An ulcer is an area where the top surface of the mouth lining is lost, producing a small ‘crater’. Mouth ulcers are painful, especially when acidic fruits or spicy foods are eaten. There are two main types of ulcer – those caused by injury, and those caused in other ways. The first type are larger and can be caused by a rough edge to a tooth, badly fitting dentures, or careless brushing of the teeth. Those of the second type are smaller, about 2-3 mm across. Most people suffer from mouth ulcers of this type from time to time. They are only unusual if you have large crops of ulcers that recur frequently – roughly one person in ten is affected in this way.
Viral infections are probably the most common cause of mouth ulcers generally, but they are not found in cases of recurrent mouth ulcers. No-one knows exactly what causes this problem, but it is diought to be some sort of infectious agent that induces the body to make antibodies against its own mouth cells. The infectious agent itself has not been tracked down yet, because it is not present in large numbers. According to this theory, the ulcers are produced by the body’s immune system attacking the lining of the mouth. Heredity seems to play a part – recurrent mouth ulcers often ‘run in the family’.
In general, food intolerance is a relatively unlikely cause of recurrent mouth ulcers – but there are certainly some cases where such ulcers clear up during an elimination diet. Those with classical allergic symptoms, such as hay-fever or asthma (atopics), are more likely to fall into this group than others. In most of those whose recurrent ulcers are due to food, there are other food-related symptoms as well, but sometimes recurrent mouth ulcers are the sole symptom of food sensitivity.
How foods might produce mouth ulcers is not known, although in atopic patients, mast cells probably play an important part. Any food can be responsible, as in all forms of food intolerance, but there is some evidence that gluten – the mixture of proteins found in wheat, rye, barley and oats – is a common offender here. So anyone who has mouth ulcers as their main symptom, or sole symptom, could try a gluten-free diet before embarking on the main elimination diet.
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