Canker sores-infection or immune attack?

DEAR DR. DONOHUE: Since my 26-year-old son was a child, he has suffered with numerous canker sores. He has tried every over-the-counter product and has asked every doctor and dentist he has seen for advice. Nothing works for him. Is it possible to culture these sores and determine the cause? -- S.B.

ANSWER: Just about everyone has had at least one canker sore. Most heal on their own in a week to 10 days even without treatment, but it's a miserable time while they're present.

Many causes have been advanced. Some feel that mouth bacteria, which have been cultured, are responsible. Others propose that canker sores are the result of an immune attack on the mouth membranes. Food allergies, hormonal changes and a genetic predisposition also have been advanced as possible causes. In a few instances, canker sores are seen in conjunction with other illnesses, like celiac disease, Crohn's disease and Behcet's disease.

There are some things your son can do to lessen the frequency of outbreaks. He has to protect his mouth from any injury, which means his toothbrush should be soft, he shouldn't eat hard, crunchy foods like toast, and he should stay away from acidic foods and drinks. Readers write in to say that when they have changed toothpastes from ones containing sodium lauryl sulfate to ones without that ingredient, their canker sores left. Others proclaim the efficacy of L-lysine. Milk of magnesia, Kaopectate and liquid Benadryl can be swished around in the mouth and then spit out, and they have helped canker sore victims. A new product, Cankermelts, is an adhesive patch containing licorice extract and has been recently featured in the dental literature as being an effective treatment. The patch dissolves. The manufacturer is Orahealth.

Cortisone drugs incorporated into gels and applied to the sore have had good reviews. Some examples are Lidex, Diprolene and Temovate. Kenalog in orabase is a pastelike cortisone product that sticks to the sores. Aphthasol oral paste is another, somewhat newer treatment that often brings relief.

DEAR DR. DONOHUE: Are you ever going to get back to me about the numbing sensation around my ankles? I have had tests and have been to three different doctors. My circulation is good, and I don't have any nerve damage. What's causing this? -- K.R.

ANSWER: I'm sorry but I don't have a clue.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com. 2006 North America Syndicate Inc. All Rights Reserved