What are the recommendations for caring for aphthous ulcers (canker sores)?

Management of Canker Sores (Aphthous Ulcers)

For effective management of canker sores, use topical anesthetics such as benzocaine-containing products for pain relief, maintain good oral hygiene with a soft toothbrush, and avoid known triggers like acidic or spicy foods. 1

Topical Treatments for Symptom Relief

• Topical anesthetics: Apply benzocaine-containing products up to 4 times daily to temporarily relieve pain 2. These provide immediate pain relief, especially before eating.

• Antimicrobial rinses: Use chlorhexidine gluconate 0.2% rinse twice daily to prevent secondary infection and promote healing 1.

• Protective barriers: Apply protective gels (like Gengigel or Gelclair) to form a barrier over the ulcer, helping with pain control and promoting healing 1.

• Non-alcoholic analgesic rinses: Consider Difflam Oral Rinse with benzydamine hydrochloride 0.15% for pain relief, particularly before eating or brushing teeth 1.

• Sucralfate suspension: Particularly effective for larger ulcers or those present for more than one week 1.

Treatment Algorithm Based on Ulcer Severity

For Minor Ulcers (most common, <1cm):

1. Apply topical anesthetics (benzocaine) up to 4 times daily
2. Use chlorhexidine rinse twice daily
3. Apply protective gels as needed for pain control
4. Expected healing time: 7-14 days 1, 3

For Larger Ulcers or Those Present >1 Week:

1. All treatments for minor ulcers
2. Add topical corticosteroids
3. Consider sucralfate suspension
4. If no response after 2 weeks, evaluate for underlying conditions 1

Preventive Measures and Lifestyle Modifications

• Oral hygiene:

  • Use a soft toothbrush
  • Choose mild fluoride-containing toothpaste without sodium lauryl sulfate
  • Replace toothbrush monthly to prevent bacterial accumulation 1

• Avoid triggers:

  • Hard, acidic, spicy, or salty foods
  • Alcohol and carbonated drinks
  • Toothpastes containing sodium lauryl sulfate 1

• Hydration and lip care:

  • Stay well-hydrated to keep oral tissues moist
  • Apply medicated lip balm containing natural moisturizers (beeswax, cocoa butter, or lanolin) several times daily 1

Special Considerations

• For denture wearers: Remove dentures at night, clean thoroughly daily, and consider adhesives to improve fit 1.

• When to seek further evaluation:

  • If sore mouth symptoms don't improve in 7 days
  • If irritation, pain, or redness persists or worsens
  • If swelling, rash, or fever develops 2
  • If ulcers recur at least 4 times per year (may indicate recurrent aphthous stomatitis requiring systemic evaluation) 1, 4

• Children: Adults should supervise use of topical products in children under 12 years; consult a dentist or doctor for children under 2 years 2.

Emerging Treatments

Recent research shows promising results with low-level laser therapy (LLLT) for canker sores. A 2022 study found that LLLT provided faster pain relief and healing compared to topical triamcinolone acetonide 0.1% 5. Another study reported complete resolution of ulcers in approximately 3 days with LLLT compared to 8.9 days in the control group 6.

While these newer treatments show promise, topical anesthetics and antimicrobial rinses remain the cornerstone of management for most patients with canker sores.