Canker sores found in the mouth are known medically as aphthous stomatitis. They occur in about one fourth of the population and tend to recur within 3 months in half of those cases. An article published in Canadian Family Physician (2005;51:844-845) discussed cases where vitamin B12 was a safe and effective choice in the treatment of aphthous stomatitis in patients who were deficient in this vitamin. Researchers summarize that infections, trauma, dryness, irritants, toxic agents, genetic factors, hypersensitivity, and autoimmune conditions predispose patients to recurrent aphthous stomatitis (RAS). They also state, "Recurrent aphthous stomatitis can also result from a nutritional deficiency, particularly lack of iron, vitamin B3 (as in pellagra), vitamin C (as in scurvy), folic acid, or vitamin B12."
The authors of the study reviewed cases where patients who had RAS for years and were otherwise healthy, were found to have vitamin B12 deficiency. In all of the cases replacement therapy was initiated with 1000ug of parenteral vitamin B12 twice a week for 6 weeks and then continued with injections once a month for a year. The physicians noticed rapid improvement and recovery within weeks of the start of vitamin B12 therapy. They also observed complete recovery of RAS with six month follow-ups.
The authors suggest that the pathogenesis of RAS in vitamin B12 deficiency may be related to suppression of cell-mediated immunity. Changes in the cells of the tongue and buccal mucosa have also been reported. These case reports are significant and patients with recurrent aphthous stomatitis should be tested for vitamin B12 deficiency (simple blood test). Replacement of vitamin B12 is safe and should be addressed immediately as this type of deficiency can cause serious problems, especially neurologic deficits.
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