What medication is used to treat aphthous ulcers on the tongue?

Treatment of Aphthous Ulcers on the Tongue

Topical corticosteroid preparations are recommended as the most effective first-line treatment for aphthous ulcers on the tongue. 1

First-Line Treatments

Topical Medications

• Topical corticosteroids: Most effective first-line treatment for mouth ulcers 1

  • Options include betamethasone sodium phosphate, fluticasone propionate, or clobetasol 0.05% ointment
  • Apply directly to ulcers 2-4 times daily

• Topical anesthetics: For immediate pain relief

  • Lidocaine viscous 2%: Standard adult dose of 15 mL (300 mg) swished and expectorated every 3 hours as needed, not exceeding 8 doses in 24 hours 1
  • For children <12 months or <10 kg: 5-7 mL per dose
  • For children >12 months: 0.15 mL/kg (3 mg/kg) per dose

• Protective gels:

  • Products like Gengigel or Gelclair can form a protective barrier over ulcers 1
  • Apply 3-4 times daily, especially before meals

Second-Line Treatments

If topical treatments are ineffective, consider:

• Sucralfate: Creates a protective coating over ulcers 2
• Benzydamine: Provides anti-inflammatory and analgesic effects 2
• Antimicrobial mouthwashes: Help prevent secondary infection but not recommended as primary treatment for established oral mucositis 2

Severe or Recurrent Cases

For severe or frequently recurring aphthous ulcers:

• Colchicine: Effective for recurrent aphthous stomatitis 3
• Systemic corticosteroids: Reserved for severe cases that don't respond to topical agents 4
• Thalidomide: Most effective for resistant cases but limited by adverse effects 3, 4

Supportive Measures

• Oral hygiene:

  • Use soft toothbrush and mild non-foaming toothpaste 1
  • Rinse with saline solution 4-6 times daily

• Dietary modifications:

  • Avoid hard, acidic, spicy, or salty foods 1, 5
  • Avoid toothpastes containing sodium lauryl sulfate 1, 5
  • Avoid alcohol and carbonated drinks 1, 5
  • Stay well hydrated

Clinical Pearls and Pitfalls

• Differential diagnosis: Rule out other causes of oral ulceration, including herpes simplex (most common differential), systemic diseases, nutritional deficiencies, and malignancy 3, 6

• Classification: Aphthous ulcers are classified as:

  • Minor (most common, 80-85%, <1cm, healing in 7-14 days) 1
  • Major (larger, deeper, may leave scars)
  • Herpetiform (multiple small clustered ulcers) 7

• Underlying conditions: Consider testing for underlying conditions in recurrent or severe cases:

  • Complete blood count, vitamin B12, folate, iron, and ferritin levels
  • Celiac disease screening
  • Inflammatory bowel disease evaluation 1, 3

• Treatment duration: Continue treatment until ulcers have completely healed to prevent recurrence and reduce pain

The goal of treatment is to relieve pain, reduce ulcer duration, restore normal oral function, and in recurrent cases, reduce the frequency and severity of recurrences 4. Most aphthous ulcers are self-limiting but proper treatment can significantly improve quality of life by reducing pain and promoting faster healing.