What is the best gel for treating mouth ulcers?

Best Gel for Mouth Ulcers

For treating mouth ulcers, Gelclair mucoprotectant gel is the best first-line topical treatment, as it provides a protective barrier over ulcerated surfaces and offers effective pain relief. 1, 2

First-Line Treatments

Barrier Protectants

• Gelclair mucoprotectant gel applied three times daily forms a protective coating over ulcerated surfaces, reducing pain and promoting healing 1, 2
• White soft paraffin ointment should be applied to the lips every 2 hours if they are affected by ulcers 1, 3

Topical Corticosteroids

• Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 1, 2
• For localized ulcers, clobetasol propionate 0.05% mixed in equal amounts with Orabase can be applied directly to the affected areas daily 1, 2

Pain Management

• Benzydamine hydrochloride oral rinse or spray should be used every 3 hours, particularly before eating 1, 4
• For more severe pain, topical anesthetic preparations such as viscous lidocaine 2% can be applied up to 3-4 times daily 1, 5, 6
• Benzocaine-containing products can be applied up to 4 times daily for adults and children over 2 years of age 7, 8

Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 3
• Use antiseptic oral rinses twice daily, such as:
  • 1.5% hydrogen peroxide mouthwash (e.g., Peroxyl) 1
  • 0.2% chlorhexidine digluconate mouthwash (can be diluted by up to 50% to reduce soreness) 1

Alternative Topical Treatments

• Topical diclofenac 3% in 2.5% hyaluronan provides sustained pain relief for up to 6 hours, significantly better than hyaluronan gel alone or viscous lidocaine 9
• Topical 5-aminosalicylic acid (5-ASA) 5% cream applied three times daily can reduce healing time and discomfort 10
• Vitamin B12 ointment has shown effectiveness as an analgesic treatment for aphthous ulcers 11

Treatment for Secondary Infections

• If candidal infection is suspected, treat with:
  • Nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
  • Miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1, 2

Second-Line Treatments for Refractory Cases

• Tacrolimus 0.1% ointment applied twice daily for 4 weeks 3
• Intralesional triamcinolone injections (weekly, total dose 28 mg) in conjunction with topical clobetasol 2, 3
• Systemic corticosteroids for highly symptomatic or recurrent ulcers 2, 3

Common Pitfalls and Considerations

• Ensure proper diagnosis of the type of mouth ulcer before initiating treatment 3
• Children under 12 years should be supervised when using topical anesthetics 7, 5
• Topical anesthetics may interfere with the gag reflex, so caution patients not to eat immediately after application 5, 6
• For patients with recurrent aphthous ulcers, consider underlying systemic conditions that may require additional treatment 3