From the Guidelines
For inpatient treatment of canker sores, topical agents like 2% lidocaine viscous solution and triamcinolone acetonide dental paste (0.1%) should be the first line of treatment to provide pain relief and reduce inflammation, as suggested by the most recent expert consensus guideline for diagnosis of difficult and complicated oral ulceration 1. The treatment of canker sores in inpatients should prioritize reducing pain and inflammation, as well as promoting healing and preventing recurrence.
- Topical agents such as 2% lidocaine viscous solution applied directly to the sores 3-4 times daily before meals and at bedtime can provide pain relief.
- Triamcinolone acetonide dental paste (0.1%) can be applied to the lesions 2-3 times daily after meals to reduce inflammation.
- For more severe cases, consider a "magic mouthwash" formulation containing equal parts of diphenhydramine, viscous lidocaine, and an antacid like Maalox, used as a rinse 4 times daily. The underlying cause of canker sores is often unclear but may involve immune dysfunction, trauma, or nutritional deficiencies, so addressing these factors can help prevent recurrence, as noted in the expert consensus guideline 1.
- Ensure the patient maintains good oral hygiene with gentle brushing and avoids spicy, acidic, or rough foods that may exacerbate pain.
- Adequate hydration and nutrition should be monitored, as painful oral lesions may lead to decreased intake. Systemic therapy may be necessary for extensive or debilitating canker sores, including prednisone 40-60mg daily for 5-7 days with a taper, although this approach is more commonly discussed in the context of Behçet disease 1.
- For patients with frequent recurrences, consider vitamin supplementation with B12, folate, and zinc after discharge.
From the Research
Treatment Options for Canker Sores
- Topical anesthetics, such as benzocaine, can provide relief from pain associated with canker sores, with Red Cross Canker Sore Medication showing the longest duration and greatest intensity of anesthetic effect 2
- Low-level laser therapy has been shown to be effective in reducing pain and ulcer size, as well as improving healing, with significant reductions in pain and erythema on days 3 and 5 compared to topical triamcinolone acetonide 0.1% 3
- Amlexanox 5% paste has been found to be effective in reducing ulcer size, pain duration, and healing time 4
- Hyaluronic acid-based products, such as barrier forming mouth rinses or topical gels, have been shown to be effective in promoting healing and improving patient quality of life, with a trend towards earlier healing onset for topical gel formulations 5
Considerations for Inpatient Treatment
- The choice of treatment may depend on the severity and frequency of canker sores, as well as the patient's overall health and medical history
- Topical treatments, such as anesthetics and hyaluronic acid-based products, may be easily administered in an inpatient setting
- Low-level laser therapy may require specialized equipment and training, but can be an effective option for patients with recurrent canker sores 3