6 simple tactics to help you avoid canker sores

Small, painful and terribly inconvenient, canker sores seemingly appear from nowhere. Researchers aren't sure what causes them, but these strategies can keep them at bay.

• Rinses containing antibacterial ingredients have significantly reduced the number of canker sores, several studies show.
• These may work because they wash away debris from hard-to-reach spots, prevent the flare-up of tiny infections or help prevent infection if you do get a sore.

• Some canker sores are caused by a food or food additive.
• Citrus fruits, tomatoes, eggplant, tea and cola drinks all triggered mouth ulcers in one study from Turkey, presumably because these foods irritated the lining of the mouth.
• Benzoic acid, cinnamon, milk, coffee, chocolate, potatoes, cheese, walnuts and figs are said to be other culprits.
• Spicy foods can also irritate sensitive mouth tissue. And skip sharp-edged edibles such as pretzels and chips.
• Before you banish all these foods from your diet, look for connections between foods you've eaten recently and the onset of a new canker sore.
• Experts recommend eliminating a suspect for a few weeks, taking note of whether you get fewer sores. Then, introduce the food again to see if it triggers a sore.

• An estimated one in 20 people who get regular canker sores have celiac disease.
• But don't give up wheat yet. If you think you may have celiac disease, talk to your doctor about testing and treatment.
• Other symptoms of gluten intolerance include diarrhea, abdominal pain, weight loss, fatigue and gas pain.

• Stress is a classic instigator of mouth ulcers. In one study, 16 percent said that extreme stress triggered outbreaks.
• Experts think stress may be a factor in up to 60 percent of first-time canker sore episodes.
• Irish researchers have found higher levels of the stress hormone cortisol in the saliva of people who get the sores.
• Try exercise, warm baths, deep breathing or anything else that helps you relax.

• When Israeli researchers gave 15 people with recurring canker sores B12, canker sores dropped from an average of 10 per month to about one every three months.
• Several studies have found low levels of B12 in people who get canker sores regularly.
• Talk to your doctor before taking a supplement.
• Top food sources include fortified cereals, meat, fish and poultry.

• About one in five people with recurring canker sores have a nutritional deficiency.
• Some need more vitamin B12. Others are low in other B vitamins, zinc or folic acid or have iron-deficiency anemia.
• Correcting low iron could cut your odds for more canker sores by 71 percent, studies show.
• Don't take extra iron on your own. For some people, it can be harmful. Ask your doctor whether you need a blood test to check for deficiencies.

Canker sores are a mysterious malady triggered by anything from food to toothpaste ingredients, and sharp-edged potato chips to stress. Researchers are trying to find definitive causes, but we already have effective ways to reduce their frequency.