What are the treatment options for canker sores?

Treatment Options for Canker Sores

Topical corticosteroids are the most effective first-line treatment for canker sores, with triamcinolone acetonide 0.1% in Orabase adhesive paste applied to dried mucosa 2-4 times daily showing significant benefit in reducing inflammation and promoting healing. 1

First-Line Treatment Options

Topical Corticosteroids

• Triamcinolone acetonide 0.1% in Orabase adhesive paste applied 2-4 times daily to dried mucosa 1
• For severe or recurrent cases, clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly 1
• Dexamethasone mouth rinse (0.1 mg/ml) can be used as an alternative 1

Topical Anesthetics for Pain Relief

• Benzocaine-containing products provide effective temporary pain relief 2
  • Red Cross Canker Sore Medication showed the longest duration and greatest intensity of anesthetic effect in clinical studies 2
• 2% viscous lidocaine for moderate pain 1
• Apply topical anesthetics cautiously, especially in children, to avoid systemic absorption 1, 3

Second-Line and Adjunctive Treatments

Pain Management

• Oral acetaminophen as first-line systemic pain management 1
• For severe pain, follow the WHO pain management ladder 1

Oral Hygiene Recommendations

• Regular oral hygiene with soft toothbrushes and antiseptic mouthwashes 1
• Use saline-containing mouthwashes instead of plain water 1
• Avoid alcohol-based mouth rinses as they can cause further irritation 1

Dietary Modifications

• Consume soft, moist, non-irritating foods 1
• Avoid acidic, spicy, salty, rough/coarse foods that may exacerbate pain 1
• Maintain adequate hydration 1

Special Considerations

Monitoring

• Assess pain at least once daily using an appropriate pain scale 1
• Monitor oral intake to prevent dehydration 1
• Follow up within 3-5 days if symptoms are not improving 1
• Persistent cases should be monitored every 3-6 months for potential malignant transformation 1

Cautions

• Prolonged use of topical corticosteroids (>2 weeks) should be avoided to prevent mucosal atrophy 1
• Topical anesthetics may have unpredictably high absorption in some individuals, which could lead to adverse effects 3
• Infants have more sensitive oral mucosa and are at higher risk for systemic absorption of topical medications 1

Novel Approaches

• Mucoadhesive tablets containing natural active agents (citrus oil and magnesium salt) have shown effectiveness in reducing pain and decreasing healing time in clinical trials 4

Treatment Algorithm

1. Start with topical corticosteroids (triamcinolone acetonide 0.1% in Orabase)
2. Add topical anesthetics for pain management as needed
3. Implement oral hygiene and dietary modifications to prevent irritation
4. Consider systemic pain management for severe cases
5. Monitor for improvement and follow up if symptoms persist beyond 7-10 days
6. Escalate to stronger corticosteroids (clobetasol) for severe or recurrent cases

By following this evidence-based approach, most canker sores will resolve within 7-14 days with minimal complications and reduced discomfort.