Could frequent, painful canker sores be a sign of Behçet's disease?

Q. I am having frequent canker sores, many at a time. They are painful and usually last two to three weeks. I am concerned it may be Behçet's disease. Who should I see to find out: a doctor, dentist, or other specialist?

A. "Canker sores" are painful ulcers on the inside of the cheek or tongue. They last up to 10 days and go away without any treatment, but they often return. Canker sores are common, affecting up to 40% of the population. In most cases, there are only one or two ulcers at a time.

The medical term for canker sores is aphthous ulcers. Although the cause is unknown, a viral infection is suspected. They may also be genetic, as they seem to run in families.

Conditions associated with multiple, recurrent, or longer-lasting aphthous ulcers include:

• medications or toxins
• a reaction to certain foods (such as pineapple or nuts)
• trauma
• deficiency of certain vitamins (such as iron or vitamin B₁₂)
• celiac disease (also called sprue) in which there is an abnormal immune reaction to foods containing gluten (such as wheat)
• infection with HIV or other viruses
• crohn's disease (a form of inflammatory bowel disease)
• Behçet's disease (or syndrome), a disease thought to be due to a "misfiring" immune system that also causes similar ulcers in the genital area, rashes, eye inflammation, and arthritis.

While a dentist, dermatologist, or primary care doctor may suspect Behçet's disease, a rheumatologist is the specialist who most commonly diagnoses and treats this condition. If you have eye inflammation, it's also important to see an ophthalmologist.

Talk to your doctor about your symptoms. He or she may recommend referral to a rheumatoligist or other specialist for further evaluation and treatment.

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