Healing Mouth Ulcers with Diet and Supplements

Mouth ulcers, canker sores, or in the medical term, recurrent aphthous stomatitis (RAS) is one of the most common wounds of the mouth mucosa seen in primary care. Aphthous ulcers affect up to 25% of the general population, with 3-month recurrence rates as high as 50%. [1]

They generally occur in the mouth tissue but can also appear on the tongue. There are minor and major wounds of mouth ulcers. 

Minor wounds or lesions are often recurring. They are painful but usually heal without treatment and without leaving any scarring in 10 to 14 days. 

Major lesions often last for six weeks or more and usually leave scars.

Treatment typically involves topical steroids, local anesthetics, and sometimes systemic steroids; however, these only deal with the symptoms and not with the core of the problem itself of why these wounds come. 

People who are more predisposed to mouth ulcers are people with allergies, smokers, or those who have braces, dentures, or use a harsh toothbrush. However, people with autoimmune disorders, HIV, or Behçet syndrome are also more likely to get mouth ulcers. But, what is less known, and is the most common cause of mouth ulcers, is a vitamin deficiency, especially a B vitamin deficiency, with a vitamin B12 deficiency being the most common. [2-5]

Here are natural ways that you can prevent recurrence and promote healing:

B vitamin supplementation

Studies on the efficacy of B vitamins, particularly vitamins B1, B2, B6, and B12, in the treatment of mouth ulcers, concluded that B vitamin supplementation effectively treated mouth ulcers and significantly reduced the possibility of recurrence. [6-7]

Since mouth ulcers can be signs of an underlying nutritional deficiency, especially a vitamin B12 deficiency or a folate deficiency, [5,8] supplementing with vitamin B12 and a B complex supplement is not only beneficial for treating the mouth ulcer, but it also accelerates ulcer healing and achieves optimal vitamin B levels. 

If you are deficient in a vitamin B12 blood test, I recommend supplementing with 1000 mcg subliminal vitamin B12 twice a week for six weeks, together with a B-complex supplement three times a week.

Research also shows that vitamin B12 has analgesic properties. So even if you have no deficiency of vitamin B12, supplementation with this vitamin when suffering from mouth ulcers will improve your quality of life. [9]

Eat a well-balanced diet.

Because nutritional deficiencies often cause mouth ulcers, it’s essential to choose healthy, nutrient-dense foods that meet your daily dietary needs for vitamins and minerals to prevent any future ulcers. A diet with a regular intake of dark leafy green vegetables, beans, tofu, lentils, peas, nuts, seeds, whole grains, and fresh fruits with frequent variation in each of these food groups will supply your body with nutrients in abundance preventing most disease states. With a B12 supplement, your nutritional needs will be met with a whole, primarily plant-based diet eliminating any mouth ulcer recurrence.

Practice good mouth hygiene

Suppose the mouth ulcer was caused by an accident or injury, such as biting yourself. In that case, you could promote healing by ensuring that you are not making the lesion worse. Prevent infection by maintaining a clean mouth environment. Drink plenty of water. Avoid hot or spicy foods. Rinse your mouth regularly with a warm salt solution (sodium chloride – NaCl). Salt rinses as a treatment of oral diseases have been around as early as 2700 B.C., so many dentists recommend salt solutions in routine oral care. Studies support that rinsing with salt promotes oral ulcer healing because it raises the mouth’s pH, which keeps bacteria from developing. [2] Rinsing with a 1.8% salt solution has been shown to significantly enhance wound closure, with a minimum remaining wound area at 24 and 48 hours. But a higher concentration of salt (7.2%) produced the opposite effect in the study. 

Be mindful of how long it takes for your mouth sores to heal. Mouth sores that persist beyond two weeks may indicate a more severe condition. It’s essential to consult with a doctor to determine if the mouth sores result from a deficiency or a more serious medical condition such as inflammatory bowel disease, diabetes mellitus, HIV/AIDS, celiac disease, or other autoimmune diseases.

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References

1. Barrons RW. Treatment strategies for recurrent oral aphthous ulcers. Am J Health Syst Pharm. 2001;58(1):41–50. 
2. Piskin S, Sayan C, Durukan N, Senol M. Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol. 2002;16:66–67. 
3. Wray D, Ferguson MM, Mason DK, Hutcheon AW, Dagg JH. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. BMJ. 1975;2(5969):490–493. 
4. Barnadas MA, Remacha A, Condomines J, de Moragas JM. Hematologic deficiencies in patients with recurrent oral aphthae. Med Clin (Barc) 1997;109:85–87.
5. Volkov I, Rudoy I, Abu-Rabia U, Masalha T, Masalha R. Case report: Recurrent aphthous stomatitis responds to vitamin B12 treatment. Can Fam Physician. 2005;51(6):844-845.
6. Shi J, Wang L, Zhang Y, Zhi D. Clinical efficacy of vitamin B in the treatment of mouth ulcer: a systematic review and meta-analysis. Ann Palliat Med 2021;10(6):6588-6596. doi: 10.21037/apm-21-1064
7. Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med. 1991;20(8):389-391. doi:10.1111/j.1600-0714.1991.tb00950.x
8. Kozlak ST, Walsh SJ, Lalla RV. Reduced dietary intake of vitamin B12 and folate in patients with recurrent aphthous stomatitis. J Oral Pathol Med. 2010;39(5):420-423. doi:10.1111/j.1600-0714.2009.00867.x
9. Liu HL, Chiu SC. The Effectiveness of Vitamin B12 for Relieving Pain in Aphthous Ulcers: A Randomized, Double-blind, Placebo-controlled Trial. Pain Manag Nurs. 2015;16(3):182-187. doi:10.1016/j.pmn.2014.06.008
10. Huynh NC-N, Everts V, Leethanakul C, Pavasant P, Ampornaramveth RS (2016) Rinsing with Saline Promotes Human Gingival Fibroblast Wound Healing In Vitro. PLoS ONE 11(7): e0159843.