What is the treatment for an ulcer on the tongue?

Treatment for Ulcer on Tongue

Topical corticosteroids are the most effective first-line treatment for most types of oral ulcers, including tongue ulcers, with options including clobetasol 0.05% ointment, betamethasone sodium phosphate, fluticasone propionate, and triamcinolone acetonide 0.1%. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

1. Determine duration and characteristics:

   • Acute (less than 2 weeks) vs. chronic (persisting beyond 2 weeks) 1
   • Solitary vs. multiple ulcers
   • Location and appearance (shape, size, borders)

2. Consider common causes:

   • Traumatic ulcers (shape corresponds to traumatic stimulus) 1
   • Recurrent aphthous ulcers (canker sores)
   • Infections (viral, bacterial, fungal)
   • Systemic diseases
   • Malignancy (especially for persistent solitary ulcers)

3. For difficult cases requiring further workup: 2

   • Blood tests: full blood count, coagulation studies, fasting blood glucose, HIV antibody, syphilis serology
   • Biopsy for persistent ulcers (especially to rule out malignancy)

Treatment Algorithm

First-Line Treatments:

1. Topical corticosteroids: 1

   • Clobetasol 0.05% ointment
   • Betamethasone sodium phosphate
   • Fluticasone propionate
   • Triamcinolone acetonide 0.1%
   • Apply 3-4 times daily directly to ulcer

2. Pain management: 1

   • Lidocaine viscous 2% solution (15 mL swished and expectorated every 3 hours as needed, maximum 8 doses in 24 hours)
   • Barrier preparations (Gengigel or Gelclair)

3. Alternative topical treatments: 1

   • Tacrolimus 0.1% ointment twice daily (comparable efficacy to triamcinolone)
   • Topical ciclosporin mouthwash (though expensive and unpleasant tasting)

For Persistent or Severe Cases:

• Intralesional triamcinolone acetonide injections 1
• Systemic therapy based on underlying cause
• Biopsy if not responding to treatment or suspicion of malignancy 2

Supportive Care Measures

1. Oral hygiene: 1

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

2. Dietary modifications: 1

   • Avoid spicy, acidic, rough foods
   • Stay well-hydrated
   • Soft diet during healing

3. For denture wearers: 1

   • Remove dentures before applying medications
   • Clean gums thoroughly
   • Consider adhesives to improve fit
   • Remove dentures at night

Special Considerations

• For traumatic ulcers: Identify and eliminate the source of trauma (sharp tooth edges, ill-fitting dentures) 1
• For recurrent aphthous ulcers: Avoid known triggers including toothpastes containing sodium lauryl sulfate 1
• For persistent ulcers: Regular follow-up every 3-6 months is recommended 1
• For ulcers associated with systemic disease: Treat the underlying condition 2, 1

Monitoring and Follow-up

• Most uncomplicated ulcers should heal within 7-14 days 1
• If no improvement after 2 weeks of treatment, reconsider diagnosis and consider biopsy 2
• Monitor for signs of systemic disease or malignancy (rapid growth, induration, bleeding) 1

Common Pitfalls to Avoid

1. Failing to rule out malignancy in persistent solitary ulcers
2. Overlooking systemic diseases that may present with oral ulcers (e.g., Crohn's disease, tuberculosis) 2
3. Inadequate pain management leading to poor nutrition and hydration
4. Not addressing underlying causes (trauma, ill-fitting dentures)
5. Overuse of topical anesthetics, which can mask symptoms without treating the cause