Treatment for Aphthous Stomatitis
Topical treatments should be used as first-line therapy for aphthous stomatitis (canker sores), with topical corticosteroids being most effective for accelerating healing and benzocaine-containing products providing the most effective pain relief. 1
First-Line Topical Treatments
Topical Corticosteroids
- Betamethasone sodium phosphate
- 0.1% Triamcinolone acetonide
- Clobetasol propionate 1
- Apply directly to ulcers 2-4 times daily
Pain Relief Options
- Benzydamine hydrochloride rinse or spray (every 3 hours, particularly before eating) 1
- Topical anesthetics such as viscous lidocaine 2% (15 mL per application) for inadequate pain control 1
- Amlexanox 5% oral paste 1, 2
Mucoprotectants and Oral Care
- Mucoprotectant mouthwash (e.g., Gelclair) three times daily 1
- Sodium bicarbonate mouthwash (non-alcoholic) 4-6 times daily, increasing to hourly if needed 1
- 0.9% saline rinses 3
- Antiseptic oral rinse containing chlorhexidine twice daily to reduce bacterial colonization 1
Prevention and Maintenance
- Maintain good oral hygiene 3
- Use non-alcoholic mouthwashes 3
- Evaluate dental appliances (braces, dentures) as they can aggravate oral mucositis 3
- Dietary modifications:
- Eat soft, moist, non-irritating food that is easy to chew and swallow
- Avoid acidic, spicy, salty, rough/coarse food
- Drink plenty of water 3
- Use lip balm for dry lips 3
Management Based on Severity
Grade 1 (Erythema of mucosa)
- Continue normal activities
- Use saline or sodium bicarbonate rinses
- Non-alcoholic mouthwash
- Consider prophylaxis against fungal, viral and/or bacterial infections 3
Grade 2 (Patchy ulcerations)
- Topical anesthetics and mucosal coating agents
- Benzydamine HCl as needed for pain relief 3
Grade 3 (Confluent ulcerations)
- Hospitalization may be indicated
- Administer appropriate pain relief 3
Severe or Recalcitrant Cases
- Systemic treatment: prednisone/prednisolone 30-60 mg or 1 mg/kg daily for 1 week with tapering over the second week 1
- Systemic analgesics following the WHO pain management ladder for severe pain 1
Emerging Treatments
Recent research indicates promising results with:
- Honey
- Insulin liposome gel
- Laser therapy
- Probiotics (helps prolong ulcer intervals and reduce recurrence) 2
Special Considerations
- Rule out underlying systemic conditions before initiating treatment 4, 5
- For recurrent aphthous stomatitis, consider nutritional deficiencies, stress, or allergies 1
- Follow-up every 3-6 months is recommended for persistent symptomatic cases 1
Common Pitfalls to Avoid
- Using alcoholic mouthwashes which can irritate ulcers 3
- Failing to identify underlying systemic diseases that may present with aphthous-like ulcers 4, 5
- Overlooking infections - take oral swabs if bacterial or candidal infection is suspected 1
- Using doxycycline or penicillin topically, which have a higher risk of adverse events 2