Treatment for Canker Sores
Topical corticosteroid preparations are the most effective first-line treatment for canker sores, with clobetasol 0.05% ointment, betamethasone sodium phosphate, or fluticasone propionate being the recommended options. 1
First-Line Treatment Options
Topical Medications
- Topical corticosteroids: Apply directly to the ulcer 2-4 times daily
- Clobetasol 0.05% ointment
- Betamethasone sodium phosphate
- Fluticasone propionate
- Tacrolimus 0.1% ointment: Apply twice daily (comparable efficacy to triamcinolone acetonide 0.1%) 1
- Benzocaine-containing products: For temporary pain relief (FDA-approved specifically for canker sores) 2
- Products like Red Cross Canker Sore Medication have shown the longest duration and greatest intensity of anesthetic effect 3
Pain Management
- Lidocaine viscous 2% solution: For short-term pain relief
- Standard adult dose: 15 mL swished and expectorated every 3 hours as needed
- Do not exceed 8 doses in 24 hours 1
- Barrier preparations: Help protect the ulcer and control pain
- Options include Gengigel or Gelclair 1
Advanced Treatment Options
- Intralesional triamcinolone acetonide injections: For severe or persistent cases to reduce time to clinical remission 1
- Topical ciclosporin mouthwash: Effective but expensive and unpleasant tasting 1
- Adhesive tablets: Containing natural active agents (citrus oil and magnesium) have shown effectiveness in reducing pain and decreasing healing time 4
Prevention and Oral Hygiene
Daily Oral Care
- Use a soft toothbrush and mild non-foaming toothpaste
- Rinse with saline solution 4-6 times daily
- Inspect oral mucosa daily to identify early signs of inflammation 1
Avoiding Triggers
- Avoid known triggers:
- Hard, acidic, spicy, or salty foods
- Toothpastes containing sodium lauryl sulfate
- Alcohol and carbonated drinks 1
- Stay hydrated to keep oral tissues moist
- Apply medicated lip balm regularly 1
For Denture Wearers
- Clean gums thoroughly and maintain proper denture hygiene
- Remove dentures at night to prevent canker sores
- Consider adhesives to improve fit 1
Important Diagnostic Considerations
- Proper diagnosis is crucial to distinguish aphthous ulcers from herpes labialis (which requires antiviral therapy instead) 1
- Aphthous ulcers are typically classified as:
- Minor (most common, 80-85%): <1cm in size, healing within 7-14 days
- Major: Larger and more persistent
- Herpetiform: Multiple small clustered ulcers 1
Clinical Pearls and Pitfalls
- Acyclovir is not effective for prevention of recurrent aphthous stomatitis 5
- Caustics such as silver nitrate can stop the growth and pain of lesions but should be used cautiously 6
- Laboratory investigations (complete blood count, vitamin B12, folate, iron, and ferritin levels) may be indicated in cases of frequent recurrence to rule out underlying conditions 1
- Regular follow-up every 3-6 months is recommended for persistent symptomatic cases 1
Remember that canker sores are self-limiting conditions, but proper treatment can significantly reduce pain and healing time. The treatment approach should follow a stepwise algorithm starting with topical corticosteroids for most effective results.