What is the treatment for Aphthous (canker sore) ulcers?

From the Guidelines

Aphthous ulcers can be effectively treated with topical corticosteroids, such as dexamethasone mouth rinse (0.1 mg/ml) or clobetasol gel/ointment (0.05%), as first-line therapy to reduce inflammation and pain. The management of aphthous ulcers involves a step-wise approach, starting with basic oral care protocols, including sodium bicarbonate containing mouthwash, to prevent stomatitis 1. For mild cases, over-the-counter topical treatments like benzocaine gel or hydrogen peroxide rinses can provide temporary pain relief. However, for more severe or recurrent ulcers, prescription options like triamcinolone dental paste or chlorhexidine gluconate mouth rinse can be used to reduce inflammation and prevent secondary infection.

When considering treatment options, it's essential to prioritize the patient's quality of life and tailor the treatment according to the severity of the ulcers. Topical measures, such as steroid preparations, lidocaine gel, and chlorhexidine, can be effective in managing oral ulcers 1. Additionally, good oral hygiene is crucial, and patients should be advised to use a soft-bristled toothbrush and mild toothpaste. In cases where ulcers are resistant to topical treatment, systemic measures like colchicine, azathioprine, or thalidomide may be considered, although their use should be carefully weighed against potential side effects.

In terms of specific treatment recommendations, topical high-potency corticosteroids, such as dexamethasone or clobetasol, should be considered as first-line therapy for aphthous ulcers. These treatments can be used in conjunction with other therapies, such as analgesics or coating agents, to manage pain and reduce inflammation. It's also important to note that systemic corticosteroids, like prednisone, may be considered in cases of highly symptomatic or recurrent ulcers, although their use should be carefully monitored due to potential side effects 1.

Key considerations in the treatment of aphthous ulcers include:

• Basic oral care protocols to prevent stomatitis
• Topical corticosteroids as first-line therapy
• Analgesics or coating agents to manage pain
• Systemic corticosteroids for highly symptomatic or recurrent ulcers
• Good oral hygiene to prevent secondary infection

By prioritizing the patient's quality of life and using a step-wise approach to treatment, healthcare providers can effectively manage aphthous ulcers and reduce their impact on daily life.

From the FDA Drug Label

Temporarily relieves pain associated with the following mouth and gum irritations: toothache sore gums canker sores braces minor dental procedures The benzocaine (TOP) drug label mentions canker sores, which are also known as aphthous ulcers.

• The drug is used to temporarily relieve pain associated with aphthous ulcers.
• Benzocaine (TOP) can be used for the treatment of aphthous ulcer pain 2.

From the Research

Treatment Options for Apthous Ulcers

• Topical medications, such as antimicrobial mouthwashes and topical corticosteroids, can achieve primary goals of relief of pain, reduction of ulcer duration, and restoration of normal oral function 3
• Systemic medications, such as levamisole, can be tried if topical therapy is ineffective, and have shown variable efficacy in reducing ulcer frequency and duration in patients with minor RAU 3
• Topical agents, such as 0.1% Triamcinolone Acetonide and 5% Amlexanox, have been proven to be more efficacious in the reduction of size, number, pain, erythema, and exudate levels compared to other treatments 4
• Low-Level Laser Therapy (LLLT) has been shown to be effective in reducing pain and ulcer size, and improving healing scores, with significant reductions in pain and erythema on days 3 and 5 5
• Topical diclofenac in hyaluronan has been found to provide sustained relief of oral aphthous ulcer pain, with a 35% to 52% pain reduction 2 to 6 hours after application 6

Management and Prevention

• Avoiding hard, acidic, and salty foods, as well as toothpastes containing sodium lauryl sulfate, can help prevent apthous ulcers 7
• Topical antiseptic/anti-inflammatory agents, such as triclosan and diclofenac, and local anesthetics, such as lidocaine, can be used to manage symptoms 7
• Systemic drugs, such as colchicine, pentoxifylline, or prednisolone, can be used in severe cases, but their efficacy is debated 7
• Treatment should be tailored to the severity of the problem, with the goal of relieving pain, lessening functional impairment, and lowering the frequency and severity of recurrences 7