How to treat aphthous ulcers (canker sores)?

From the Guidelines

To treat aphthous ulcers, or canker sores, consider using a topical corticosteroid four times daily, such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-min rinse-and-spit preparation, as it has been shown to be effective in managing symptoms 1. When managing aphthous ulcers, it's essential to reduce bacterial colonization of the mucosa. This can be achieved by using an antiseptic oral rinse twice daily, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash 1. Some key points to consider when treating aphthous ulcers include:

• Using a topical anaesthetic preparation, such as viscous lidocaine 2%, to alleviate severe oral discomfort 1
• Taking oral and lip swabs regularly to check for bacterial or candidal secondary infection 1
• Treating candidal infection with nystatin oral suspension or miconazole oral gel 1
• Considering the use of a more potent topical corticosteroid, such as clobetasol propionate 0.05%, for severe cases 1 It's crucial to note that slow healing of the oral mucosa may reflect secondary infection by, or reactivation of, HSV, and therefore, regular monitoring and adjustment of treatment may be necessary 1.

From the Research

Treatment Options for Aphthous Ulcers

• Topical anesthetics, such as benzocaine, can provide relief from pain associated with aphthous ulcers 2
• Low-level laser therapy has been shown to be effective in reducing pain and promoting healing of aphthous ulcers, with significant improvements seen by day 3 3
• Topical triamcinolone acetonide 0.1% can also be used to treat aphthous ulcers, with reductions in pain and ulcer size seen by day 3 3
• A new topical oral medication, ORABASE Soothe.N.Seal, has been shown to be an effective pain-relieving adjunct to healing therapies for oral ulcerations 4
• Topical clobetasol propionate in various preparations (ointment, oral analgesic base, and adhesive denture paste) has been found to be effective in producing remission of symptoms in patients with aphthous ulcers 5

Preferred Treatment Approach

• Topical medications are preferred for treating oral aphthous ulcers due to their minimal side effects 6
• Topical corticosteroids are considered the first line of treatment for oral aphthous ulcers 6
• Systemic medications may be necessary if the disease progresses or if the ulcers are caused by an underlying disease process 6

Considerations for Treatment

• The cause of the aphthous ulcers should be determined to guide treatment, as the ulcers can be related to systemic disease processes or be idiopathic 6
• A detailed history and thorough examination of systems can assist in defining the cause of the ulcers and guiding treatment 6