What is the treatment for tongue ulcers?

Treatment for Tongue Ulcers

Topical corticosteroid preparations should be the first-line treatment for tongue ulcers, with options including betamethasone sodium phosphate, fluticasone propionate, or clobetasol 0.05% ointment. 1

Treatment Algorithm Based on Severity

Mild Ulcers

1. First-line: Topical measures

   • Protective gels (Gengigel or Gelclair) to form a protective barrier 1
   • Topical anesthetics (benzocaine-containing products) for pain relief 1
   • Chlorhexidine gluconate 0.2% rinse twice daily to prevent secondary infection 1

2. Administration of topical corticosteroids

   • Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution, 1-4 times daily 1
   • Fluticasone propionate nasules diluted in 10 mL water, twice daily 1

Moderate to Severe Ulcers

1. Topical corticosteroids

   • Clobetasol 0.05% ointment mixed in 50% Orabase and applied to dried mucosa, twice weekly 1
   • Tacrolimus 0.1% ointment applied twice daily 1

2. For resistant cases:

   • Colchicine (especially for erythema nodosum lesions) 2
   • Azathioprine for resistant mucocutaneous lesions 2
   • Interferon alpha (IFNα) for resistant cases 2
   • TNFα antagonists for most resistant cases 2

Special Considerations

Underlying Conditions

• Investigate for potential underlying causes:
  • Nutritional deficiencies (vitamin B1, B2, B6, B12, folate, iron) 3
  • Gastrointestinal diseases (celiac disease, inflammatory bowel diseases) 4
  • Immune disorders (HIV infection, neutropenia) 4
  • Behçet's disease (characterized by recurrent bipolar aphthosis) 4

Important Cautions

• Ciclosporine A should not be used in patients with Behçet's disease with central nervous system involvement due to potential neurotoxicity 2
• Any solitary chronic ulcer that doesn't heal within 2 weeks should be biopsied to rule out squamous cell carcinoma 5
• Thalidomide, while effective for recurrent aphthous ulceration, has serious adverse effects including teratogenicity and peripheral neuropathy 2

Prevention Strategies

• Avoid potential triggers:
  • Hard, acidic, spicy, or salty foods 6
  • Toothpastes containing sodium lauryl sulfate 6
  • Alcohol and carbonated drinks 6
• Maintain good oral hygiene with a soft toothbrush 1
• Apply medicated lip balm regularly 1
• Stay hydrated to keep oral tissues moist 1

Treatment Pitfalls to Avoid

• Don't delay biopsy for atypical or non-healing ulcers, as neoplastic ulcerated lesions can mimic benign ulcerative lesions 5
• Don't overlook systemic diseases in patients with recurrent aphthous stomatitis (RAS) - laboratory investigations may be necessary 1
• Don't use ciclosporine A in patients with neurological involvement of Behçet's disease 2
• Don't use thalidomide as first-line therapy due to serious adverse effects 2

By following this structured approach based on ulcer severity and considering potential underlying causes, most tongue ulcers can be effectively managed with significant improvement in pain, function, and recurrence rates.