What is the treatment for aphthous ulcers on the tongue?

Treatment of Aphthous Ulcers on the Tongue

For aphthous ulcers on the tongue, first-line treatment should be topical corticosteroids such as betamethasone sodium phosphate 0.5 mg dissolved in 10 mL of water as a 2-3 minute rinse-and-spit solution four times daily. 1, 2

First-Line Topical Treatments

• Apply topical corticosteroids as primary therapy, with options including:

  • Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 1, 2
  • Fluticasone propionate nasules diluted in 10 mL of water twice daily 2
  • For localized ulcers, clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly to dried mucosa 1, 2

• Use mucoprotectant agents to form a protective barrier:

  • Gelclair mucoprotectant gel three times daily forms a protective coating over ulcerated surfaces 1
  • White soft paraffin ointment applied to affected lips every 2 hours 1

Pain Management

• Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1, 3
• For more severe pain, topical anesthetic preparations such as viscous lidocaine 2% can be applied 3-4 times daily 1
• Barrier preparations such as Gengigel mouth rinse/gel or Gelclair for pain control 2

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 0.2% chlorhexidine digluconate mouthwash 1, 3

Second-Line Treatments for Refractory Cases

• Tacrolimus 0.1% ointment applied twice daily for 4 weeks for recalcitrant ulcers 1, 2
• Intralesional triamcinolone injections in conjunction with topical clobetasol for ulcers that don't respond to topical treatment 1, 2

Systemic Therapy for Severe Cases

• For highly symptomatic or recurrent ulcers, consider systemic corticosteroids (prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week) 2, 3
• For recurrent aphthous stomatitis, colchicine can be effective, especially for erythema nodosum or genital ulcers 4, 3
• In resistant cases, consider azathioprine, interferon-alpha, or TNF-alpha antagonists 4, 3

Treatment for Secondary Infections

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

Common Pitfalls and Considerations

• Ensure proper diagnosis of the type of mouth ulcer before initiating treatment 1
• Avoid premature tapering of corticosteroids before disease control is established 3
• Hard, acidic, and salty foods should be avoided, along with alcohol and carbonated drinks 5
• For patients with recurrent aphthous ulcers, consider underlying systemic conditions that may require additional treatment 1, 6
• Topical agents containing sodium lauryl sulfate should be avoided 5

Efficacy of Treatment Options

• Recent research shows that 0.1% Triamcinolone Acetonide and 5% Amlexanox are more efficacious in reducing size, number, pain, erythema, and exudate levels compared to other treatments 7
• Glycyrrhiza (licorice) extract in dissolving oral patches has been shown to reduce lesion duration, size, and pain 8