From the Guidelines
To treat mouth ulcers, start with over-the-counter topical treatments like Orajel, Anbesol, or Kank-A that contain benzocaine or lidocaine for pain relief, as recommended by the most recent and highest quality study 1. When managing oral ulcers, it's essential to consider the patient's quality of life and the potential underlying causes of the ulcers.
- Apply topical treatments directly to the ulcer 3-4 times daily for pain relief.
- Use saltwater rinses (1/2 teaspoon salt in 8 ounces warm water) to clean the area and reduce inflammation.
- Avoid spicy, acidic, or rough foods that may irritate the ulcer.
- For faster healing, try products containing antimicrobial agents like chlorhexidine mouthwash or hydrogen peroxide diluted with equal parts water, as suggested by 1. Some key considerations for treatment include:
- Topical corticosteroid pastes like triamcinolone dental paste (Kenalog in Orabase) can reduce inflammation when applied 2-3 times daily.
- Most mouth ulcers heal within 7-14 days, but if an ulcer persists beyond two weeks, is unusually large (over 1 cm), extremely painful, or recurs frequently, seek medical attention as prescription treatments like stronger corticosteroids or antibiotics may be needed, as indicated by 1. It's also important to note that mouth ulcers can result from minor trauma, stress, or immune system reactions, and addressing these underlying causes can help prevent recurrence.
- In cases of severe oral discomfort, cocaine mouthwashes 2%–5% can be used three times daily, as recommended by 1.
- Antiseptic oral rinses, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, can be used twice daily to reduce bacterial colonization of the mucosa, as suggested by 1.
From the Research
Treatment Options for Oral Ulcers
The treatment options for oral ulcers (mouth ulcers) can be categorized into several approaches, including:
- Avoiding hard, acidic, and salty foods and toothpastes containing sodium lauryl sulfate, as well as alcohol and carbonated drinks 2
- Using topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac, and local anesthetics such as lidocaine 2, 3, 4
- Applying topical corticosteroids for more severe cases 2
- Combining local measures with systemic drugs, such as colchicine, pentoxifylline, or prednisolone, in severe cases 2
- Using immunosuppressive agents systemically for refractory or particularly severe oral aphthous ulcers due to Adamantiades-Behçet disease 2
Topical Anesthetics
Topical anesthetics, such as lidocaine, can be effective in reducing pain associated with oral ulcers 3, 4, 5
- A study found that topical 2% lidocaine cream led to a significant reduction in pain intensity in children with oral mucosal lesions due to trauma or aphthous ulcers 4
- However, another study found that viscous lidocaine did not improve oral intake in children with painful oral ulcers, although it may provide some pain relief 5
Management of Drug-Associated Oral Ulceration
It is essential to recognize and manage drug-associated oral ulceration, which can be caused by systemic medications 6
- Early recognition and management of drug-associated oral ulcers (DAOUs) in general dental practice settings are crucial, including referral to general medical practitioners and specialists in oral medicine 6