My husband has always suffered from mouth ulcers, which get worse when he eats sugary foods or is under a lot of stress. Now our 13-year-old daughter is starting to get them as well. They look like his do, white ulcers on her tongue or inner cheeks that are extremely painful. They go away in a week or so, and come back every few months. Are these genetic, and what can be done about them? - M.N.
I'll assume these are aphthous ulcers, for which her symptoms sound very typical. Although there are a few dangerous causes of oral ulcers (autoimmune diseases, cancer) these are very rare, especially in a non-smoking healthy young lady whose ulcers heal completely. Aphthous ulcers are described as being idiopathic. This is a fancy term for, "We have no idea what's causing this."
About 20 per cent are genetically linked. As best we can tell, aphthous ulcers occur when the body attacks itself, mistaking our own oral mucosal tissue for enemy cells. The most effective treatment is often a topical steroid such as triamcinolone, which comes in a paste that sticks to the mouth lining and suppresses our overactive inflammatory response.
Other recommendations are preventive: avoid sharp foods such as potato crisps, which can cause localised microtrauma to the mucosa, maintain excellent oral hygiene, avoid acidic or excessively salty or sugary foods, and try B vitamin supplements for a couple of months as some ulcers are related to B-vitamin deficiency.
To start, have your daughter see her doctor to make sure the ulcers are really just aphthous ulcers.
If they are, she can expect them to reduce in severity, or disappear completely, by the time she reaches 40.