What are the causes and treatments of Aphthous ulcers (canker sores)?

From the Guidelines

To treat aphthous ulcers, also known as canker sores, use over-the-counter topical treatments containing benzocaine or lidocaine for pain relief, as recommended by the most recent expert consensus guideline for diagnosis and treatment of oral ulcers 1. The causes of aphthous ulcers are complex and diverse, including traumatic, infectious, allergic factors, and may be associated with skin disease, autoimmune disease, tumor, inflammatory bowel disease, and so on 1. Some key points to consider when treating aphthous ulcers include:

• Applying topical treatments directly to the sore 3-4 times daily for pain relief
• Rinsing with a saltwater solution (1/2 teaspoon of salt in 1 cup of warm water) several times a day to promote healing
• Avoiding spicy, acidic, or abrasive foods that may irritate the sore further
• Considering over-the-counter products containing benzyl alcohol or hydrogen peroxide for faster healing Most aphthous ulcers heal on their own within 1-2 weeks, but if a sore persists beyond 3 weeks, is unusually large, or is accompanied by fever, it is essential to consult a healthcare provider 1. The treatment of aphthous ulcers should be tailored according to the patient's quality of life, and topical measures such as steroid preparations, lidocaine gel, and chlorhexidine may be effective in managing oral ulcers 1. In cases where the ulcers are resistant to treatment, systemic measures such as azathioprine, IFNa, and TNFa antagonists may be considered, but their use should be limited due to potential side effects 1. The most crucial aspect of treating aphthous ulcers is to prioritize the patient's quality of life and to seek medical attention if the ulcers persist or are accompanied by other concerning symptoms 1.

From the Research

Causes of Aphthous Ulcers

• The exact cause of aphthous ulcers is not well understood, but it is believed to be multifactorial 2
• Local diseases, genetic, immunologic, and infectious factors may all play a role in the development of aphthous ulcers, especially in HIV-positive individuals 3
• Recurrent aphthous stomatitis (RAS) is characterized by recurrent episodes of solitary or multiple painful ulcerations without association with systemic diseases 2

Symptoms of Aphthous Ulcers

• Painful ulcerations in the oral mucosa 2
• Lesions can be solitary or multiple, and can last for varying lengths of time 2
• In HIV-infected individuals, aphthous ulcers can occur more frequently, last longer, and produce more painful symptoms than in immunocompetent persons 3

Treatments for Aphthous Ulcers

• Topical anesthetics, such as benzocaine, can provide relief from pain associated with aphthous ulcers 4
• Topical oral health care medications, such as Red Cross Canker Sore Medication, Maximum Strength Anbesol, and Orajel Mouth Aid, can provide anesthetic effects and relief from pain 4
• A new topical oral medication, ORABASE Soothe.N.Seal, has been shown to be an effective pain-relieving adjunct to healing therapies 5
• Barrier methods, such as a compound of cellulose rubber and a calcium/sodium copolymer PVM/MA, can reduce pain and promote healing 6
• Treatments with insulin and chitosan gel, and a film composed of polyurethane and sesame oil with chitosan, have also been shown to be effective in reducing pain and promoting healing 6
• Laser therapy has been shown to reduce pain and promote healing, especially in the early stages of treatment 6
• In HIV-infected individuals, treatment may include topical anesthetics, binding agents, and corticosteroids, as well as systemic prednisone and immunomodulators such as thalidomide 3