Food Additives May Play Role In Recurrent Aphthous Stomatitis (RAS)

By Shannon McCarthy

Recurrent aphthous stomatitis (RAS) is a common disease of the oral mucosa with an unknown etiology, but some believe that food additives may play a role.¹ RAS is labeled as recurrent, multiple, small, round, or ovoid ulcers, with circumscribed margins, having yellow or gray floors and are surrounded by haloes. RAS is present first in childhood or adolescence and recurs multiple times later in life depending on severity of the disease.² Predisposing factors to RAS are genetics, trauma to oral mucosa, tobacco use, certain drug use, certain vitamin and mineral deficiencies, ingredients in toothpaste and gluten sensitive enteropathy. There are many predicted predisposing factors and this is why it is hard to accurately prove the actual cause of RAS.² In a study where a patch test was performed among the participants, the most common allergen that showed positive patch test of patients with RAS results was cochineal red (62.5 percent). Cochineal red is a common red dye used in foods, made from dried and crushed up bugs. Since this dye was such a common allergen in the population of RAS patients in the study, it is believed that this dye may have something to do with the onset of RAS. There were a few other common food additives that more than 25 percent of the population of RAS patients had in common.

Food additives have tricky laws and wording around them, sometimes allowing harmful substances to be labeled as safe for human consumption, temporarily.³ More research needs to be conducted on the matter and all RAS predispositions need to be evaluated before jumping to conclusions about food additives being the cause of this disease. Food additives should be reevaluated and tested due to this kind of skepticism and experiments taking place.

Treatment strategies for RAS must be directed toward providing symptomatic relief by reducing pain, increasing the duration of ulcer-free periods and accelerating ulcer healing. Mouth rinses, creams, antimicrobial medications and the like are used to reduce the pain, the number of ulcers and the size of the ulcers.² Since there is no cure for RAS, currently these types of symptomatic treatments are all that are available at this point in time. These treatment strategies seem to be working well and are sustaining the population with RAS. It is important to understand that RAS is very common but many other conditions and diseases need to be ruled out in order to diagnose RAS. Simply having an ulcer or cut or bump inside the mouth does not mean that RAS is present. This disease and its causes still needs to be experimented on and studied extensively before any further conclusions can be made linking the cause of RAS and food additives.



1. Gulseren D, Hapa A, Ersoy-Evans S, Elcin G, Karaduman A. Is there a role of food additives in recurrent aphthos stomatitis? A perspective study with a patch testing. International Journal of Dermatology. 2017;56(3):302-306.

2. Preeti L, Magesh KT, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac Pathol. 2011;15(3):252-256.

3. Zelman K. Get familiar with food additives. Academy of Nutrition and Dietetics. 2017; 37.


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