Treatment for Minor Aphthous Ulcers
Topical corticosteroids, such as 0.1% triamcinolone acetonide in orabase applied 2-4 times daily, are the first-line treatment for minor aphthous ulcers. 1
First-Line Treatment Options
Topical Corticosteroids
- 0.1% triamcinolone acetonide in orabase: Apply 2-4 times daily until healing (typically 7-14 days)
- Alternative corticosteroid options:
- Clobetasol 0.05% ointment
- Betamethasone sodium phosphate
- Fluticasone propionate
Pain Management
- Topical anesthetics: Lidocaine viscous 2% solution for immediate pain relief
- Barrier preparations: Gengigel or Gelclair to protect the ulcer and promote healing 1
Additional Supportive Measures
Oral Hygiene
- Use soft toothbrush and mild non-foaming toothpaste
- Rinse with saline solution 4-6 times daily
- Use alcohol-free mouthwash 1
Dietary Modifications
- Avoid spicy, acidic, and rough foods that can irritate the ulcer
- Stay well hydrated
- Avoid foods that trigger recurrence (hard, acidic, spicy, or salty foods)
- Avoid toothpastes containing sodium lauryl sulfate 1, 2
Second-Line Treatment Options
For resistant cases, consider:
- Tacrolimus 0.1% ointment
- Intralesional triamcinolone acetonide injections 1
- Sucralfate suspension (shown effective for oral ulcers) 3
When to Consider Systemic Therapy
For severe or recurrent cases that don't respond to topical treatments:
- Colchicine (particularly effective for erythema nodosum lesions) 3, 2
- Pentoxifylline
- Short courses of systemic corticosteroids 3, 2
Important Clinical Considerations
Differential Diagnosis
Minor aphthous ulcers must be distinguished from:
- Oral herpes simplex
- Traumatic ulcers
- Infectious causes
- Autoimmune conditions
- Medication-related ulcers
- Systemic diseases 1, 4
Red Flags Requiring Further Investigation
- Ulcer persisting beyond 2 weeks despite treatment
- Induration or fixation of the lesion
- Unexplained bleeding
- Cervical lymphadenopathy
- Lesion growth despite treatment 1
Follow-up
- Regular monitoring for persistent cases
- Follow-up every 3-6 months for persistent symptomatic cases 1
Minor aphthous ulcers are typically self-limiting, with healing occurring within 7-14 days with appropriate treatment. The goal of therapy is to manage pain, promote healing, and prevent recurrence.