From the Guidelines
To treat canker sores, the most effective approach is to use a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day, as expert opinion suggests this can help prevent and treat stomatitis 1.
Key Considerations
- The use of sodium bicarbonate mouthwash is recommended for both prevention and treatment of stomatitis, with the frequency increased up to each hour if necessary 1.
- For pain management, expert opinion suggests using anesthetic mouthwashes, such as viscous lidocaine 2%, coating agents, or systemic analgesics following the WHO pain management ladder 1.
- Topical NSAIDs, like amlexanox 5% oral paste, may be considered for moderate pain, while acetaminophen or fast-acting fentanyl preparations can be used for more severe pain 1.
Treatment Options
- Sodium bicarbonate mouthwash: rinse the mouth four to six times a day to prevent and treat stomatitis 1.
- Anesthetic mouthwashes: use viscous lidocaine 2% for pain relief 1.
- Topical NSAIDs: consider amlexanox 5% oral paste for moderate pain 1.
- Systemic analgesics: use acetaminophen or fast-acting fentanyl preparations for severe pain 1.
Important Notes
- The treatment approach should prioritize reducing inflammation and promoting healing, as canker sores occur when the protective lining of the mouth is compromised 1.
- It is essential to avoid spicy, acidic, or rough foods that can irritate the sore further.
- If a sore persists beyond two weeks, is unusually large, or is accompanied by fever, seek medical attention.
From the Research
Canker Sore Treatment Options
- Topical corticosteroids are considered the first line of treatment for oral aphthous ulcers, also known as canker sores, due to their minimum side effects 2
- Lactic acid 5% mouth wash has been shown to be a natural, safe, and effective alternative to corticosteroids for the treatment and prophylaxis of recurrent aphthous ulcers, with a lower recurrence rate compared to Kenalog in Orabase 0.1% 3
- Topical antiseptic/anti-inflammatory agents, such as triclosan and diclofenac, and local anesthetics, such as lidocaine, can be used to treat oral aphthous ulcers, especially in cases where corticosteroids are not effective 4
- Avoiding hard, acidic, and salty foods, as well as toothpastes containing sodium lauryl sulfate, alcohol, and carbonated drinks, can help prevent the occurrence of oral aphthous ulcers 4
Treatment Goals
- Reducing pain and discomfort associated with canker sores 5
- Promoting healing and preventing recurrence of oral aphthous ulcers 5
- Relieving pain, lessening functional impairment, and lowering the frequency and severity of recurrences 4
Treatment Approaches
- Symptomatic treatment, mainly with topically applied agents, tailored to the severity of the problem in the individual case 4
- Systemic treatment, such as colchicine, pentoxifylline, or prednisolone, may be necessary in severe cases or when topical treatment is not effective 4
- Management of oral aphthous ulcers revolves around reducing pain, promoting healing, and preventing recurrence, and may involve a combination of topical and systemic therapies 5, 6