What is the best treatment for a canker sore?

Treatment of Canker Sores

Topical corticosteroid preparations are the most effective first-line treatment for canker sores (aphthous ulcers), as they reduce inflammation and promote healing. 1

First-Line Treatment Options

Topical Corticosteroids

• Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 2-3 minute rinse-and-spit solution 1-4 times daily
• Fluticasone propionate nasules diluted in 10 mL water twice daily
• Clobetasol 0.05% ointment mixed in 50% Orabase applied to dried mucosa twice weekly 2

Pain Management

• Topical anesthetics:
  • Lidocaine viscous 2% solution: 15 mL swished and expectorated every 3 hours as needed (not exceeding 8 doses in 24 hours) 1
  • Benzocaine-containing products for temporary pain relief 3
    • Red Cross Canker Sore Medication has shown the longest duration and greatest intensity of anesthetic effect compared to other benzocaine products 4

Second-Line Treatment Options

Other Topical Agents

• Tacrolimus 0.1% ointment applied twice daily (comparable efficacy to triamcinolone acetonide 0.1%) 2
• Barrier preparations such as Gengigel or Gelclair for pain control 2, 1
• Sucralfate and antimicrobial mouthwashes to help prevent secondary infection 1

For Severe or Recalcitrant Cases

• Intralesional triamcinolone acetonide injections may reduce time to clinical remission 2
• Topical ciclosporin mouthwash (though expensive and unpleasant tasting) 2

Supportive Care and Prevention

Oral Hygiene

• Use soft toothbrush and mild non-foaming toothpaste
• Rinse with saline solution 4-6 times daily
• Inspect oral mucosa daily to identify early signs of infection or inflammation 1

Dietary Modifications

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

For Denture Wearers

• Clean gums thoroughly and maintain proper denture hygiene
• Remove dentures before applying medications
• Consider adhesives to improve fit and remove dentures at night 1

Important Considerations

When to Seek Further Medical Attention

• If sore mouth symptoms do not improve within 7 days
• If irritation, pain, or redness persists or worsens
• If swelling, rash, or fever develops 3

Monitoring

• Most minor aphthous ulcers (80-85% of cases) typically heal within 7-14 days 1
• Regular follow-up every 3-6 months for persistent symptomatic cases

Pitfalls and Caveats

1. Misdiagnosis: Ensure proper diagnosis as aphthous ulcers can be confused with herpes labialis, which requires antiviral therapy 2
2. Underlying Conditions: Consider laboratory investigations (complete blood count, vitamin B12, folate, iron, ferritin levels) in recurrent or severe cases to rule out systemic diseases 1
3. Medication Cautions:
   • Lidocaine viscous is contraindicated in patients with hypersensitivity to amide-type anesthetics, severe liver disease, and complete heart block
   • Avoid concurrent use of multiple local anesthetics to prevent additive toxicity 1
4. Treatment Timing: For optimal therapeutic effect, initiate treatment as early as possible in the course of the ulcer 2

By following this structured approach to canker sore management, focusing first on topical corticosteroids for inflammation control and appropriate pain management, most patients will experience significant symptom relief and faster healing.