What is the management and treatment for a canker sore?

Management and Treatment of Canker Sores

Topical corticosteroids, such as 0.1% triamcinolone acetonide in orabase applied 2-4 times daily, are the first-line treatment for canker sores (recurrent aphthous stomatitis). 1

Diagnosis and Initial Assessment

• Canker sores (recurrent aphthous stomatitis) are characterized by:

  • Painful ulcerations in the oral mucosa
  • Recurrent episodes of solitary or multiple ulcers
  • No association with systemic diseases 2

• Important to differentiate from herpes labialis (cold sores), which requires antiviral therapy 3

  • Canker sores occur inside the mouth on movable mucosa
  • Herpes lesions typically occur on the lip/outside the mouth

Treatment Algorithm

First-Line Treatments:

1. Topical corticosteroids:

   • 0.1% triamcinolone acetonide in orabase, applied 2-4 times daily until healing (typically 7-14 days) 1
   • Alternative options: clobetasol 0.05% ointment, betamethasone sodium phosphate, fluticasone propionate 1

2. Pain management:

   • Topical anesthetics (e.g., benzocaine) for temporary pain relief 4
   • FDA-approved for canker sores and provides immediate symptom relief 4
   • Red Cross Canker Sore Medication (containing benzocaine) has shown the longest duration and greatest intensity of anesthetic effect 5

Second-Line Treatments:

1. For persistent or severe cases:

   • Tacrolimus 0.1% ointment 1
   • Intralesional triamcinolone acetonide injections 1
   • Low-level laser therapy - shown to provide faster pain relief and healing compared to topical triamcinolone in recent studies 6

2. Barrier preparations:

   • Products like Gengigel or Gelclair to protect the ulcer and promote healing 1

Supportive Measures

1. Oral hygiene:

   • Soft toothbrush and mild non-foaming toothpaste
   • Rinse with saline solution 4-6 times daily
   • Use alcohol-free mouthwash 1

2. Dietary modifications:

   • Avoid spicy, acidic, and rough foods
   • Stay hydrated
   • Avoid toothpastes containing sodium lauryl sulfate 1

When to Seek Further Medical Attention

Stop treatment and consult a healthcare provider if:

• Sore mouth symptoms do not improve in 7 days
• Irritation, pain, or redness persists or worsens
• Swelling, rash, or fever develops 4
• Ulcer persists beyond 2 weeks despite treatment (requires biopsy to rule out malignancy) 1

Important Considerations

• Acyclovir and other antiviral medications are not effective for canker sores, as they are not caused by herpes virus 7
• Regular monitoring is essential for persistent cases to ensure proper diagnosis and treatment 1
• Low-level laser therapy has shown promising results with significant reductions in pain and erythema by day 3 compared to topical triamcinolone 6

Prevention of Recurrence

• Identify and avoid triggers (stress, certain foods)
• Maintain good oral hygiene
• Consider regular follow-up every 3-6 months for persistent symptomatic cases 1