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Canker Sores - Causes

Canker Sore Causes

Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jul;114(1):93-8.

CC chemokine ligand 3 and receptors 1 and 5 gene expression in recurrent aphthous stomatitis.

Gallo CB, Borra RC, Rodini CO, Nunes FD, Sugaya NN.


Stomatology Department, School of Dentistry, University of São Paulo, São Paulo, Brazil.



The aim of this study was to investigate the local and systemic expression of CC-chemokine ligand 3 (CCL3) and its receptors (CCR1 and CCR5) in tissue samples and peripheral blood mononuclear cells of recurrent aphthous stomatitis (RAS) canker sore patients.


This case-control study enrolled 29 patients presenting severe RAS canker sore manifestations and 20 non-RAS patients proportionally matched by sex and age. Total RNA was extracted from biopsy specimens and peripheral blood mononuclear cells for quantitative reverse-transcription polymerase chain reaction. The data obtained by relative quantification were evaluated by the 2(-ΔΔCt) method, normalized by the expression of an endogenous control, and analyzed by Student t test.


The results demonstrated overexpression in canker sore tissue samples of all of the chemokines evaluated compared with healthy oral mucosa, whereas the blood samples showed only CCR1 overexpression in RAS canker sores patients.


These findings suggest that the increased expression of CCL3, CCR1, and CCR5 may influence the immune response in RAS (canker sores) by T(H)1 cytokine polarization.

Copyright © 2012 Elsevier Inc. All rights reserved.


Turk J Gastroenterol. 2012 Feb;23(1):14-8.

Clinical importance of celiac disease in patients with recurrent aphthous stomatitis.

Yaşar S, Yaşar B, Abut E, Aşiran Serdar Z.


Haydarpafla Numune Education and Research Hospital, Department of Dermatology, İstanbul, Turkey.



Recurrent aphthous stomatitis, or frequent canker sores, is a common disease of the oral mucosa that is characterized by recurrent, painful canker sore ulcers of unknown etiology. The association between celiac disease and canker sores has been evaluated in several studies, but variable results have been reported. The purpose of this study was to determine the prevalence of celiac disease in patients with recurrent aphthous stomatitis, RAS, or more commonly, canker sores.


The study group consisted of 82 patients, all of whom had a history of RAS canker sores. The control group included 82 patients who did not have canker sores. Patients were screened for IgA anti-endomysial antibodies, IgG anti-endomysial antibodies, IgA anti-gliadin antibodies, and IgG anti-gliadin antibodies. Patients with positive serology underwent endoscopic biopsies of the duodenal mucosa. Patients in both groups were also questioned regarding gastrointestinal symptoms.


One patient (1.2%) out of 82 in the study group was diagnosed with celiac disease by biopsy. Gastroesophageal reflux disease symptoms, heartburn and regurgitation were determined to be of higher incidence in the study group (p<0.001 and p<0.001, respectively). None of the 82 patients in the control group were diagnosed as having celiac disease.


It is concluded that there is no apparent etiological link between recurrent aphthous stomatitis, or frequent canker sores, and celiac disease and that screening recurrent aphthous stomatitis patients for celiac disease has little clinical value. Additionally, regurgitation of gastric acid to the oral cavity may precipitate the formation of canker sores.


J Oral Maxillofac Pathol. 2012 Jan;16(1):49-53.

Determination of levels of salivary IgA subclasses in patients with minor recurrent aphthous ulcer.

Saluja R, Kale A, Hallikerimath S.


Department of Oral Pathology and Microbiology, Swami Devi Dyal Hospital and Dental College, Barwala, Haryana, India.



Recurrent Aphthous Ulcer (RAU) is an inflammatory disease characterized by recurrent, painful oral canker sore ulcers. It is of multifactorial etiology. Salivary immunoglobulins have important role in the protection of mucosal surfaces.


The aim of this study was to determine salivary immunoglobulin A1 (IgA1) and IgA2 in acute and remission phases of the disease.


Thirty clinically confirmed cases of RAU canker sores and 30 age-and sex-matched controls were included in the study. After detailed case history and thorough clinical examination, 2 mL of saliva was collected in both acute and remission phases of the disease. The obtained saliva samples were subjected to quantification of IgA1 and IgA2 levels using RID kit.


The mean IgA2 level was significantly higher (P<.001) in both acute and remission phase of the study group. The mean IgA1 level also showed a significant increase in the canker sore acute phase compared to remission as well as controls (P<.05). Females exhibited a higher level in acute phase for IgA1 and in both phases for IgA2 (P<.05).


The results associated with clinical observations suggest that acute phase is characterized with increase in IgA2 that might reflect increased immune response as a possible result of the microbial stimulation seen in the acute phase in comparison to the remission period. IgA plays an important role in the pathogenesis of RAU canker sores and it can be used as a parameter to assess the mucosal immune status.


J Eur Acad Dermatol Venereol. 2012 Feb;26(2):231-5. doi: 10.1111/j.1468-3083.2011.04041.x. Epub 2011 Mar 24.

Efficacy of tumour necrosis factor-α antagonists in aphthous ulceration: review of published individual patient data.

O'Neill ID.


de l'immeuble 3, Centre d'Affaires Poincaré, Nice, France.



Severe aphthous ulceration - severe canker sores may require systemic immunosuppressive or immunomodulatory therapy, but a small subset of patients remains resistant to or intolerant of these agents. Although use of TNF-α antagonists in aphthous canker sore ulceration is increasingly reported, the current evidence base for use is weak and evaluation of individual cases may provide the best available data to support such use.


The aim of this study was to review all published data on the use of TNF-α antagonists in patients with severe aphthous canker sore ulceration refractory to systemic agents and discusses this in the context of any possible benefits that may guide any future use.


A comprehensive search on MEDLINE and EMBASE from 1995 to 2010 was performed using pre-defined search terms, with articles included if they met specific criteria.


Sixteen cases from individual case reports or small case-series in which use of TNF-α antagonists in canker sore ulceration were identified in which details of previous systemic therapy and use of subsequent adjunctive therapy were available. Agents with reported success in resolving active canker sores and reducing canker sore recurrence were infliximab, etanercept and adalimumab.


Evidence for efficacy of TNF-α antagonists in aphthous canker sore ulceration infection is limited. Such data suggest that in patients with severe aphthous canker ulceration TNF-α antagonists have some efficacy in inducing canker ulcer resolution and reducing canker sore recurrence. These agents may represent an option in severe refractory aphthosis, although in the absence of controlled studies, caution is advocated if use is to be considered.

© 2011 The Author. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.


Int J Oral Maxillofac Surg. 2012 Mar;41(3):384-8. Epub 2012 Jan 10.

Psychological profiles in patients with recurrent aphthous ulcers.

Al-Omiri MK, Karasneh J, Lynch E.


Department of Prosthodontics, University of Jordan, Amman 11942, Jordan.


The aim of this study was to investigate the psychological profiles of patients with recurrent aphthous ulcers (RAUs), or canker sores. 50 patients (27 men and 23 women, mean age 31.44±9.95 years) with diagnosed RAUs, frequent canker sore episodes, participated in this study. 50 controls who matched the patients in age and gender were also recruited. The participants' personality and psychological profiles were assessed using the Hospital Anxiety and Depression Scale (HAD) and the Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI). Data analysis showed that females had higher HAD anxiety scores than males in both patients and controls. Patients' age, intensity of pain and number, position, duration, and frequency of canker sores had no relation to HAD and NEO-FFI scores. Patients reported higher levels of anxiety in comparison to controls, but both reported comparable depression scores. Patients' NEO-FFI scores were not different from those reported by controls and the psychological profiles of patients and controls were similar. In conclusion; stressful situations and conditions (i.e. anxiety) rather than personality profiles and stable psychological traits were related to the occurrence of recurrent aphthous canker sore ulcers.

Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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