What is the role of hematinic deficiency in the etiology of aphthous stomatitis (canker sore)?

Updated: Sep 25, 2020
  • Author: Ginat W Mirowski, MD, DMD; Chief Editor: William D James, MD  more...
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In several studies, hematinic (iron, folic acid, vitamins B-6 and B-12) deficiencies were twice as common in patients with recurrent aphthous ulcers as in control subjects. As many as 20% of patients with recurrent aphthous ulcer have a hematinic deficiency, with some studies also reporting notable elevations of blood homocysteine. [16] Lower dietary intake of folate and vitamin B-12 is more common among persons with aphthous ulcers [38] and treatment with 1000 mcg/d has shown benefit in individuals regardless of serum B-12 levels. [39, 40] A small group of adolescents were shown to have reduced incidence and pain from recurrent aphthous stomatitis when given 2000 mg/d of ascorbic acid. [41] Vitamin D deficiency is also more prevalent in patients with recurrent aphthous stomatitis, although there is no correlation between vitamin D levels and a patient’s clinical course, including number of ulcers, duration of ulcers, or frequency of ulcer development. [42]

Thus, serologic workup is warranted. Hemoglobin and RBC indices are not sufficient in all cases.

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