinse was very helpful at accelerating the healing of mouth ulcers. 

It is unsurprising that liquorice may be helpful in reducing the swelling and pain associated with mouth ulcers as it does seem to poses anti-inflammatory properties.  If you have a mouth ulcer you may well find it helpful to drink liquorice teas (powdered liquorice root is widely available and can be used to make a tea or mouth rinse), make a mouth rinse using herbal extract or chew on a liquorice tablet twenty minutes before eating in order to help reduce pain.

Liquorice may well be helpful in treating a mouth ulcer once it has already taken painful residence in the mouth however, more importantly for those of you who may suffer from recurrent mouth ulcers, there are a number of ways to prevent their occurrence in the first place.

Toothpaste seems an unlikely place to start, however, a number of studies(4,5,6) have linked recurrent mouth ulcers to Sodium Lauryl Sulfate (SLS), a common foaming ingredient in most toothpastes.  SLS may dry out and irritate the lining membranes of the mouth and tongue and increase the risk of mouth ulcers from reoccurring.  The studies have shown that using SLS-free toothpaste is helpful to individuals susceptible to mouth ulcers.  Natural SLS-free toothpaste is now widely available and it may well be worth switching to such a paste for three months to see if it is helpful in minimising the frequency of your attacks.

Another common factor(7,8,9,10) in individuals who suffer from regular mouth ulcers is insufficiency in a variety of B vitamins (including B12, B1, B2, B6 and folic acid).  Supplementation with a multi-B vitamin complex is often very helpful to those who frequently suffer from mouth ulcers.

As a final note I would like to mention stress.  For as long as I can remember people have said that mouth ulcers are caused by stress and some resources suggest this to be an ‘old wives tale’.  Being ever curious, I started to dig around in the medical literature.  Stress is linked to inflammation in the body and so it would be feasible for a link to mouth ulcers to exist.  I did find a supportive study that looked specifically at stress and anxiety(11) in the causation of mouth ulcers and one(12) that found a relaxation therapy was very effective in reducing the recurrence of ulcers in susceptible individuals.  Stress may be linked to the depletion of many nutrients in the body.  A healthy balanced diet will help keep your nutrient levels high – important for a well functioning immune system!  In addition to this, if you regularly find yourself feeling stressed or pressured you may wish to consider supplementing with a broad-spectrum, high quality, multi vitamin and mineral product to prevent any dietary shortfalls.

(1)  Burgess JA et al.  2008.  Review of over-the-counter treatments for apthous ulceration and results from use of a dissolving oral patch containing glycyrrhiza complex herbal extract.  J Comp Dent Pract.  9:88-89
(2) Martin MD et al.  2008.  A controlled trial of a dissolving oral patch containing glycyrrhiza (licorice) herbal extract for the treatment of aphthous ulcers.  Gen Dent.  56:206-210
(3) Das SK, Das V, Gulati AK, Singh VP.  1989.  Deglycyrrhizinated liquorice in aphthous ulcers.  J Assoc Physicians India.  37(10):647
(4) Herlosfson BB et al.  1994.  Sodium lauryl sulfate and recurrent aphthous ulcers.  A preliminary trial.  Acta Odontol Scand.  52:257–59.
(5) Herlosfson BB et al.  1996.  The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers.  Acta Odontol Scand.  54:150-153.
(6) Chanine L et al.  1997.  The effect of sodium lauryl sulfate on recurrent aphthous ulcers:  a clinical study.  Compend Contin Educ Dent.  18:1238-1240.
(7) Piskin S et al.  2002.  Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis.  J Eur Acad Dermatol Venereol.  16(1):66-7
(8) Haisraeli-Shalish M, Livneh A, Katz J, Doolman R, Sela BA.  1996.  Recurrent aphthous stomatitis and thiamine deficiency.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod.  82(6):634-6
(9)Barnadas MA et al.  1997.  [Hematologic deficiencies in patients with recurrent oral aphthae].  Med Clin (Barc).  109(3):85-87
(10)Nolan A et al.  1991.  Recurrent aphthous ulceration.  J Oral Pathol Med.  20:389-391.
(11)Andrews V H et al.  1990.  The Effects of Relaxation/Imagery Training on Recurrent Aphthous Stomatitis:  A Preliminary Study.  Psychosomatic Medicine, September/October 1990; 52(5):526-535.
(12)McCartan BE et al.  1996.  Salivary cortisol and anxiety in recurrent aphthous stomatitis.  J Oral Pathol Med.  25(7):357

Written by Ani Kowal