How are tongue aphthous ulcers treated?

Treatment of Tongue Aphthous Ulcers

Topical corticosteroids, such as 0.1% triamcinolone acetonide in orabase applied 2-4 times daily until healing, are the first-line treatment for tongue aphthous ulcers. 1

First-Line Treatment Options

1. Topical Corticosteroids:

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

2. Topical Anesthetics and Pain Management:

   • Lidocaine viscous 2% solution for pain relief 1
   • Barrier preparations (Gengigel, Gelclair) to protect ulcers and promote healing 1

3. Supportive Measures:

   • Saline rinses 4-6 times daily 1
   • Avoid spicy, acidic, rough foods, and alcohol 1
   • Use soft toothbrush and mild non-foaming toothpaste 1
   • Alcohol-free mouthwash 1

When to Escalate Treatment

If symptoms do not improve within 7 days or worsen, discontinue current treatment and seek professional evaluation 2. For resistant cases, consider:

1. Second-Line Topical Options:

   • Tacrolimus 0.1% ointment 1
   • Intralesional triamcinolone acetonide injections 1
   • Sucralfate suspension 1, 3

2. Systemic Treatments (for severe or recurrent cases):

   • Colchicine (particularly effective for recurrent aphthous stomatitis) 1, 3, 4
   • Pentoxifylline 1, 4
   • Short courses of systemic corticosteroids (reserved for severe cases) 1, 5

Classification and Monitoring

Aphthous ulcers are classified into three types 3, 6:

• Minor (most common, 80-90%)
• Major (larger, deeper, may leave scars)
• Herpetiform (multiple small ulcers)

Monitor for:

• Persistence beyond 2 weeks (requires biopsy to rule out malignancy) 1
• Signs of systemic disease 1
• Development of swelling, rash, or fever 2

Prevention Strategies

• Avoid known triggers: hard, acidic, spicy, or salty foods 1, 4
• Avoid toothpastes containing sodium lauryl sulfate 1, 4
• Limit alcohol and carbonated drinks 1, 4
• Address any nutritional deficiencies (iron, folates) 3

Important Considerations

• Aphthous ulcers affect 10-25% of the population with high recurrence rates 5, 6
• Rule out underlying conditions such as celiac disease, inflammatory bowel diseases, HIV infection, or Behçet's disease in recurrent cases 3
• Differentiate from herpes simplex virus infections, which require antiviral therapy 6
• A multidisciplinary approach may be necessary for refractory cases 7

Red Flags Requiring Immediate Evaluation

• Ulcer persisting beyond 2 weeks despite treatment 1
• Induration or fixation of the lesion 1
• Unexplained bleeding 1
• Cervical lymphadenopathy 1
• Numbness or paresthesia 1