From the Guidelines
Recurrent aphthous ulcers (canker sores) should be managed with a comprehensive approach that includes symptomatic treatment and preventive measures, with a focus on reducing pain, promoting healing, and preventing recurrence, as recommended by the most recent and highest quality study 1. The approach to managing recurrent aphthous ulcers involves a combination of topical treatments, systemic therapy, and preventive measures. For immediate relief, topical treatments such as benzocaine (Orajel, Anbesol) for pain, triamcinolone acetonide dental paste (0.1%) applied 2-3 times daily, or 2% lidocaine rinse for more diffuse pain can be used.
Key Considerations
- For moderate to severe cases, consider dexamethasone elixir (0.5mg/5mL) as a rinse-and-spit solution 2-4 times daily.
- Systemic therapy may be necessary for severe cases, including prednisone (40-60mg daily for 5 days) or colchicine (0.6mg twice daily).
- Prevention is crucial, and patients should avoid triggers like spicy foods, acidic beverages, and trauma from sharp foods or dental appliances.
- Good oral hygiene is essential, using a soft-bristled toothbrush and mild toothpaste without sodium lauryl sulfate.
- Vitamin supplementation (particularly B12, folate, and zinc) may help patients with deficiencies.
- Underlying conditions like inflammatory bowel disease, celiac disease, or Behçet's syndrome should be ruled out in patients with severe or persistent ulcers.
Diagnostic Challenges
The diagnosis of oral ulcers can be challenging due to the diversity and complexity of oral ulcerations, as discussed in the study by Ming Zhong et al. 1. A comprehensive diagnostic work-up, including detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening, is necessary to improve diagnostic accuracy and timeliness.
Treatment and Prevention
The study by the European Society for Medical Oncology (ESMO) 1 provides expert opinion recommendations for the management of oral and gastrointestinal mucosal injury, including the use of sodium bicarbonate containing mouthwash, chewing gum, candy, salivary substitutes or sialogogues, and analgesics. However, the most recent and highest quality study 1 provides a more comprehensive approach to managing recurrent aphthous ulcers, emphasizing the importance of symptomatic treatment, preventive measures, and comprehensive diagnostic work-up. In summary, a comprehensive approach that includes symptomatic treatment, preventive measures, and comprehensive diagnostic work-up is necessary for managing recurrent aphthous ulcers, as recommended by the most recent and highest quality study 1.
From the Research
Approach to Managing Recurrent Aphthous Ulcers
The approach to managing recurrent aphthous ulcers involves a combination of topical and systemic therapies aimed at reducing pain, frequency, and severity of recurrences.
- Topical symptomatic relief is the standard of care for simple cases of recurrent aphthosis, with agents such as 0.1% Triamcinolone Acetonide and 5% Amlexanox proven to be effective in reducing size, number, pain, erythema, and exudate levels 2.
- In cases of major aphthosis or systemic involvement, topical therapies can be combined with systemic therapy, such as colchicine, pentoxifylline, or prednisolone 3, 4.
- Systemic immunomodulatory drugs can inhibit the development of new lesions in cases of Adamantiades-Behçet disease 3, 4.
- Avoiding hard, acidic, and salty foods, toothpastes containing sodium lauryl sulfate, alcohol, and carbonated drinks can also help in managing recurrent aphthous ulcers 4.
- The treatment of chronic recurrent oral aphthous ulcers is symptomatic, mainly with topically applied agents, and is tailored to the severity of the problem in the individual case 4.
Topical Treatment Options
Topical treatment options for recurrent aphthous ulcers include:
- 0.1% Triamcinolone Acetonide, which has been shown to be effective in reducing size, number, pain, erythema, and exudate levels 2, 5
- 5% Amlexanox, which has been proven to be efficacious in the reduction of size, number, pain, erythema, and exudate levels 2
- 20% Benzocaine gel, which can provide symptomatic relief 2
- Topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac 4
- Local anesthetics such as lidocaine 4
Systemic Treatment Options
Systemic treatment options for recurrent aphthous ulcers include:
- Colchicine, which can be used in combination with topical therapies for severe cases 3, 4
- Pentoxifylline, which can be used in combination with topical therapies for severe cases 3, 4
- Prednisolone, which can be used in combination with topical therapies for severe cases 3, 4
- Systemic immunomodulatory drugs, which can be used to inhibit the development of new lesions in cases of Adamantiades-Behçet disease 3, 4