From the Guidelines
The management of aphthous ulcers primarily focuses on pain relief and promoting healing, with topical treatments like lidocaine gels or benzocaine being the first line of treatment for mild cases. For mild cases, over-the-counter topical treatments like benzocaine (Orajel, Anbesol) or lidocaine gels can provide temporary pain relief, as seen in the management of oral mucosa inflammation 1. Patients should apply these 3-4 times daily before meals and at bedtime.
Key Treatment Options
- Antimicrobial mouth rinses containing chlorhexidine 0.12% used twice daily can reduce secondary infection and promote healing.
- For more painful ulcers, topical corticosteroids like triamcinolone acetonide 0.1% dental paste (Kenalog in Orabase) applied 2-3 times daily directly to ulcers can reduce inflammation and speed healing, as suggested by the EULAR recommendations for the management of Behçet disease 1.
- Patients should apply a small amount to dry ulcers and avoid eating or drinking for 30 minutes afterward.
Systemic Treatments
For severe or recurrent cases, systemic treatments may be necessary, including prednisone (starting at 40-60mg daily with taper over 1-2 weeks) or colchicine (0.6mg twice daily), although the use of colchicine is not strongly supported by evidence except in specific cases like erythema nodosum lesions and genital ulcers among women 1.
Supportive Measures
Supportive measures include:
- Avoiding spicy, acidic, or rough foods that may irritate ulcers
- Maintaining good oral hygiene with soft-bristled toothbrushes
- Using alcohol-free mouthwashes
- Vitamin supplements, particularly B12, zinc, and folate, may help patients with deficiencies, as these treatments work by reducing inflammation, providing pain relief, and creating conditions that allow the oral mucosa to heal naturally, as aphthous ulcers are believed to result from immune dysregulation and local trauma to the oral mucosa.
From the Research
Management of Aphthous Ulcers
- The management of aphthous ulcers involves a variety of preventative measures and therapies aimed at reducing ulcer pain, stimulating ulcer healing, and preventing ulcer recurrence 2.
- First-line treatment options include topical medications such as corticosteroids (triamcinolone acetonide), anti-inflammatory drugs (amlexanox), antibiotics (doxycycline), and antiseptics (lidocaine) 2.
- In more severe cases, systemic drugs such as corticosteroids (prednisone), immunomodulatory drugs (thalidomide), and antibiotics/antimicrobials (clofazimine) can be effective 2.
- Avoiding hard, acidic, and salty foods, toothpastes containing sodium lauryl sulfate, alcohol, and carbonated drinks can also help in managing aphthous ulcers 3.
- Topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac, and local anesthetics such as lidocaine can be used as first-line treatment, followed by topical corticosteroids if ineffective 3.
- Systemic treatment with colchicine, pentoxifylline, or prednisolone can be considered in severe cases, but its efficacy is debated 3.
- Low-level laser therapy has also been shown to be effective in reducing pain and ulcer size, and improving healing scores in recurrent aphthous stomatitis subjects 4.
Treatment Modalities
- Topical medications such as antimicrobial mouthwashes and topical corticosteroids (dexamethasone, triamcinolone, fluocinonide, or clobetasol) can reduce pain and improve healing time, but do not improve recurrence or remission rates 5.
- Systemic medications can be tried if topical therapy is ineffective, but should be tailored to the severity of the problem and the individual case 5.
- A multidisciplinary treatment approach can be effective in managing major aphthous ulcers, which are refractory and can persist for several weeks to months 6.