From the Guidelines
Aphthous ulcers (canker sores) can be treated with topical corticosteroids, analgesics, and oral care protocols.
Treatment Options
- Topical corticosteroids: such as dexamethasone mouth rinse (0.1 mg/ml) or clobetasol gel or ointment (0.05%) can be used to treat aphthous ulcers 1.
- Analgesics: such as viscous lidocaine 2%, topical NSAID (e.g. amlexanox 5% oral paste), or systemic analgesics can be used to manage pain from aphthous ulcers 1.
- Oral care protocols: including sodium bicarbonate containing mouthwash, sugarless chewing gum or candy, salivary substitutes or sialogogues can be used to prevent and treat aphthous ulcers 1.
Diagnosis and Prevention
- Diagnosis: of aphthous ulcers can be challenging due to the diversity and complexity of oral ulcerations, and a comprehensive assessment is often needed 1.
- Prevention: of aphthous ulcers can be achieved through basic oral care protocols, such as rinsing with a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day 1. It is essential to note that the exact cause of aphthous ulcers is often unknown, and treatment should be focused on managing symptoms and preventing further complications 1.
From the Research
Treatment Options for Aphthous Ulcers
The treatment options for aphthous ulcers, also known as canker sores, are varied and depend on the severity and frequency of the ulcers. Some of the treatment options include:
- Topical treatments, such as topical anesthetics, topical steroids, and sucralfate, which are often used as first-line therapy 2
- Topical antiseptic/anti-inflammatory agents, such as triclosan and diclofenac, and local anesthetics, such as lidocaine, which can be used to relieve pain and reduce inflammation 3
- Corticosteroids, which can be used to reduce inflammation and promote healing 3, 4
- Systemic medications, such as colchicine, pentoxifylline, or prednisolone, which may be used in severe cases or in cases where the ulcers are associated with an underlying systemic disease 3, 2
- Laser therapy, which has been shown to reduce or eliminate pain and inflammation in some cases 5
Considerations for Treatment
When treating aphthous ulcers, it is important to consider the underlying cause of the ulcers, as well as the severity and frequency of the ulcers. In some cases, the ulcers may be associated with an underlying systemic disease, such as celiac disease, inflammatory bowel disease, or immune disorders, and treatment of the underlying disease may be necessary to manage the ulcers effectively 6, 2. Additionally, avoiding triggers such as hard, acidic, or salty foods, and toothpastes containing sodium lauryl sulfate, may help to reduce the frequency and severity of the ulcers 3.
Types of Aphthous Ulcers
There are several types of aphthous ulcers, including minor, herpetiform, and major aphthous ulcers, each with different characteristics and treatment approaches 2. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year, and may require more aggressive treatment, such as colchicine or thalidomide, in some cases 2.