Research Article

Print This Page Printable version of this page

Your Toothpaste May Be Giving You Canker Sores And... Bad Breath!

  By Dr. Harold Katz
  Founder, California Breath Clinics

Canker sores, also known as mouth ulcers, plague the lives of millions of people all over the world. These small oral ulcers can make life unbearable when eating, drinking, speaking or swallowing. Frustration sets in when your dentist or doctor doesn't know how to respond to your questions about these annoying and recurring ulcerations.

Unfortunately, many people are actually creating their own canker sore problems by using commercial toothpastes containing an ingredient proven to be linked to canker sores. Sodium Lauryl Sulfate (SLS) is placed into toothpaste and some mouthwashes to create that foaming effect that we have come to rely upon. Did you know that Sodium Lauryl Sulfate is also the main ingredient in your shampoo? Check it out!

The harshness of this chemical has been proven to create microscopic damage to the oral tissue which lines the inside of your mouth... and this leads to canker sores. TheraBreath Oral Products do not contain Sodium Lauryl Sulfate (SLS) - never have, never will - and are the only group of oral products designed to fight bad breath that are 100% SLS-free.

The Science Of Canker Sores

Canker sores are also known as mouth ulcers, aphthous ulcers, recurrent aphthous stomatitis or oral ulcers.

Many people, including doctors, confuse canker sores with cold sores that are really fever blisters. Although both types of sores are painful, annoying and recurring, there are major differences:

Canker Sores	Cold Sores
Only occur inside the mouth	Mostly on outside of the mouth, sometimes on the inside of the mouth, but appear only on hard surfaces, such as the palate
Not Contagious	Contagious
Not Viral, not caused by a virus	Caused by viruses
Caused by damage to oral tissue, often by Sodium Lauryl Sulfate, a common foaming agent ingredient in almost all toothpastes	First sign is the appearance of small blisters called vesicles

What Causes Canker Sores?

The latest research shows that certain chemical compounds trigger the production of canker sores, and one of those compounds is... soap. Yes soap, inside your mouth! For many years, major pharmaceutical companies have used soap (chemically known as Sodium Lauryl Sulfate, SLS) to create a foaming agent when you brush your teeth. Why? Even though the foam doesn't provide any benefits to the toothpaste, it does fool you, the user, into thinking that the foaming action is directly related to the strength of the cleaning action. After speaking with many of these pharmaceutical companies, their most common reply is, "We use Sodium Lauryl Sulfate as a surfactant to blend all of our ingredients together and make them work more effectively." A surfactant is a chemical agent that allows other chemical molecules to get closer to each other. However, there are many surfactants out there that are not soapy and do not cause allergic reactions that can result in canker sore production.

The establishment of the link between the development of canker sores and the SLS additive common to almost all commercial toothpastes is a very important medical discovery.

Because SLS acts just like a detergent, it is used in the laboratory as a membrane destabilizer and solubilizer of proteins and lipids. SLS is used in toothpaste to emulsify (mix together) oil and water-based ingredients.

Because SLS is classified as a soap, you can easily understand why, for many people, this ingredient can cause drying inside the mouth. And remember, dryness is one of several factors that lead to bad breath!

For susceptible individuals, SLS can cause microscopic trauma or membrane disruption to the skin cells in the mouth… and this trauma or disruption of the immune system can lead to canker sore formation.

Recent studies have also shown a link between the use of toothpastes containing SLS and recurrent aphthous stomatitis (RAS), also known as canker sores or mouth ulcers.

A Synopsis Of Three European Scientific Studies

At the University of Oslo in Oslo, Norway, Drs. Barkvoll and Brokstad revealed a 60% to 70% reduction in the number of canker sores in patients who used SLS-free toothpaste during the three month test period. Additional studies have since shown equally promising results.

In these clinical studies, patients using an SLS toothpaste displayed a greater amount of desquamation (loss of a layer of skin lining the inside of the mouth). This discovery led to the theory that SLS may contribute to RAS (canker sores) by causing injury to the oral epithelial cells (skin cells lining the inside of the mouth).

By denaturing protective mucus proteins, SLS can also disrupt the protective layer of mucus which lines the inside of the mouth. A denatured protein is a protein which has lost its three dimensional shape and thereby becomes nonfunctional and useless. The denaturing of mucus proteins makes the cells lining the mouth more susceptible to injury and canker sore formation.

REFERENCES
1. Herlofson, Bente and Barkvoll, Pal. Sodium Lauryl Sulfate and Recurrent Aphthous Ulcers: A Preliminary Study. Acta Odontol Scand. 1994, 52:257-259

2. Herlofson, Bente and Barkvoll, Pal. The Effect of Two Toothpaste Detergents on the Frequency of Recurrent Aphthous Ulcers. Acta Odontol Scand. 1996, 54(3): 150-153

3. Barkvoll, Pal and G. Rolla, Possible Effects of Sodium Lauryl Sulfate (SLS) on the Oral Mucosa. J Dent Res. 1989, 68:991

What is especially exciting about these findings is that many of my patients have experienced tremendous improvements as a result of using SLS-free toothpaste. As well, many visitors to my website have found canker sore relief by using an SLS-free toothpaste.

At the present time, research is being conducted to determine what makes a person susceptible to canker sores in the first place, in addition to what actions and mechanisms trigger canker sore outbreaks. Among those things that may trigger an attack or make a person more susceptible are:

1. SLS found in toothpaste and some mouthwashes
2. Allergies to food products and certain preservatives
3. Trauma from brushing teeth too vigorously
4. Lip Biting
5. Stress
6. Trauma from eating hard, rough foods (potato chips, pretzels)
7. Deficiencies in Vitamin B12, iron and folic acid

Current theories on the causes of canker sores have also focused on the immune system. This research suggests that canker sores may be caused by the body's own immune system attacking the cells that line the inside of the mouth.

The first appearance of canker sores usually occurs between the ages of 10 and 20. During adult life, episodes usually, but not always, become less frequent and less severe. Interestingly, women often report increased susceptibility to canker sore formation during certain times of their menstrual cycle. Some women report total relief from canker sores during pregnancy.

As well, canker sores affect people with varying degrees of severity. Some people may get an occasional outbreak of canker sores once or twice a year, while others may suffer near continuous, overlapping episodes.

Preventing Canker Sores

The most important advice we can give you is avoid toothpaste that contains Sodium Lauryl Sulfate (SLS). Check the list of ingredients.

Trauma to the inside of the mouth can trigger the production of canker sores. Try to avoid overzealous tooth brushing. Unfortunately, most people just can't stop doing so because hard tooth brushing is an ingrained habit developed during childhood. Consequently, we encourage our patients to use our SuperSoft Nylon Toothbrush, made exclusively for TheraBreath by expert toothbrush manufacturers in England. Its soft, yet strong bristles make it virtually impossible to cause any damage to the inside of the mouth.

Cut down on hard or sharp foods, such as potato chips, pretzels, nachos, cut apples and hard candies which might nick, abrade or otherwise traumatize the oral tissue and scrape the inside of your mouth.

Many people bite the insides of their cheeks or their tongues while sleeping or in a state of nervousness and stress. We suggest that you wear a mouth guard while sleeping because this device can be very effective at preventing further oral trauma. Contact your dentist for more information.

Reactions to certain food products can also be responsible for some cases of canker sores. Nuts, peanut butter, sea food, wheat products, chocolate and milk can sometimes cause these sores to appear.

Treatment of Canker Sores

Usually canker sores clear up within 7 to 14 days without treatment. During this time, the sores can be very painful especially when eating or drinking. Treatment can help to ease the pain as well as possibly reduce the time required for the sores to heal and go away.

Other Viable Treatments

1. Anti-Microbial Mouthwashes
Surprisingly, anti-microbial mouthwashes have provided many people with effective relief. Because canker sores are not caused by bacteria or a virus, the mechanisms by which these anti-microbial mouthwashes work remain unclear. Commonly used anti-microbial oxygenating mouthwashes include TheraBreath's Oral Rinse and PerioTherapy Oral Rinse.

2. Analgesic (Pain Relieving) and Protective Ointments and Gels
Local drug stores carry some pain relieving medications, including Zilactin and Oragel. After application, they create a protective cover over the sensitive areas.

3. Corticosteroid Rinses and Gels
These prescription medications must be authorized by your dentist or physician and should only be used for severe or very painful cases. The application of these types of rinses and gels may be painful at first. The most common topical steroid gel is Lidex applied very gently to the canker sore 2 to 4 times per day.

Systemic Conditions Associated with Canker Sores

In a very small number of cases, canker sores can be indicative of a bodily (systemic) disorder, such as Behcet's disease characterized by canker sores, genital lesions, eye lesions and dermal afflictions.

Those infected with HIV can also develop stomach/internal/topical/ ulcers that resemble cancer sores.

Crohn's disease, celiac disease, ulcerative colitis and gluten hypersensitivity (wheat allergy) are some digestive conditions that display canker sores as part of their disorder.

Consult your doctor if any of these conditions are associated with your canker sore problem.