What is the treatment for canker sores?

Treatment for Canker Sores

The most effective treatment for canker sores includes topical anesthetics like benzocaine for pain relief, protective barrier agents, topical corticosteroids for inflammation, and antiseptic mouthwashes to prevent secondary infection. 1, 2

Understanding Canker Sores

Canker sores (recurrent aphthous stomatitis) are painful ulcerations of the oral mucosa that occur without association with systemic diseases. They are the most common inflammatory ulcerative condition of the oral mucosa and can significantly impact quality of life due to pain when eating, drinking, or speaking 3.

First-Line Treatment Options

Pain Management

• Topical anesthetics: Apply benzocaine-containing products (such as Anbesol or Orajel) directly to the ulcer for immediate pain relief 1, 4
  • These provide temporary relief of pain associated with canker sores
  • Can be applied before meals to make eating less painful
  • Red Cross Canker Sore Medication has been shown to have the longest duration and greatest intensity of anesthetic effect 4

Protective Barriers

• Mucoprotectant mouthwashes: Use three times daily to protect ulcerated surfaces 2
  • Products like Gelclair form a protective film over the ulcer
• White soft paraffin ointment: Apply to affected areas every 2-4 hours 2

Anti-inflammatory Treatments

• Topical corticosteroids: Consider for moderate to severe cases 2
  • Betamethasone sodium phosphate 0.5 mg in 10 mL water as a rinse-and-spit preparation four times daily
  • For localized lesions, clobetasol propionate 0.05% mixed with equal amounts of Orabase can be applied directly to the ulcer
  • Limit use to the acute phase to avoid side effects

Antiseptic Mouthwashes

• Antiseptic rinses: Use twice daily to reduce bacterial colonization 2
  • Options include:
    • 0.2% chlorhexidine digluconate mouthwash (may dilute by up to 50% to reduce soreness)
    • 1.5% hydrogen peroxide mouthwash

Additional Measures

Cleaning Techniques

• Clean the mouth daily with warm saline mouthwashes 2
• Use gentle technique to avoid further trauma to the area

Secondary Infection Management

• Monitor for signs of bacterial or candidal infection 2
• If candidal infection is suspected, treat with:
  • Nystatin oral suspension 100,000 units four times daily for 1 week, or
  • Miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week

Anti-inflammatory Oral Rinses

• Use benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 2

Treatment Algorithm Based on Severity

Mild Canker Sores

1. Topical anesthetics (benzocaine) for pain relief
2. Protective barriers (white soft paraffin)
3. Warm saline rinses

Moderate Canker Sores

1. All treatments for mild sores
2. Add antiseptic mouthwash twice daily
3. Consider topical corticosteroid preparations

Severe or Persistent Canker Sores

1. All treatments for moderate sores
2. More potent topical corticosteroids
3. Consider evaluation for underlying systemic conditions 5

Common Pitfalls to Avoid

• Inadequate pain control: Ensure appropriate use of topical anesthetics before meals
• Overuse of topical corticosteroids: Limit use to the acute phase to prevent side effects
• Missing secondary infection: Monitor for signs of bacterial or fungal overgrowth
• Ignoring potential systemic causes: Consider evaluation for underlying conditions in recurrent or severe cases 5
• Inappropriate use of antibiotics: Topical antiseptics are preferred over antibiotics unless clear evidence of infection exists

Special Considerations

• Canker sores often occur at sites of trauma, so avoiding irritating foods and careful oral hygiene are important 6
• Some patients may have food triggers that should be identified and avoided 6
• Recurrent or severe cases may warrant investigation for underlying conditions such as hematinic deficiencies, gastrointestinal diseases, or immunologic disorders 5