What is the management and treatment for a canker sore?

Management and Treatment of Canker Sores

Topical treatments are the first-line therapy for canker sores, including topical corticosteroids, pain relievers, and protective agents to promote healing and reduce discomfort. 1

Initial Management

Pain Relief Options

• Topical anesthetics:
  • Benzocaine-containing products (such as Red Cross Canker Sore Medication, Maximum Strength Anbesol, and Orajel) 2
  • Viscous lidocaine 2% for severe pain 3, 1
  • Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 3, 1

Protective Agents

• Apply white soft paraffin ointment to affected areas every 2 hours 3
• Use mucoprotectant mouthwash (e.g., Gelclair) three times daily to protect ulcerated surfaces 3, 1
• Adhesive tablets that gradually erode over 8 hours can provide sustained relief 4

Anti-inflammatory Treatments

• Topical corticosteroids:
  • Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 3-minute rinse-and-spit solution four times daily 3, 1
  • For localized lesions: clobetasol propionate 0.05% mixed with equal parts Orabase applied to dried mucosa 3
• Amlexanox 5% oral paste for pain relief 1

Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes (0.9% saline) 3, 1
• Use antiseptic oral rinse twice daily to reduce bacterial colonization:
  • 0.2% chlorhexidine digluconate mouthwash (may be diluted by up to 50% to reduce soreness) 3, 1
  • 1.5% hydrogen peroxide mouthwash 3
• Avoid alcoholic mouthwashes which can irritate ulcers 1

Management of Secondary Infections

• Take oral swabs if bacterial or candidal secondary infection is suspected 3, 1
• For candidal infection:
  • Nystatin oral suspension 100,000 units four times daily for 1 week 3, 1
  • Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 3

Lifestyle Modifications

• Modify diet to include soft, moist, non-irritating food 1
• Avoid acidic, spicy, salty, rough/coarse food that may aggravate ulcers 1
• Use lip balm for dry lips and maintain adequate hydration 1

Treatment for Severe or Persistent Cases

• For severe cases, consider a single application of a desiccating agent (concentrated mixture of sulfates) which can cauterize affected tissue and reduce pain 5
• Systemic corticosteroids may be necessary for severe cases that don't respond to topical treatments 1

Pitfalls and Caveats

• Early treatment is crucial: Treatment should be initiated as soon as possible to ensure optimal therapeutic effect 3
• Differential diagnosis: Investigate for underlying systemic diseases that may present with aphthous-like ulcers to prevent delayed diagnosis 1
• Monitoring: Follow-up every 3-6 months is recommended for persistent symptomatic cases to monitor for any changes that could suggest malignant transformation 1
• Timing of application: Since peak viral titers (in cases of herpes labialis) occur in the first 24 hours after lesion onset, early intervention is essential 3

The evidence strongly supports a stepwise approach starting with topical treatments for pain relief and inflammation reduction, with progression to more intensive therapies for severe or persistent cases. Maintaining good oral hygiene and avoiding irritants are fundamental components of effective management.