From the Guidelines
Stomatitis treatment should prioritize good oral hygiene, pain management, and avoidance of irritants, as recommended by the most recent guidelines from the National Comprehensive Cancer Network (NCCN) in 2024 1.
Key Recommendations
- Good oral hygiene using a soft toothbrush and gentle alcohol-free mouthwash
- Pain relief with topical anesthetics like benzocaine (Orajel) or lidocaine rinses, or over-the-counter pain medications such as acetaminophen or ibuprofen
- Saltwater rinses (1/2 teaspoon salt in 8 ounces warm water) 4-6 times daily to reduce inflammation and promote healing
- Avoidance of spicy, acidic, or rough foods during healing, and staying hydrated with cool water
Specific Treatments
- Aphthous stomatitis (canker sores): topical corticosteroids like triamcinolone dental paste applied 2-3 times daily
- Herpetic stomatitis: antiviral medications like acyclovir 400mg five times daily for 5 days
- Denture stomatitis: antifungal treatments like nystatin rinse (100,000 units/mL, 4-6mL swished for 2 minutes, four times daily) or clotrimazole troches
Additional Considerations
- Referral to dermatology or dentistry may be necessary for further evaluation and treatment
- Regular follow-up with a healthcare professional to monitor symptoms and adjust treatment as needed
- Consideration of other treatments, such as coating agents, topical analgesic or anti-inflammatory agents, and alternative mouthwashes, as recommended by expert opinion 1 and guidelines from the European Society for Medical Oncology (ESMO) in 2015 1
From the Research
Treatment Options for Stomatitis
- Topical corticosteroids, such as triamcinolone acetonide, are commonly used to treat stomatitis 2, 3, 4
- Zinc mouthwash may be as effective as typical treatment modalities for recurrent aphthous stomatitis 2
- Chlorhexidine digluconate may also be used to treat recurrent aphthous stomatitis, although its efficacy is similar to that of triamcinolone acetonide 3
- Other topical medications, such as sucralfate, doxycycline, hyaluronic acid, and chamomile, may also be effective in reducing pain and promoting wound healing 5
Efficacy of Treatment Options
- A network meta-analysis found that topical doxycycline was the most efficacious intervention in promoting healing of recurrent aphthous stomatitis 5
- The same meta-analysis found that sucralfate, doxycycline, hyaluronic acid, and chamomile were the most efficacious treatment options for pain reduction at different evaluation times 5
- However, the quality of evidence was low to moderate, and further well-designed clinical trials with larger sample sizes are warranted 5
Novel Treatment Developments
- A novel triamcinolone acetonide-loaded spray solution has been developed for the treatment of stomatitis, which has shown excellent anti-inflammatory properties and good film properties 4
- This spray solution may be a potential candidate for the treatment of stomatitis, although further studies are needed to confirm its efficacy and safety 4