What is the treatment for severe mouth ulcers?

Treatment for Severe Mouth Ulcers

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

First-Line Treatment Options

Topical Corticosteroids

• 0.1% triamcinolone acetonide in orabase (first choice) 1
• Alternative options:
  • Clobetasol 0.05% ointment
  • Betamethasone sodium phosphate
  • Fluticasone propionate

Pain Management

• Topical anesthetics (e.g., lidocaine viscous 2% solution) 1
  • Note: Research shows lidocaine may not significantly improve oral intake in children with painful mouth ulcers compared to placebo 2
• Barrier preparations (Gengigel or Gelclair) 1
• Oral analgesics for more severe pain

Second-Line Treatment Options

For ulcers that don't respond to topical corticosteroids:

1. Sucralfate suspension 1
2. Tacrolimus 0.1% ointment 1
3. Intralesional triamcinolone acetonide injections 1

Severe or Recurrent Cases

For resistant or recurrent severe ulcers:

1. Colchicine (particularly effective for erythema nodosum lesions) 1, 3
2. Pentoxifylline 1, 3
3. Short courses of systemic corticosteroids 1

Supportive Measures to Promote Healing

Oral Hygiene

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

Dietary Modifications

• Avoid triggers that can worsen ulcers:
  • Hard, acidic, spicy, or salty foods
  • Toothpastes containing sodium lauryl sulfate
  • Alcohol and carbonated drinks 1, 3
• Stay hydrated 1

Important Considerations

Diagnostic Evaluation

• Any ulcer persisting beyond 2 weeks despite treatment requires biopsy to rule out malignancy 1
• Red flags for malignancy:
  • Induration or fixation of the lesion
  • Unexplained bleeding
  • Cervical lymphadenopathy
  • Lesion growth despite treatment
  • Persistent numbness or paresthesia 1

Common Pitfalls

1. Failure to identify underlying causes: Mouth ulcers can be associated with systemic conditions like inflammatory bowel disease, celiac disease, nutritional deficiencies, or immune disorders 4
2. Misdiagnosis: Many conditions can mimic aphthous ulcers, including herpes simplex, erythema multiforme, lichen planus, pemphigoid, and pemphigus vulgaris 5, 6
3. Inadequate treatment duration: Topical treatments typically require 7-14 days for healing 1
4. Overuse of systemic immunosuppressants: These should be reserved for refractory cases or specific conditions like Adamantiades-Behçet disease 3

Remember that treatment should be tailored to the severity of the problem, including frequency of ulcers, intensity of pain, and responsiveness to treatment 3. Regular monitoring is essential, especially for persistent cases, with follow-up every 3-6 months for persistent symptomatic cases 1.