What are the treatment options for canker sores?

Treatment Options for Canker Sores

For canker sores (recurrent aphthous ulcers), topical anesthetics containing benzocaine are recommended as first-line treatment for effective pain relief, followed by protective gels and antimicrobial rinses for larger or persistent ulcers. 1, 2

First-Line Treatment Options

Pain Relief

• Topical anesthetics:
  • Benzocaine-containing products (FDA-approved for canker sores) 2
  • Apply directly to the ulcer for immediate pain relief
  • Red Cross Canker Sore Medication has shown the longest duration and greatest intensity of anesthetic effect among benzocaine products 3
  • Other options include Maximum Strength Anbesol and Orajel Mouth Aid 3

Antimicrobial and Healing Agents

• Chlorhexidine gluconate 0.2% rinse:

  • Use twice daily to prevent secondary infection
  • Promotes healing of canker sores 1
  • Particularly useful for larger ulcers present for more than one week

• Protective barriers:

  • Sucralfate suspension: Effective for larger ulcers or those present for more than one week 1
  • Protective gels (Gengigel, Gelclair): Form a barrier over the ulcer to help with pain control and promote healing 1

Second-Line Treatment Options

• Non-alcoholic analgesic rinses:

  • Difflam Oral Rinse with benzydamine hydrochloride 0.15%
  • Particularly helpful before eating or brushing teeth 1

• Topical corticosteroids:

  • Reserved for large, persistent ulcers (present for one week or more)
  • Should be used alongside chlorhexidine oral rinse 1

• Mucoadhesive tablets:

  • Contain natural active agents that can reduce pain and accelerate healing
  • Gradually erode over 8 hours, providing sustained release of active ingredients 4

Prevention Strategies

• Oral hygiene:

  • Use a soft toothbrush
  • Choose toothpastes without sodium lauryl sulfate
  • Replace toothbrush monthly to prevent bacterial accumulation 1

• Avoid triggers:

  • Hard, acidic, spicy, or salty foods
  • Alcohol and carbonated drinks
  • Mechanical trauma to oral mucosa 1

• Maintain hydration:

  • Increase water intake to improve overall hydration
  • Apply medicated lip balm containing natural moisturizers regularly 1

When to Seek Further Medical Evaluation

• Ulcers persisting for more than 2 weeks
• Unusually large or painful ulcers
• Frequent recurrences
• Associated systemic symptoms
• Atypical presentations requiring biopsy 1

Special Considerations

• Canker sores may be the first sign of systemic diseases like Crohn's disease 1
• Consider laboratory investigations (complete blood count, vitamin B12, folate, iron, ferritin levels) in recurrent or severe cases 1
• For denture wearers: remove dentures at night, clean thoroughly daily, and consider adhesives to improve fit 1

Monitoring and Follow-up

• Regular follow-up every 3-6 months for persistent symptomatic cases
• Daily assessment of pain and healing progress
• Monitor for signs of systemic disease 1

Canker sores affect 20-60% of the population, with onset typically in the second decade of life and peak occurrence in the third decade 5. While they are generally benign and self-limiting, proper treatment can significantly reduce pain and healing time, improving quality of life for affected individuals.