From the Guidelines
The treatment for recurrent aphthous ulcers should focus on pain relief, promoting healing, and reducing inflammation, with topical corticosteroids such as triamcinolone dental paste being a recommended option 1. When managing recurrent aphthous ulcers, it's essential to consider the complexity and diversity of oral ulcerations, which can pose diagnostic and therapeutic challenges 1. The exact cause of recurrent aphthous ulcers is often unknown, but factors such as disturbed immune response, genetic predisposition, nutrient deficiency, oral trauma, anxiety, or stress may contribute to their development 1.
Treatment Options
- For mild cases, over-the-counter topical treatments like benzocaine or lidocaine gels can provide temporary pain relief.
- Rinsing with salt water or a 1:1 mixture of hydrogen peroxide and water can help clean the area and reduce inflammation.
- Topical corticosteroids such as triamcinolone dental paste (0.1%) applied directly to ulcers 2-3 times daily can reduce inflammation and pain 1.
- For more severe or frequent ulcers, prescription options include dexamethasone elixir or tetracycline/minocycline mouth rinses, which provide both antimicrobial and anti-inflammatory effects.
Preventing Recurrences
- Avoiding triggers like spicy foods, acidic beverages, and stress can help prevent recurrences.
- Patients should also use soft-bristled toothbrushes and SLS-free toothpaste to reduce irritation and promote healing.
- By reducing inflammation, providing pain relief, and creating conditions that promote healing of the oral mucosa, these treatments can improve outcomes and quality of life for patients with recurrent aphthous ulcers 1.
From the Research
Treatment Options for Recurrent Aphthous Ulcers
The treatment for recurrent aphthous ulcers (RAU) aims to relieve pain, reduce ulcer duration, and restore normal oral function 2. The primary goals of therapy can be achieved through topical medications, while systemic medications can be used if topical therapy is ineffective.
Topical Medications
- Antimicrobial mouthwashes and topical corticosteroids can achieve primary goals but have not been shown to alter recurrence or remission rates 2
- Topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac, and local anesthetics such as lidocaine can be used to treat oral aphthous ulcers 3
- Triamcinolone acetonide ointment has been shown to be effective in treating aphthous ulcers in patients with Behcet's syndrome 4
Systemic Medications
- Levamisole has shown variable efficacy in reducing ulcer frequency and duration in patients with minor RAU 2
- Oral corticosteroids should be reserved for severe cases of major RAU that do not respond to topical agents 2
- Colchicine, pentoxifylline, or prednisolone can be used in severe cases, combined with local measures 3
- Phenytoin syrup has been compared with triamcinolone acetonide ointment in treating aphthous ulcers in patients with Behcet's syndrome, with the latter showing greater effectiveness 4
Management and Prevention
- Avoiding hard, acidic, and salty foods, as well as toothpastes containing sodium lauryl sulfate, can help prevent oral aphthous ulcers 3
- A multidisciplinary treatment approach can be effective in managing major aphthous ulcers 5
- Ruling out an oral manifestation of systemic disease is important in the management of recurrent aphthous ulcers 6