What is the treatment for aphthous stomatitis?

Treatment for Aphthous Stomatitis

Topical corticosteroids are the first-line treatment for aphthous stomatitis, with high-potency options like dexamethasone mouth rinse (0.1 mg/ml) or clobetasol gel (0.05%) recommended for more severe cases. 1

Treatment Algorithm Based on Severity

Mild to Moderate Cases

1. Basic oral care and pain management:

   • Sodium bicarbonate mouthwash (non-alcoholic, bland) 4-6 times daily, increasing to hourly if needed 1
   • White soft paraffin ointment applied to lips every 2 hours 1
   • Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 1

2. Topical medications:

   • Topical corticosteroids: triamcinolone acetonide or betamethasone sodium phosphate (0.5 mg in 10 mL water as rinse-and-spit preparation) 4 times daily 1, 2
   • Amlexanox 5% oral paste for pain relief 1, 3
   • Topical anesthetics: viscous lidocaine 2% for pain control 1

3. Antiseptic measures:

   • Antiseptic oral rinse twice daily (options include 1.5% hydrogen peroxide or 0.2% chlorhexidine digluconate mouthwash) 1
   • Mucoprotectant mouthwash three times daily (e.g., Gelclair) 1

Severe or Recalcitrant Cases

1. More potent topical treatments:

   • Clobetasol propionate 0.05% mixed with equal amounts of Orabase applied directly to affected areas daily 1
   • Dexamethasone mouth rinse (0.1 mg/ml) for widespread oral involvement 1

2. Systemic medications when topical treatments fail:

   • Prednisone/prednisolone: 30-60 mg or 1 mg/kg daily for 1 week with tapering over the second week 1, 4
   • Immunomodulatory drugs (thalidomide) for severe recurrent cases 2, 4
   • Colchicine, dapsone, or pentoxifylline as alternatives 5

Special Considerations

Pain Management

• For moderate pain: Topical NSAIDs (amlexanox 5%) 1, 3
• For severe pain: Consider systemic analgesics following WHO pain management ladder 1
• When oral medications are difficult: Consider transdermal or intranasal routes 1

Prevention of Recurrence

• Probiotics have shown benefit in prolonging ulcer intervals and reducing recurrence 3
• Regular oral hygiene and avoidance of identified triggers
• Laser therapy has demonstrated good short-term efficacy during exacerbation phases 3

Monitoring and Follow-up

• Regular examination of the mouth during acute illness
• Monitor for secondary infections (bacterial or candidal)
• For suspected candidal infection: Nystatin oral suspension 100,000 units four times daily or miconazole oral gel after meals four times daily for 1 week 1
• Slow healing may reflect secondary infection or reactivation of herpes simplex virus 1

Important Caveats

• All current therapies are palliative and none result in permanent remission 5
• Doxycycline and penicillin have higher risk of adverse events compared to other options 3
• Always rule out systemic diseases that may present with aphthous-like ulcers before initiating treatment 4, 6
• For recurrent aphthous stomatitis associated with systemic disease, treating the underlying condition is essential 6