What are the available treatments for aphthous ulcers in Canada?

Available Treatments for Aphthous Ulcers in Canada

Topical corticosteroids are the first-line treatment for aphthous ulcers in Canada, with 0.1% triamcinolone acetonide in orabase being the most recommended option, applied 2-4 times daily until healing occurs. 1

First-Line Treatments

Topical Medications

1. Topical Corticosteroids

   • 0.1% triamcinolone acetonide in orabase (apply 2-4 times daily)
   • Alternative options: clobetasol 0.05% ointment, betamethasone sodium phosphate, fluticasone propionate 1

2. Topical Anesthetics

   • Lidocaine (apply to affected area 3-4 times daily) 2
   • Benzocaine (apply to affected area up to 4 times daily) 3

3. Other Topical Agents

   • Amlexanox (anti-inflammatory) 4
   • Doxycycline (antibiotic) 4
   • Antimicrobial mouthwashes 5

Second-Line Treatments (For Severe or Recurrent Cases)

Systemic Medications

1. Oral Corticosteroids (for severe cases unresponsive to topical treatments)

   • Prednisone 4

2. Immunomodulatory Drugs (for resistant cases)

   • Thalidomide (effective but limited use due to adverse effects) 1, 4
   • Levamisole (variable efficacy) 5

3. Antibiotics/Antimicrobials

   • Clofazimine 4

Supportive Measures

Pain Management

• Topical anesthetics (lidocaine, benzocaine)
• Oral analgesics 1

Preventive Measures

1. Oral Hygiene

   • Soft toothbrush and mild non-foaming toothpaste
   • Saline solution rinses 4-6 times daily
   • Alcohol-free mouthwash 1

2. Dietary Modifications

   • Avoid spicy, acidic, and rough foods
   • Stay hydrated
   • Avoid known triggers (hard, acidic, spicy foods)
   • Avoid toothpastes containing sodium lauryl sulfate 1

Treatment Algorithm Based on Severity

Mild Aphthous Ulcers

1. Start with topical corticosteroids (0.1% triamcinolone acetonide)
2. Add topical anesthetics for pain relief
3. Implement supportive measures

Moderate to Severe Aphthous Ulcers

1. More potent topical corticosteroids (clobetasol 0.05%)
2. If inadequate response after 7-14 days, consider systemic therapy
3. Continue supportive measures

Recurrent Aphthous Stomatitis

1. Identify and address any underlying conditions
2. Consider maintenance therapy with topical agents
3. For frequent recurrences, consider systemic medications

Important Considerations

• Any oral ulcer persisting beyond 2 weeks requires further investigation to rule out malignancy 1
• Patients with recurrent aphthous stomatitis should be evaluated for underlying conditions such as celiac disease, inflammatory bowel diseases, nutritional deficiencies, and immune disorders 6
• Regular monitoring is essential, especially for persistent cases 1

Common Pitfalls to Avoid

1. Misdiagnosis: Aphthous ulcers can be confused with herpes simplex virus infections, which require different treatment 7
2. Inadequate Treatment Duration: Topical treatments should be continued until complete healing
3. Overlooking Underlying Conditions: Persistent or recurrent ulcers may indicate systemic disease
4. Inappropriate Use of Systemic Medications: Reserve systemic treatments for severe cases unresponsive to topical therapy

By following this structured approach to treatment, most aphthous ulcers can be effectively managed with available treatments in Canada.