What are the treatment options for canker sores?

Treatment Options for Canker Sores

Topical treatments are the first-line therapy for canker sores, with benzocaine-containing products providing effective pain relief and topical corticosteroids accelerating healing for more severe cases. 1, 2

Initial Assessment and Management

• Pain Relief Options:

  • Benzocaine-containing products (e.g., Anbesol, Orajel) provide immediate pain relief 2, 3
  • Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 1
  • Viscous lidocaine 2% (15 mL per application) for more severe pain 1

• Protective Measures:

  • Apply white soft paraffin ointment to lips every 2 hours 1
  • Use mucoprotectant mouthwash three times daily (e.g., Gelclair) to protect ulcerated surfaces 1
  • Mucoadhesive tablets can provide prolonged relief by gradually releasing active ingredients over 8 hours 4

Anti-inflammatory Treatment

• Topical Corticosteroids:

  • For mild to moderate cases: Betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-minute rinse-and-spit preparation, four times daily 1
  • For severe or localized cases: 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 more severe aphthous stomatitis 1

• Other Topical Agents:

  • Amlexanox 5% oral paste for pain relief 1
  • Warm saline mouthwashes or gentle oral sponge cleaning daily 1

Antiseptic Measures

• Use antiseptic oral rinse twice daily to reduce bacterial colonization:
  • 1.5% hydrogen peroxide mouthwash 1
  • 0.2% chlorhexidine digluconate mouthwash (may be diluted by up to 50% to reduce soreness) 1

Treatment of Secondary Infections

• For Candidal Infection:

  • Nystatin oral suspension 100,000 units four times daily for 1 week 1
  • Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1

• For Suspected Bacterial Infection:

  • Take oral and lip swabs regularly 1
  • Consider antimicrobial treatment based on culture results

Systemic Treatment Options

• For severe cases: Prednisone/prednisolone 30-60 mg or 1 mg/kg daily for 1 week with tapering over the second week 1
• Consider systemic analgesics following the WHO pain management ladder for severe pain 1

When to Seek Further Medical Attention

• If sore mouth symptoms do not improve in 7 days 2
• If irritation, pain, or redness persists or worsens 2
• If swelling, rash, or fever develops 2
• If canker sores are frequent, severe, or associated with systemic symptoms (may indicate underlying conditions like Behçet's disease, complex aphthosis, or nutritional deficiencies) 5

Important Considerations

• Canker sores (aphthous ulcers) are different from cold sores (herpes simplex virus) and require different treatment approaches 6
• Acyclovir is not effective for prevention of recurrent aphthous stomatitis 7
• Recurrent or severe canker sores may be associated with systemic disorders including hematinic deficiencies and gastrointestinal diseases 5