What is the treatment for recurrent aphthous ulcers (canker sores)?

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Last updated: May 9, 2025View editorial policy

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From the Guidelines

For the treatment of lip canker sores, the most effective approach is to use topical measures such as local corticosteroids, lidocaine gel, and chlorhexidine, as these have been shown to provide relief and promote healing 1. When it comes to treating canker sores, several options are available.

  • For immediate relief, over-the-counter products containing benzocaine (like Orajel or Anbesol) can temporarily numb the area.
  • Applying topical pastes containing ingredients like benzocaine 20% or lidocaine 2% directly to the sore 3-4 times daily can provide pain relief.
  • Rinsing with saltwater (½ teaspoon salt in 4 ounces warm water) or a 1:1 mixture of hydrogen peroxide and water several times daily helps clean the area and reduce inflammation.
  • For persistent or severe canker sores, prescription options include triamcinolone dental paste (0.1%) applied 2-3 times daily, or chlorhexidine gluconate mouthwash used twice daily.
  • Taking 1000mg of L-lysine daily may help prevent recurrences.
  • While healing, avoid spicy, acidic, or rough foods that can irritate the sore further. Most canker sores heal within 7-14 days without scarring.
  • If a canker sore is unusually large (over 1cm), extremely painful, lasts longer than two weeks, or is accompanied by fever, see a healthcare provider as this may indicate a more serious condition requiring different treatment. It's also important to note that the diagnosis and treatment of oral ulcers can be complex and diverse, and may require a comprehensive assessment, including a detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening 1. In terms of prevention, basic oral care protocols, such as rinsing with a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day, can help prevent stomatitis 1. Overall, the treatment of lip canker sores should prioritize the use of topical measures, such as local corticosteroids, lidocaine gel, and chlorhexidine, and should be tailored to the individual patient's needs and medical history.

From the Research

Lip Canker Sore Treatment Options

  • Topical oral medications, such as ORABASE Soothe.N.Seal, have been shown to be effective in relieving pain and promoting healing in oral ulcers, including canker sores 2.
  • Topical analgesics, including NSAIDs, capsaicin, and lidocaine, have been found to be effective in treating various types of pain, including musculoskeletal pain and neuropathic pain 3, 4.
  • Topical NSAIDs, in particular, have been shown to be useful in treating acute musculoskeletal pain syndromes and osteoarthritis 3, 4.
  • Lidocaine has been widely studied and found to reduce pain in patients with postherpetic neuralgia, and may also be effective in treating canker sores 3, 5.

Considerations for Treatment

  • The choice of topical agent should be guided by the type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost 4.
  • Antihistamines may also be considered as a treatment option, although their efficacy in treating canker sores is not well established 6.
  • It is essential to note that while these treatments may be effective, they may not completely eliminate the pain and discomfort associated with canker sores, and further research is needed to determine the most effective treatment options 2, 3, 4.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Clinical treatment evaluations of a new topical oral medication.

Compendium of continuing education in dentistry. (Jamesburg, N.J. : 1995). Supplement, 2001

Research

Comprehensive Review of Topical Analgesics for Chronic Pain.

Current pain and headache reports, 2021

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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