What are the treatment options for aphthous ulcers (canker sores)?

Treatment of Canker Sores (Aphthous Ulcers)

For canker sores, topical benzocaine-containing products are recommended as first-line treatment to provide pain relief, followed by topical corticosteroids for persistent cases, with systemic medications reserved for severe or refractory cases. 1, 2

First-Line Treatment Options

Topical Treatments

• Topical anesthetics:

  • Benzocaine-containing products (FDA-approved for canker sores) provide immediate pain relief 1
  • Apply directly to the ulcer as needed for pain management
  • Products vary in duration and intensity of anesthetic effect 3
  • Discontinue if symptoms don't improve within 7 days or if irritation worsens 1

• Antiseptic mouthwashes:

  • Saline or sodium bicarbonate rinses help maintain a clean oral environment 2
  • Non-alcoholic mouthwashes can reduce irritation

Supportive Measures

• Avoid irritants:

  • Hard, acidic, salty foods
  • Products containing sodium lauryl sulfate
  • Alcohol and carbonated drinks 4

• Oral hygiene:

  • Regular brushing with soft toothbrush
  • Use mild fluoride-containing toothpaste
  • Replace toothbrush monthly 2

Second-Line Treatment Options

For Persistent Symptoms (>7 days)

• Topical corticosteroids:

  • Effective for reducing inflammation and accelerating healing
  • Should be limited to <2 weeks of use to avoid adverse effects 2
  • Apply directly to ulcers after meals and before bedtime

• Protective agents:

  • Barrier products that cover ulcers and protect from further irritation
  • Can be combined with anesthetics for enhanced relief

Treatment for Severe or Recurrent Cases

Systemic Medications

• For severe, refractory cases:
  • Colchicine - effective for recurrent aphthous stomatitis 4, 5
  • Pentoxifylline - may reduce frequency and severity 4
  • Oral corticosteroids - reserved for major aphthous ulcers unresponsive to topical treatments 6, 4
  • Thalidomide - most effective but limited by toxicity profile; use only when other treatments fail 6, 5

Monitoring and Follow-up

• If sore mouth symptoms don't improve within 7 days, consult a healthcare provider 1
• Regular assessment of pain using an appropriate scale 2
• Regular follow-up every 3-6 months for persistent symptomatic cases 2

Special Considerations

• Underlying conditions: Consider evaluation for systemic diseases if ulcers are severe, frequent, or don't respond to treatment 6, 5
• Pain management: Critical component of treatment; may require combination of topical and systemic approaches for severe cases 2
• Duration of treatment: Most minor aphthous ulcers heal within 7-14 days with or without treatment 4

Common Pitfalls

• Failing to distinguish aphthous ulcers from other oral conditions (herpes labialis, traumatic ulcers, etc.)
• Using topical corticosteroids for extended periods (>2 weeks)
• Not addressing potential underlying systemic conditions in severe or recurrent cases
• Overuse of topical anesthetics, which may mask symptoms without addressing the cause