Can a low ferritin level cause mouth ulcers?

Low Ferritin and Mouth Ulcers

Yes, a low ferritin level of 20 μg/L can cause mouth ulcers as it indicates iron deficiency, which is a recognized cause of oral ulceration. 1

Relationship Between Low Ferritin and Oral Ulceration

Diagnostic Criteria for Iron Deficiency

• In patients without inflammation, a serum ferritin level < 30 μg/L indicates absolute iron deficiency 2, 3
• Your ferritin level of 20 μg/L falls below this threshold, confirming iron deficiency
• Iron deficiency is a recognized cause of recurrent oral ulceration, with studies showing a significant association between low ferritin levels and mouth ulcers 1, 4

Evidence Supporting This Connection

• Research has demonstrated that 66% of patients with oral ulcers had decreased ferritin values, which was statistically significant 1
• Another study found that the prevalence of low serum ferritin levels was about 8% in patients with recurrent oral ulceration, compared with less than 3% in controls 4
• Serum ferritin is considered a more accurate indicator of iron deficiency than serum iron levels 4

Clinical Implications

Assessment of Iron Status

• When evaluating mouth ulcers with low ferritin:
  • Check transferrin saturation (TSAT) to fully assess iron availability 3
  • TSAT < 16% with ferritin < 30 μg/L confirms iron deficiency 2
  • Consider inflammatory markers (CRP, ESR) as inflammation can mask iron deficiency by falsely elevating ferritin 2

Treatment Approach

• Iron supplementation is recommended for treating iron deficiency 2
• Oral iron supplementation should be initiated to address both the iron deficiency and associated mouth ulcers 1
• Be cautious with the form of iron supplement, as some forms (like ferrous sulfate tablets) can occasionally cause oral ulceration themselves 5
• Consider ferrous fumarate or other formulations if ulceration worsens with supplementation 5

Monitoring and Follow-up

• Monitor ferritin levels until they reach at least 30 μg/L (or higher if inflammation is present) 2, 3
• Assess for resolution of oral ulcers as ferritin levels normalize
• Investigate potential causes of iron deficiency (e.g., blood loss, malabsorption, poor dietary intake) 6
• Long-term monitoring may be necessary as recurrence of iron deficiency is common 2

Important Considerations

• Mouth ulcers may be the presenting sign of iron deficiency in some patients 4
• In patients with pre-existing recurrent oral ulceration, concurrent iron deficiency may exacerbate the condition 4
• Both groups typically show therapeutic response to correction of iron deficiency 4
• Other nutritional deficiencies (vitamin B12, folate) should also be considered in persistent cases 1

In conclusion, your ferritin level of 20 μg/L indicates iron deficiency that is likely contributing to your mouth ulcers. Treating the underlying iron deficiency should help resolve the oral ulceration and improve your overall health.